Everyone feels sad or low at times. Depression is different. It is a health condition that lasts for weeks, and it changes how you feel, think, sleep, eat and handle daily life.¹

Depression does not always look like sadness. In some people it shows up as anger, tiredness, aches and pains, or simply not caring about anything anymore.^1,4 This page explains the signs doctors look for, how long they need to last, and how depression can hide in men, in older adults and in the body. It also explains when to get help right away.

Key points

Doctors look for 9 main symptoms. Depression is likely when 5 or more are present most of the day, nearly every day, for at least 2 weeks.²
At least one of those symptoms must be low mood or loss of interest or pleasure in things you used to enjoy.^1,2
Men may seem angry or irritable instead of sad. Older adults may feel flat or empty rather than sad.¹
Depression can show up mostly as body symptoms, like aches, headaches, stomach trouble or no energy.¹
Thoughts of death or suicide are a reason to get help now. Call or text 988. If someone is in danger, call 911.¹

The main symptoms, in plain words

Doctors in the U.S. use a guide called the DSM-5 (the official handbook of mental health conditions). It lists nine symptoms of a major depressive episode (a stretch of time when depression is present).² Here they are in everyday language.

Symptom	What it can look like day to day
1. Low mood	Feeling sad, empty, hopeless or down. Some people feel irritable instead.^1,2
2. Loss of interest or pleasure	Hobbies, food, friends or family no longer bring any joy. You stop doing things you used to like.^2,3
3. Appetite or weight change	Eating much less or much more. Losing or gaining weight without trying.²
4. Sleep change	Trouble falling or staying asleep, waking too early, or sleeping far more than usual.^1,2
5. Moving or talking more slowly, or being restless	Others notice you are slowed down, or you cannot sit still and pace or fidget.^2,3
6. Tiredness or low energy	Even small tasks, like showering, feel exhausting.^1,2
7. Feeling worthless or guilty	Blaming yourself for things that are not your fault, or feeling like a burden.^2,3
8. Trouble thinking	Hard to focus, remember things or make even small decisions.^1,2
9. Thoughts of death or suicide	Thinking often about death, wishing you were not alive, or thinking about suicide.²

Not everyone has every symptom. Each person's mix is a little different.¹

Depression can also change behavior. A person may pull away from friends, get angry more easily, drink more alcohol, take risks, or stop keeping up with bills, chores or work.¹

How long symptoms need to last

For a diagnosis of major depression, the symptoms usually need to be present most of the day, nearly every day, for at least 2 weeks in a row.² They also need to be a change from how you normally are. And they need to cause real distress or make it harder to work, keep up a home or enjoy relationships.^2,3

Two weeks is a guide for doctors, not a waiting period. If you feel very unwell, you do not need to wait to ask for help. People with only a few symptoms may also benefit from treatment.¹

Some forms of depression last much longer but feel less intense. Persistent depressive disorder means milder symptoms that last for 2 years or more.¹ See types of depression for this and other forms.

What doctors rule out. The same symptoms can come from other causes. Thyroid problems, low vitamin levels, some medicines, and alcohol or drug use can all look like depression.^1,3 Depression is diagnosed only when the symptoms are not better explained by a medical condition or a substance.² If a person has ever had mania (very high energy and mood with little need for sleep), the low periods may be part of bipolar disorder instead.² Learn what the visit looks like in getting checked for depression.

How depression can look in men

Many men do not describe themselves as sad. Depression in men may show up as anger, irritability or a short temper.¹ Men are also more likely to talk about body symptoms, and to use alcohol or drugs to cope.¹

Other signs family members may notice:

Pulling away from family and friends¹
Letting work, bills or other duties slide¹
Risky or reckless behavior¹
Trouble sleeping, or sleeping much more¹
Sexual problems¹

These signs are easy to miss or to explain away as stress. That matters, because in the U.S., men die by suicide at about 4 times the rate of women. Men make up nearly 80% of suicide deaths, or about 4 in 5.⁷ Depression is treatable, and getting help early can change that path. Read more in depression in men.

How depression can look in older adults

Depression is not a normal part of aging. But in later life it is often missed or not treated.⁵

One reason is that older adults may not feel sad, or may not use the word "depressed." Instead they may feel flat, numb or empty.^1,4 Researchers call this "depression without sadness." Hopelessness, such as often saying "what's the use?", can be a more important clue than sadness.⁴

Signs that are common in later life include:^4,5

Tiredness, poor appetite and poor sleep. These are easy to blame on age or illness.
Aches and pains with no clear cause, or pain that seems worse than the illness explains.
Worry and nervousness.
Memory complaints, or new trouble concentrating.
No longer enjoying things, such as visits with grandchildren.
Moving or talking more slowly.
Not taking care of oneself: skipping meals, not bathing, or not taking medicines as prescribed.

Life changes and health problems raise the risk. These include losing a spouse or friends, chronic pain, giving up driving, moving from home, and illnesses such as heart disease, stroke, cancer, Parkinson's disease, thyroid disease and dementia.⁵ Alcohol and some medicines, such as sleep aids, can also play a part.⁵

Depression or dementia? Severe depression can cause memory and thinking problems that look like dementia.^1,5 The two can also happen together. A person with memory complaints should be checked for both, and followed over time.⁴ See depression in later life and treatable conditions that look like dementia.

When depression shows up mainly in the body

Some people with depression notice body symptoms first, or only. They may not feel sad at all. Depression can cause:¹

Headaches that keep coming back
Aches and pains in different parts of the body
Stomach and bowel problems
A racing heart or a tight feeling in the chest
Deep tiredness, and changes in sleep and appetite

A clue is when these problems do not get better with the usual treatment, or no medical cause is found.^1,4 Your doctor should still look for a physical cause first. They will usually do an exam, ask about your medicines, and may order blood tests.^1,4

Never assume chest pain is "just stress" or depression. Sudden chest pain or pressure, trouble breathing, or pain spreading to the arm, jaw or back can be a heart attack. Call 911 right away.

Depression and long-term illness often go together, and each can make the other worse. See depression with heart disease, stroke, diabetes and pain.

Is it grief or depression?

Grief after a death is normal, and it can look a lot like depression. Doctors no longer treat grief as a reason to rule out depression.² Some differences can help:³

Grief

Pain comes in waves, often mixed with warm memories of the person.
Your sense of your own worth usually stays the same.
Thoughts of death may be about wanting to be with the person who died.

Depression

Low mood or loss of interest lasts most of the time, for weeks.
Feelings of worthlessness or hating yourself are common.
Thoughts of death may be about ending your life because you feel worthless or cannot bear the pain.

Grief and depression can happen at the same time. When they do, grief tends to be heavier and last longer.³ See grief and prolonged grief disorder.

When it is an emergency

Some signs mean a person needs help today, not at the next checkup. Warning signs of suicide include:⁶

Talking about wanting to die, or feeling like a burden to others
Feeling trapped, hopeless, or having no reason to live
Making a plan, or looking up ways to die
Saying goodbye, giving away important things, or suddenly making a will
Pulling away from people, or big mood swings
Drinking or using drugs more

These signs are most urgent when they are new or getting worse.⁶

Get help right away.

If someone has made a suicide attempt, or is in immediate danger, call 911. Do not leave the person alone.^1,5
If you or someone you know is having thoughts of suicide, call or text 988, or chat at 988lifeline.org. It is free and confidential.⁸
Veterans and service members can call 988 and press 1. Press 2 for Spanish.⁸

If you are worried about someone, see helping someone with depression and make a safety plan together.

Older adults are at real risk too. In 2023, people aged 85 and older had the highest suicide rate of any age group in the U.S.⁷ Hopeless talk, saying goodbye or giving away belongings deserve a real conversation and a call for help, not just reassurance.^4,6

When to get help

Make an appointment with a doctor, nurse practitioner or mental health professional if:

You have had several of the symptoms above for 2 weeks or more
Low mood, worry or body symptoms are making daily life harder
Family or friends say you do not seem like yourself
You are drinking more to cope

Depression is common and treatable. You can take a short, private check-in to help you put your feelings into words before the visit. For crisis lines and other services, see get help. To learn what comes next, read treatment for depression.

Can I have depression if I don't feel sad?

Yes. Loss of interest or pleasure counts on its own. Many people, especially men and older adults, feel angry, numb or tired rather than sad.^1,2

Can depression come and go?

Some forms do. Seasonal depression comes and goes with the seasons. It usually starts in late fall or early winter.¹ If low periods keep coming back, tell your doctor, even if you feel fine right now.

Is it normal to feel depressed when you are old or sick?

Feeling down after bad news is normal. But depression that lasts weeks is not a normal part of aging or illness, and it can be treated.⁵

In crisis or thinking about suicide? Call or text 988 (Suicide & Crisis Lifeline, 24/7, free). If someone is in immediate danger, call 911.

Sources

National Institute of Mental Health. Depression (NIH Publication No. 24-MH-8079). NIMH, 2024. NIMH
Substance Abuse and Mental Health Services Administration. Table 9: DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison. In: DSM-5 Changes: Implications for Child Serious Emotional Disturbance. SAMHSA, 2016. NCBI Bookshelf
American Psychiatric Association. What Is Depression? APA, reviewed 2024. APA
Gallo JJ, Rabins PV. Depression without sadness: alternative presentations of depression in late life. Am Fam Physician, 1999. AAFP
MedlinePlus, National Library of Medicine. Depression - older adults. NLM, reviewed 2024. MedlinePlus
National Institute of Mental Health. Warning Signs of Suicide. NIMH, 2025. NIMH
Centers for Disease Control and Prevention. Suicide Data and Statistics (2023 data). CDC, accessed 2026. CDC
988 Suicide & Crisis Lifeline. Get Help. 988 Lifeline, 2026. 988 Lifeline

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.