Evidence-Based Resources About Opioid Overdose

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SAMHSA’s Evidence-Based Practice Resource Center (EBPRC) contains a wide variety of downloadable resources available from SAMHSA and other federal partners about opioid overdose and other substance use and mental health topics to help communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.

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SAMHSA Resources

Medication-Assisted Treatment (MAT) – The use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Medications, Counseling, and Related Conditions – Medications approved to treat Alcohol and Opioid Use Disorders relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. Medications used for treatment are evidence-based treatment options

Opioid Overdose – Learn the warning signs of opioid overdose and how naloxone and medications for OUD treatment can help treat and prevent it.

Know the Risk of Using Drugs – All drug use comes with risk. Know the facts before letting drugs take their toll on you and your family.

Tips for Teens: The Truth About Opioids – This fact sheet for teens provides facts about opioids. It describes short- and long-term effects and lists signs of opioid use. The fact sheet helps to dispel common myths about opioids. Access sources cited in this fact sheet.

Opioid Overdose Prevention Toolkit -This toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families, and those recovering from opioid overdose.

Use of Medication-Assisted Treatment in Emergency Departments – This guide examines emerging and best practices for initiating medication-assisted treatment (MAT) in emergency departments.

Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings -This guide focuses on using medication-assisted treatment for opioid use disorder in jails and prisons and during the reentry process when justice-involved persons return to the community.

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders – This guide reviews ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders including opioid overdose among adults.

TIP 63: Medications for Opioid Use Disorder – This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine.

Advisory: Opioid Therapy in Patients With Chronic Noncancer Pain Who Are in Recovery From Substance Use Disorders – This advisory addresses screening and assessment tools, nonpharmacologic and nonopioid treatment for chronic pain, and the role of opioid therapy in people with chronic noncancer pain and SUDs.

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Other Federal Resources

Overdose Prevention & Naloxone Manual | HRC – This Harm Reduction Coalition (HRC) manual outlines the process of developing an Overdose Prevention and Education Program that may involve a take-home naloxone component.

Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States | CDC (PDF |  11.5 MB) – This CDC document reviews evidence-based strategies to reduce overdose. It explains why these strategies work, the research behind them, and examples of organizations that have put these strategies into practice.

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit | National Council of Behavioral Health – Developed by the National Council of Behavioral Health, this guide provides correctional administrators and healthcare providers tools for implementing MAT in correctional settings.

Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers | CDC (PDF | 785 KB) – This fact sheet helps employers understand the risk of opioid overdose and provides guidance about establishing a workplace naloxone program.

Opioids | HHS – Increased prescription of opioid medications like oxycodone and hydrocodone led to widespread misuse of both prescription and non- prescription opioids. Prevention, treatment, and recovery information is available here to help health professionals and families combat the epidemic.

Opioids | NIDA – Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Drug Overdose | CDC – Overdose Data to Action (OD2A) supports jurisdictions in collecting high quality, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to inform prevention and response efforts.

Rx Awareness | CDC – Prescription opioids can be addictive and dangerous. CDC’s Rx Awareness campaign tells the stories of people whose lives were impacted by prescription opioids.

Last Updated

Last Updated: 06/09/2023

Does Depression Cause Weight Gain or Weight Loss? What’s the Depression/Weight Connection?

Written by Monique Brouillette

• The Link Between Depression and Weight
• Breaking the Link

Food and mood often go together. You might reach for a comforting bag of chips when you feel down. Or feel so stressed that you can’t even think about eating.

It’s normal for difficult emotions to make you overeat or eat too little. But if you live with clinical depression, changes in eating can be long-term and lead to drastic weight gain or loss.

Weight gain and depression can stem from social, environmental, and biological causes, says Roger McIntyre, MD, a professor of psychiatry and pharmacology at the University of Toronto. For example, people with financial insecurity or who’ve had troubled childhoods are at a higher risk of both obesity and depression.

Things in the environment also can play a role for those who live in “food deserts or food swamps,” McIntyre says. Living amid fast-food joints and convenience stores and far from grocery stores with fresh produce makes it harder to eat healthy.

The depression-weight link cuts both ways. People who are depressed are more likely to be obese. And people with obesity are at higher risk of depression.

It’s the classic “chicken and egg question,” says Rodrigo Mansur, MD, a psychiatrist at the University of Toronto. Scientists are still trying to parse the complex web of factors behind those relationships.

“It’s not as simple as people develop depression, they are less motivated to exercise and they eat more, therefore they gain weight,” Mansur says. “There’s obviously some truth to that. But that is an oversimplification of what actually happens.”

One of the classic symptoms of depression is the loss of interest and pleasure in activities. The clinical name for this is anhedonia. Scientists say it is rooted in the brain’s reward system and can make once enjoyable activities suddenly seem mundane.

Take food, for example. Your mouth detects tastes such as sweetness and satisfying umami. But the pleasure you get from eating is processed by your brain. If that reward system goes haywire, it can lead you to seek more food in order to make up for the dull or absent pleasure.

“When they ingest food, it doesn’t satisfy the anticipated reward,” McIntyre says. This can lead to food addiction, “terrible cravings for food that are uncontrollable.”

Depression also can interfere with your impulse control. Studies have shown that people who are depressed are more likely to take risks, such as having unsafe sex. Similar cognitive impairments can result in eating disorders like binge eating and bulimia.

And the stress hormone cortisol can also play a role because it is linked to insulin resistance and obesity. At first, stress can dampen your appetite. But long-term stress can lead to higher insulin levels that drive down blood sugar and cause cravings for sugary and fatty foods.

In rare cases, people who are depressed can have cognitive distortions or thoughts that change their worldview in a way that leads to changes in weight, says Elizabeth Prince, DO, a psychiatrist at Johns Hopkins University. Prince says she checks her patients for signs that they aren’t purposely avoiding food because of a belief that “they aren’t deserving of food,” for example. If that is the case, it is a sign their depression has become severe.

Your depression symptoms may be very different from those of someone else. So your treatments should be tailored for you.

“There’s not one thing that will always treat depression. It’s really individualized and something people should work on with their doctor who knows them best,” Prince says. She says a comprehensive treatment plan that addresses both the depression and the weight issue is best “because they clearly impact one another.”

For McIntyre, the first question is whether his patients are sleeping well. He sometimes prescribes medication if he thinks it might help. He also stresses the basics of healthy eating. Finally, he urges people to get some kind of physical activity. In his research, he has shown that people who remain active, even just by going to work, school, or volunteering in the community, have much better outcomes with anti-depression treatment.

“We are not suggesting running a marathon, but there has to be some activity,” he says.

The fact is that there are no universal rules for treating depression and weight issues. “There is no silver bullet,” McIntyre says. Still, he’s is hopeful that more research and data in this area will lead to better, evidence-based approaches. ”I think the future holds a ton of promise in improving outcomes.”

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How it manifests itself on the physical level

Content

• 1 Depression and its physical manifestations
  • 1. 1 Depression and its physical effects
  • 1.2 Physical symptoms of depression
  • 1.3 When is depression becomes a physical problem
  • 1.4 Relationship between depression and chronic pain
  • 1.5 Weakened immunity and depression
  • 1.6 Loss of appetite and weight in depression
  • 1.7 Changes in sleep and insomnia in depression
  • 1.8 Effects of depression on heart and blood pressure
  • 1.9 Fatigue and weakness in depression
  • 1.10 Depression and digestive problems
  • 1.11 Depression and sexual dysfunction
  • 1.12 Depression and decline physical activity
  • 1.13 Memory and concentration disorders in depression
  • 1.14 Related videos:
  • 1.15 Q&A:
    • • 1.15.0.1 What physical symptoms may indicate depression?
      • 1.15.0.2 How is physical activity related to depression?

Learn about the somatic symptoms of depression, such as body aches, fatigue, and sleep problems, and how they relate to the patient’s mental state. Find out how these manifestations can affect your life and how to get help to treat and alleviate them.

Depression is a mental disorder that affects many aspects of a person’s life. However, few people think about the fact that depression can also manifest itself on a physical level. The physical symptoms of depression can be as severe as the emotional and psychological ones.

One of the main physical manifestations of depression is a constant feeling of tiredness and weakness. People suffering from depression may experience physical weakness even if they get enough sleep or do not engage in physical activity. This feeling of fatigue may be accompanied by general muscle weakness and lethargy.

Another physical symptom of depression is a change in appetite. Many depressed patients experience loss of appetite, which can lead to weight loss, general emaciation, and nutritional deficiencies. However, for some people, depression can cause an increase in appetite and lead to overeating and weight gain.

In addition, some people who suffer from depression may have trouble sleeping. They may suffer from insomnia, have trouble falling asleep, or wake up early in the morning. Failure to get enough and quality sleep can only aggravate depression and lead to additional physical and mental fatigue.

Depression and its physical effects

Depression is a serious mental disorder that can have a significant impact on a person’s physical condition.

Depression can also cause changes in appetite and weight. Some people develop an aversion to food and lose their appetite, resulting in weight loss. Others, on the contrary, face increased appetite and unhealthy food choices, which can lead to weight gain.

Physical soreness is another common comorbidity of depression. People with depression may experience general soreness in the body, as well as migraines, muscle and joint pain. This is due to disturbances in pain perception and a decrease in the level of neurotransmitters responsible for the regulation of pain signals.

Weakened immunity is another physical characteristic of depression. Increased stress levels and imbalances in the body’s chemicals can weaken the immune system, making a person more vulnerable to infectious diseases and lingering medical problems.

A general feeling of unpleasant physical symptoms such as headaches, abdominal pain, insomnia, and indigestion are also common comorbidities of depression. They often interfere with a person’s normal functioning and can aggravate their emotional state.

Physical symptoms of depression

Depression is a mental disorder, but it can also manifest itself through a range of physical symptoms. Patients may experience a change in taste preferences, as well as a violation of the diet. This can lead to weight changes and even the development of obesity or malnutrition

Physical soreness is another symptom of depression. Patients may experience chronic pain in various parts of the body such as the head, back, abdomen, and chest. These pains can be associated with muscle tension, nervous tension and psychosomatics

Armipania and impotence are obligatory symptoms of depression. Patients often feel weak and without strength, and also experience a sense of inner restlessness and anxiety. This can lead to reduced physical activity and deterioration in overall fitness.

When depression becomes a physical problem

Depression is a mental illness, but it can also have significant physical manifestations. Most people associate depression with a bad mood, an empty soul, and a lack of joy. However, physical health can also suffer from this mental condition.

First, depression can cause sleep problems. Many depressed people experience insomnia—they can’t sleep, wake up in the middle of the night, or simply don’t feel fully rested after sleeping. This can lead to fatigue, decreased concentration, and impaired general physical condition.

Physical activity can also be affected by depression. Many people who suffer from this condition lose interest and energy to play sports or simply exercise. This can lead to a decrease in muscle tone, a decrease in physical endurance and a general weakness of the body.

Finally, depression can also cause severe pain and physical discomfort. Many depressed people experience pain in various parts of the body, such as headaches, back, neck, or muscle pain. Stress-induced tension and general poor physical condition can contribute to this.

In general, depression has a negative impact on a person’s physical condition. It can cause problems with sleep, appetite, digestion, physical activity and cause power pain. Therefore, it is necessary to pay attention not only to mental, but also to physical health in the fight against depression.

Relationship between depression and chronic pain

Depression and chronic pain are often linked and can influence each other. Depression can cause chronic pain as well as worsen and increase its intensity. In turn, chronic pain may be a risk factor for depression.

Depression alters the levels of neurochemicals in the body, including serotonin and norepinephrine, which play an important role in regulating pain perception. This can lead to increased sensitivity to pain and an increase in its subjective perception.

On the other hand, chronic pain, especially if it becomes unbearable or prolonged, can leave a person feeling helpless, desperate and hopeless. The constant presence of pain can limit the possibilities of self-realization, socialization and participation in activities, which leads to a decrease in mood and the development of depression.

It follows that the treatment of depression and chronic pain should be comprehensive and include not only pharmacotherapy, but also psychotherapy, physical therapy, exercise, as well as adequate sleep and proper nutrition. It is very important to visit a doctor to get professional help and develop an individual treatment plan that takes into account the characteristics of each patient.

Weakened immunity and depression

Depression can have a negative effect on the immune system, leading to a weakened immune system and an increased risk of various diseases.

The stress that accompanies depression activates the release of certain hormones, such as cortisol and adrenaline, which can reduce the activity of immune cells. This weakens the body’s defenses and makes it more vulnerable to infections.

In addition, depression can reduce the effectiveness of the immune system by influencing the activation of inflammatory processes in the body. The constant activation of inflammation can lead to the development of chronic diseases such as asthma, arthritis, cardiovascular disease, and others.

Depression can also negatively affect sleep, and lack of sleep, in turn, can affect the immune system. Healthy sleep is necessary to maintain the normal function of the immune system, and its violation can lead to its weakening.

It is interesting to note that a weakened immune system caused by depression can create a virtuous circle, as physical problems caused by a weakened immune system can exacerbate depression and affect overall well-being.

Appetite and weight loss due to depression

Depression can have a negative effect on a person’s appetite and weight. One of the typical symptoms of depression is loss of appetite and consequent weight loss.

Dietary changes such as reduced appetite and appetite may be caused by depression and become a long-term problem.

Loss of appetite often manifests itself as an inability to feel hungry and enjoy food, as well as a complete lack of interest in food. People with depression may find it difficult to recognize when they are hungry or full. This can lead to them skipping meals or not eating at all.

In turn, weight loss can have a negative impact on overall health. With depression, the body experiences a stressful state, which can lead to a change in metabolism and muscle breakdown. This affects a person’s strength and energy, and can lead to feelings of weakness and fatigue.

If you suspect depression and notice changes in your appetite and weight, it is important to seek medical attention. The doctor will be able to diagnose and offer treatment that will be aimed at improving your physical and emotional state.

Sleep changes and insomnia associated with depression

Depression is a serious mental disorder that has a significant impact on a person’s physical condition. One of the most common symptoms of depression is sleep changes and problems with sleep quality. Insomnia becomes a constant companion of the patient.

During a depressive state, a person may experience problems of drowsiness, when he experiences constant fatigue and drowsiness even after sleep. Despite this, such a dream does not bring rest and recovery to the body, and a person wakes up in the morning still tired and overwhelmed.

However, it is much more common for people with depression to have problems falling asleep and staying awake. The person may have difficulty sleeping, such as having difficulty falling asleep or waking up in the middle of the night and not being able to fall asleep again. Insomnia is often accompanied by nocturnal waking and waking up too early in the morning. As a result, the patient feels constant fatigue and exhaustion.

Disrupted sleep patterns in depression may be associated with disruption of neurochemical processes in the brain. The level of serotonin, a hormone responsible for mood and emotional state, can be disturbed, which affects the regulation of sleep and wakefulness. Also, people with depression have an increased activity of the hypothalamus, which controls the sleep-wake cycle.

Sleep is essential for normal functioning of the body and mental health. Therefore, sleep problems and insomnia in depression are a serious symptom that requires attention and treatment from specialists.

Effects of depression on the heart and blood pressure

Depression, as a mental disorder, can have a negative effect on the functioning of the cardiovascular system and blood pressure. Patients with depression often experience changes in their heart rhythm, which can lead to heart attacks and other heart problems.

Depression can cause problems with blood pressure. In some patients, depression can cause an increase in blood pressure, which increases the risk of developing cardiovascular diseases such as hypertension. In other patients, depression can cause a decrease in blood pressure, which is also undoubtedly unfavorable for the functioning of the heart and circulatory system.

Depression can also affect normal vascular function, which can lead to vasoconstriction or dilation. This can lead to circulation problems, blood clots, and an increased risk of strokes and heart attacks.

It is therefore important to take depression seriously and seek medical attention if you experience symptoms to prevent possible negative effects on your heart and blood pressure.

Fatigue and weakness in depression

Fatigue and weakness are among the most characteristic physical symptoms of depression. They may be constant or intermittent, but always accompany the patient suffering from this mood. Fatigue and weakness are the result of impaired energy regulation and changes in the processing of information in the brain.

Patients with depression experience persistent fatigue and difficulty maintaining physical activity. They often feel exhausted and unable to cope with everyday tasks. This can lead to a loss of interest in previous activities and a deterioration in the quality of life.

In turn, fatigue and weakness can exacerbate symptoms of depression such as low mood, indifference, loss of energy and difficulty concentrating. Patients may feel like recluses, avoid social events and social contacts due to lack of strength and desire.

Coping with fatigue and weakness in depression may include physical activity, regular sleep and nutrition, and following a daily routine. Some patients may be prescribed drugs that can help restore energy and reduce physical fatigue.

No matter what treatment you use, it is important to understand that depression fatigue and weakness are real symptoms and should be discussed with your doctor. He will be able to suggest the most effective methods and help you return to an active and fulfilling life.

Depression and digestive problems

Depression, as a mental disorder, can affect the health and functioning of the body. One of the physical manifestations of depression can be a violation of the digestive system.

When suffering from depression, a person may experience problems with appetite. Some people lose interest in food and become anorexic, refusing to eat. For others, on the contrary, a compulsive appetite appears and they begin to overeat, resorting to bouts of food aggression.

In addition to changes in appetite, depression can adversely affect the digestion of food. Often, depressed people suffer from a decrease in stomach activity, which leads to constipation and difficulty defecation. There may also be problems with the gallbladder and pancreas, since it is with depression in the body that the level of gastrins and stomach juices, as well as the enzymes necessary for digesting food, decreases.

The feeling of heaviness and constipation may be associated with the low physical activity and reduced motor activity that often accompanies depression. In addition, an increased amount of stress and regressing hormones in the body of a depressed person leads to disruption of the internal organs and metabolism.

Depression and sexual dysfunction

Depression can have a significant impact on sexual function and satisfaction, leading to sexual dysfunction. Often this is due to the physical and emotional changes caused by depression.

One common symptom of depression that affects sexual dysfunction is loss of interest in sexual activity. People suffering from depression may experience a lack of sexual desire and enjoyment of intimate relationships.

In addition, depression can lead to problems with arousal and erection in men, as well as decreased lubrication and orgasm in women. Sexual dysfunction can seriously affect the quality of your sex life and cause emotional distress.

Other physical changes associated with depression, such as sleep disturbances, fatigue, and loss of energy, can also affect sexual function. They can lead to a decrease in energy and excitability, which in turn affects sexual desire and the ability to achieve sexual satisfaction.

It is important to see a specialist for the treatment of sexual dysfunction caused by depression. A therapist or sexologist can help you understand the cause of the problem and suggest appropriate treatments, which may include antidepressants, psychotherapy, or lifestyle changes.

Depression and decreased physical activity

Depression significantly affects a person’s physical activity. One of the main symptoms of depression is a decrease in interest and pleasure in previous activities, including physical activity. People with depression lose motivation and energy, resulting in decreased physical activity and fitness levels.

People suffering from depression often experience drowsiness and fatigue. This is because depression affects our circadian rhythm and how we sleep and wake. A tired body and mind do not motivate to engage in physical activity, which affects overall performance and the body’s ability to maintain a high level of physical activity.

Depression can also lead to decreased appetite and changes in eating behavior. People may become less interested in food and lose weight. It also affects physical activity as the body does not get enough energy and nutrients to maintain an active lifestyle.

Reduced physical activity is associated with a number of negative health outcomes. It can lead to a deterioration in physical fitness, muscle weakness, and a decrease in endurance. Also, people with depression have an increased risk of developing various diseases, such as cardiovascular disease and obesity. Therefore, it is important to be aware of the link between depression and reduced physical activity and take steps to maintain an active lifestyle.

Memory and concentration disorders in depression

Depression negatively affects memory and concentration in patients. Often, people suffering from depression experience problems with short-term memory associated with remembering new information and performing tasks that require memory recall.

Depressed patients also often complain of difficulty concentrating and feeling “blurred” thoughts. They may have difficulty staying focused on one task and switching between tasks. This can lead to decreased productivity and increased error rates at work or school.

Memory and concentration problems in depression may be due to an imbalance of chemicals in the brain, such as serotonin and norepinephrine, which affect the transmission of nerve impulses between cells.

Another possible mechanism is the effect of stress on the hippocampus, the region of the brain responsible for memory formation and storage. Stress can lead to a decrease in the volume of the hippocampus and a violation of its function.

Also, depression can be accompanied by sleep disorders such as insomnia or increased sleepiness, which also negatively affects memory and concentration.

It is important to understand that memory and concentration problems in depression are symptoms that can improve with adequate treatment of depression. Therefore, it is important to consult a doctor for diagnosis and appropriate treatment.

Related videos:

Q&A:

What physical symptoms may indicate depression?

Physical symptoms of depression may include: decreased energy, sleep disturbance (insomnia or increased sleepiness), changes in appetite and weight (increase or decrease), anxiety, psychosomatic symptoms (stomach pain, headaches, muscle pain, etc.), fatigue , decreased concentration and interest in life.

How is physical activity related to depression?

Physical activity can play an important role in managing depression. Physical activity has been shown to improve mood, reduce anxiety, increase self-esteem, and manage symptoms of depression. Regular exercise or just being active can be helpful options for depression.

Bipolar disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. They may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.

• Bipolar I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis).
• Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
• Cyclothymic disorder. You have had at least two years – or one year in children and adolescents – many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders caused by certain drugs or alcohol, or due to health conditions such as Cushing’s disease, multiple sclerosis, or stroke.

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment.

Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time.

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization.

Both a manic episode and a hypomanic episode include three or more of these symptoms:

• Abnormally optimistic or nervous
• Increased activity, energy or excitement
• Exaggerated sense of well-being and self-confidence (euphoria)
• Reduced need for sleep
• Unusual talkativeness
• Distractibility
• Poor decision-making – for example, in speculation, in sexual encounters or in irrational investments

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. Episode includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may present as irritability)
• Marked loss of interest or feeling of displeasure in all (or nearly all) activities
• Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)
• Either insomnia or sleeping too much
• Either anxiety or slow behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others.