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When someone exhibits at least five of the symptoms listed below for a two-week period or longer, it is considered a major depressive episode. They can happen spontaneously, or after a painful life event like the death of a loved one, a romantic breakup, or a medical illness.

There are some exclusions to this. For example, if any of the below symptoms are caused by a medical condition, by another psychiatric condition, or by substance use, they not be attributable to depression.

• Persistent sad mood, most of the day, nearly every day 

• Loss of interest or pleasure in hobbies and activities, including sex 

• Feelings of guilt, worthlessness, helplessness 

• Decreased energy, fatigue, feeling “slowed down” 

• Restlessness or irritability 

• Difficulty concentrating, remembering, making decisions 

• Insomnia, early-morning awakening, or excessive sleeping 

• Low appetite and weight loss or overeating and weight gain 

• Thoughts of death or suicide, suicide attempts

Persistent Depressive Disorder is similar to Major Depressive Disorder except that symptoms are typically milder, persist for at least two years, and are consistently present with no more than two consecutive months of non-depressed mood. It is possible for someone to have a major depressive episode while also qualifying for persistent depressive disorder.

High-functioning depression isn't a formal diagnosis, but it's a very real experience for many people. People described as having high-functioning depression often maintain their daily routines and responsibilities, appearing to be coping well. However, they experience internal symptoms of depression, such as low mood, loss of interest, fatigue, and self-criticism.

Because they are still functioning, their struggles may be minimized by themselves and others, delaying them from seeking help. Some experts suggest that many people described as having high-functioning depression might meet the criteria for PDD which is a chronic form of depression with less severe but long-lasting symptoms.