About Specific Symptoms A mental health professional will carefully evaluate a person's symptoms to determine whether the symptoms meet the criteria for a diagnosis of a mood disorder. This section describes some of these symptoms in more detail. Depressed Mood At least one of two essential features of clinical depression must be present in order to suspect a diagnosis of major depressive disorder. One of these is depressed mood, and the other is a loss of interest or pleasure in activities. A mental health professional will evaluate whether a person has depressed mood in any of several ways. A person may simply state that he or she has been feeling sad, depressed, blue, empty, "down in the dumps," hopeless, etc. If a person denies such feelings, but either appears to be on the edge of tearfulness, shows a depressed facial expression and disposition, or appears to be overly irritable, then these may also indicate the presence of depressed mood. Children and adolescents may display mood that is cranky or irritable rather than mood that appears sad or despondent. This, of course, would be different than "spoiled child" behaviors. Additionally, some people may be more likely to report physical complaints (i.e., aches, pains, headaches) rather than depressed mood. This may be because some people more easily recognize physical than emotional symptoms, they experience their mood in physical terms, or it may be more socially acceptable to report physical symptoms. Nevertheless, such physical symptoms can sometimes suggest the presence of depressed mood. For the symptom to meet the criteria towards a diagnosis of major depression, a person must have had a depressed mood for most of the day, nearly every day for a two-week period of time. Feelings of Hopelessness, Helplessness Feelings of hopeless and/or helplessness are common in those who are clinically depressed. They are also some of the most frustrating feelings that depressed individuals experience. Research on the cognitive theory of depression has shown that people who are depressed struggle with feelings of hopelessness and helplessness more so than people who are not depressed (Sacco & Beck, 1995). A sense of hopelessness reflects a negative view of the future. This includes expectations of personal dissatisfaction, failure, and a continuation of pain and difficulty-- a belief that nothing will get better. Feelings of helplessness reflect a negative view of the self. Depressed individuals view themselves more negatively, their self-esteem suffers, and they have little or no self-confidence. They do not believe they have any control or that they can help themselves to feel better. They may have an urge to give up and think, "what's the use?" Research has also indicated that severe hopelessness may be a predictor of suicide (Beck, 1987; Fawcett, 1990). Now, this does not mean that if a person feels hopeless that he or she will attempt to commit suicide. This is a common symptom of clinical depression. What it does tell us, however, is that depressed individuals who struggle with strong feelings of hopelessness may be at a higher risk for self-harm. They should receive treatment from a trained medical or mental health professional. Cognitive therapy or Cognitive-Behavioral therapy often address feelings of hopelessness and helplessness in a direct manner. Loss of Interest or Pleasure At least one of two essential features of clinical depression must be present in order to suspect a diagnosis of major depressive disorder. One of these is loss of interest or pleasure, and the other is depressed mood. People who become depressed tend to lose interest in things they once found enjoyable. Activities such as going out to dinner or a movie, visiting with friends, working, or doing hobbies are just not as interesting or enjoyable as they once were. This includes losing interest or desire in having sex. People who are depressed may say such things as, "I just don't care anymore," or "nothing matters anymore." Friends and family of the depressed person may notice that he/she has withdrawn from friends, or has neglected or quit doing activities that were once a source of enjoyment. This loss of interest or pleasure in activities includes a loss of interest in sex. Some people who have had more than one bout with depression may recognize their diminished interest in sex as an early warning sign of the return of their illness. For a person who is depressed, sex may seem like too much trouble. It may even be hard to remember why sex was ever enjoyable at all. Attempts to have sex may only result in problems with achieving an erection or orgasm. Negative thoughts about oneself can also feed into a lack of interest in sex. Depressed people tend to have problems with self-esteem and may believe that no one, not even a spouse or partner, find them attractive. For the symptom to meet the criteria towards a diagnosis of major depression, a person must have had a significant reduction in level of interest of pleasure in most activities, nearly every day for a two-week period of time. Appetite and Weight Changes People who develop clinical depression often have changes in their appetite. On the one hand, some people never feel very