Because feelings of sadness, disappointment and frustration are part of normal living, the diagnosis of severe depressive states is made only is such states are intense, pervasive, persistent and interfere with usual social and physiological functioning

	depressed mood characterized by feeling sad, low, blue, hopeless, helpless, useless, guilty, ashamed, remorseful
	loss of interest at work
	loss of feelings for family and friends
	anxiety, fears, worries
	worthlessness, undeserving even of help
	pessimism
	loss of interest in sex
	inability to experience pleasure, have fun.

	slowed thinking, difficulty in concentrating, in making decisions, mixed-up thoughts
	preoccupation with failures, loss of self-esteem, obsession with certain thoughts that one cannot seem to turn off.
	loss of touch with reality, hearing voices (hallucinations) or having strange ideas (delusions), thoughts of suicide, or homicide (approximately 15% of untreated or inadequately treated patients with an affective illness commit suicide, often just as the depression is lifting and more energy and activity is to be experienced)

	changes in appetite and weight (70% lose weight, others gain); sometimes a craving for sweets and carbohydrates develops
	sleep problems: although insomnia is most frequently reported, about 15 to 30 percent feel the need to sleep excessively and never feel rested in spite of 12 to 14 hours of sleep
	loss of energy, fatigue, lethargy
	bodily complaints e.g. headaches, muscle aches
	sour taste in mouth, blurred vision, indigestion
	agitation or restlessness

	slowed talking, moving
	withdrawal from social contacts
	crying easily or not at all even though one might like to
	excessive use of alcohol and/or non-prescription drugs