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The person becomes apathetic and loses interest in enjoyable activities, including sex. It is also common for a person with depression to have difficulty concentrating. He or she may show signs of agitation, such as pacing or hand wringing, along with slowed speech and response time. Fatigue can be so great that even the smallest everyday tasks, such as dressing, seem to require enormous effort.

Depressed people often feel a diminished sense of self-worth—so much so that they may unreasonably feel responsible for unfavorable events that are beyond their control. For example, a salesman may blame himself for failing to make sales even when the general economy is bad and most other salespeople are also missing their sales targets. The intensity of symptoms often varies with the time of day. Often, a depressed person wakes up early with almost no energy but improves as the day goes on, although some people experience worse symptoms at night. As the disorder progresses, depression may deepen until it becomes chronic and the person may become totally withdrawn.

Characteristic symptoms of depression can change with age. Depressed children may express vague physical discomforts (such as a stomachache), be irritable, cry a lot, express a fear of death, or withdraw socially. They may also be extremely sensitive to rejection or failure. Adolescents who have depression often sleep excessively, display disruptive or reckless behavior, are frequently absent from school or perform poorly in school, and abuse alcohol or drugs. They may also have a concurrent anxiety disorder (see page 718).

The most serious risk of depression is suicide. If you think that you or someone you know may be depressed, talk to your doctor immediately. Untreated, depression often persists and can worsen, with episodes occurring more frequently and becoming more severe over time. This is why it is so important to seek treatment early.

The Risks and Warning Signs of Suicide

Recognizing and treating depression and other mental disorders as early as possible can be lifesaving. About 70 percent of people who commit suicide or attempt it are depressed. Always take a suicide attempt—even just talking about suicide—very seriously. Attempted suicide is always a plea for help from someone who is combating a mental disorder or a substance abuse problem. If someone you know threatens to commit suicide, listen to him or her without judgment, try to get him or her to see a doctor or call a suicide hot line, or call a suicide hot line yourself.

Women attempt suicide more often than do men, but men are four times as likely to be successful. More than 20 percent of adolescents seriously consider suicide each year, and the risk increases with age. The highest suicide rate occurs in white males over age 85. The following factors put a person at risk of committing suicide:

• Having previously attempted suicide

• Having a mental disorder

• Having a family history of a mental disorder, substance abuse, suicide, or physical or sexual abuse

• Keeping a firearm in the home

• Being imprisoned

• Being exposed to the suicidal behavior of others, including media exposure

A suicide attempt often follows clearly visible warning signs such as the following:

• Talking about suicide or death, even jokingly

• Having problems coping with an adverse life event (such as job loss or the death of a loved one)

• Withdrawing from friends and activities

• Hoarding pills or purchasing a gun

• Abusing alcohol or other drugs

• Giving away prized possessions

• Showing a lack of interest in the future

• Writing notes or poems about death

• Changing eating or sleep habits

• Neglecting personal appearance

• Behaving impulsively

The best way to prevent someone from attempting suicide is to get professional help for him or her immediately. Limiting access to firearms also helps; nearly 60 percent of suicides in the United States are committed with a firearm. If someone you know is in immediate danger, call 911