Anxiety & Mood
Depression Symptoms in Adults: How to Recognise Them and When to See a Psychiatrist
The symptoms of depression in everyday language, how depression differs from ordinary sadness, what a psychiatric assessment looks at, and how depression is treated.
Short answer
Depression is more than sadness. Its two core symptoms are a low, irritable or empty mood and a loss of interest or pleasure in things you used to enjoy. Other symptoms include poor concentration, guilt or low self-worth, hopelessness, thoughts of death or suicide, disturbed sleep, changes in appetite or weight, and tiredness. A depressive episode lasts most of the day, nearly every day, for at least two weeks [1]. If this describes you and it affects your work, your relationships or your daily life, it is time for an assessment. Depression can be treated.
The symptoms, in everyday language
Low mood. Feeling sad, empty or irritable most of the day. Some people notice irritability more than sadness.
Loss of interest or pleasure. Things that used to matter, such as friends, hobbies or work, feel flat.
Tiredness and low energy. Simple tasks take much more effort than before.
Sleep changes. Waking too early, difficulty falling asleep, or sleeping much more than usual.
Appetite or weight changes. Eating much less, or much more, than usual.
Poor concentration. Reading, decisions and work tasks become hard.
Guilt and low self-worth. Feeling useless or to blame for everything.
Hopelessness. The future looks closed.
Thoughts of death or suicide. These are a symptom of the illness and a reason to seek help now.
This list follows the World Health Organization’s description of a depressive episode [1].
When sadness becomes depression
Everyone has low days. The difference is how long the low mood lasts, how strong it is and what it does to your life. At this practice we use a simple rule. When low mood or loss of interest lasts most of the day, nearly every day, for two weeks or more, and it starts to affect your work, your relationships or how you look after yourself, then an assessment is worthwhile, because waiting rarely helps and effective treatment exists.
What the psychiatric assessment looks at
Assessment comes before treatment. Beyond the symptoms themselves, the assessment covers many areas; four of them often change the treatment plan:
Past periods of high energy. Before any treatment we ask whether you have ever had days of unusually high energy, little need for sleep or racing thoughts, because depression within bipolar disorder is treated differently [1]. Read more: ADHD or bipolar disorder?.
Physical health. Depression is closely linked to physical health [1], so we ask about illnesses, medicines and alcohol, and may suggest tests.
Anxiety, ADHD and other conditions. They often appear together with depression, and the order of treatment matters: severe depression or anxiety is usually treated first. Read more: ADHD, anxiety or depression?.
Safety. We ask directly about thoughts of death or suicide. It is a routine part of every assessment.
Treatment
Psychological treatment is the first-line option for depression. For moderate or severe depression it can be combined with medication, while mild depression does not need antidepressants [1]. At this practice psychotherapy is structured and brief, and focused on skills for the present. When medication is used, we treat it as a trial with a clear goal: start low, adjust step by step, review what has changed, and stop it if it does not help. Read more: depression treatment.
Getting help in Greece
You can be seen in person in Trikala or online, in Greek or in English. If you are not sure whether you need a psychiatrist or a psychologist, read Psychiatrist or psychologist in Greece?.
If you have thoughts of ending your life, do not wait for an appointment. Call the suicide prevention line 1018 (Klimaka) [2] or 112, or go to the nearest hospital emergency department.
Frequently asked questions
Can depression show up mainly as physical symptoms?
Yes. Tiredness and changes in sleep and appetite are part of depression [1], and sometimes they are what people notice first.
Is depression the same as burnout?
No. Burnout is linked to long-term work stress, while depression affects every area of life. The two can overlap, and an assessment helps tell them apart. Read more: stress and burnout.
Do I need a referral to see a psychiatrist?
No. You can book an appointment directly.
Depression: what is it?
Depression, known medically as major depressive disorder, is an illness that affects mood, interest, thinking, sleep and appetite [3]. It is not a weakness of character and it does not pass with willpower. About one in six adults will have it at some point in their life, and women about twice as often as men [3].
There is no single cause. Heritability explains about 35% of the risk, and difficult experiences in childhood and long-term stress also play a part [3]. In Greece, two nationwide surveys using a structured clinical interview found that the share of adults with major depression in the past month rose from 3.3% in 2008 to 8.2% in 2011, during the years of the economic crisis [4].
Some people say: “I’m not sad, I just can’t get started.” In the assessment we ask what exactly is missing. When mood and pleasure are missing, we think of depression. When mood is fine but it is hard to get organised and begin, we also look at ADHD.
Severe depression and major depressive disorder: are they the same?
In everyday language, “severe depression” usually means major depressive disorder, that is, depression that meets the diagnostic criteria. But “major” does not always mean “severe”. Depending on the number and intensity of the symptoms, a depressive episode is described as mild, moderate or severe [1]. The degree changes the treatment, so we assess it from the first meeting.
Severe depression: symptoms that point to a serious episode
Almost all of the symptoms in the list above, intense and present most of the day [1].
Great difficulty with daily life: you cannot work or look after yourself or your home [1].
Psychotic symptoms: beliefs or experiences that do not match reality. This is called depression with psychotic features, and it needs specific treatment [5].
Thoughts of death or suicide. They are a reason to seek help now, not to wait for an appointment (see the note above).
In severe depression, hopelessness feels like a fact. What you feel is not proof of reality. Hopelessness is a symptom of the illness, not a forecast of your future.
How is severe depression treated?
Psychotherapy and medication together. In an analysis of 101 studies with 11,910 adults, most of them with moderate or severe depression, the combination was more effective than psychotherapy alone or medication alone [6].
Depression with psychotic features. The combination of an antidepressant and an antipsychotic is more effective than either on its own [5].
When several attempts have not helped. Electroconvulsive therapy is the treatment with the strongest research evidence for treatment-resistant depression [3]. It is given in hospital, by referral.
Action comes before mood. In behavioural activation we plan small, specific steps before the mood “arrives”, because inactivity reduces the things that give you pleasure and lowers mood even further. Behavioural activation has research support in depression [7].
Read more about depression treatment and about dysthymia, the long-lasting milder form. If you cannot come to Trikala, you can see an online psychiatrist.
Sources
[1] World Health Organization. Depressive disorder (depression), fact sheet. Updated 2026.
[2] Klimaka NGO. Suicide prevention line 1018 (suicide-help.gr).
[3] Otte C, Gold SM, Penninx BW, et al. Major depressive disorder. Nat Rev Dis Primers. 2016;2:16065. https://doi.org/10.1038/nrdp.2016.65
[4] Economou M, Madianos M, Peppou LE, Patelakis A, Stefanis CN. Major depression in the era of economic crisis: a replication of a cross-sectional study across Greece. J Affect Disord. 2013;145(3):308–314. https://doi.org/10.1016/j.jad.2012.08.008
[5] Wijkstra J, Lijmer J, Burger H, Cipriani A, Geddes J, Nolen WA. Pharmacological treatment for psychotic depression. Cochrane Database Syst Rev. 2015;(7):CD004044. https://doi.org/10.1002/14651858.CD004044.pub4
[6] Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020;19(1):92–107. https://doi.org/10.1002/wps.20701
[7] Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007;27(3):318–326. https://doi.org/10.1016/j.cpr.2006.11.001
General information, not a substitute for medical advice. In an emergency call 112 or go to the nearest hospital emergency department.
Author: Dr. Georgios Mylonas, Psychiatrist – Psychotherapist. Last updated: 7 November 2026.
