Persistent sadness or low mood
The person appears subdued, with a sad expression or frequent crying over several consecutive weeks. They may say they feel empty or that nothing matters, or they may simply become quieter than usual. Unlike transient sadness triggered by a specific event, this low mood does not lift in response to good news or company and remains stable for most of the day.
If the low mood persists for most of the day, nearly every day, for more than two weeks with no clear cause, it is time to consult a healthcare professional. If the person stops expressing any emotion at all, whether positive or negative, assessment should be a priority.
Loss of interest in everyday activities
They stop enjoying things they used to love: going for walks, watching their favourite programme, playing cards, or chatting with friends. They seem indifferent to plans or suggestions that once excited them. Unlike the natural reduction in activities due to physical limitations, depressive anhedonia affects even passive pursuits requiring no effort, such as watching television or listening to.
When the lack of interest extends to nearly all activities for more than two weeks and is accompanied by increasing social withdrawal. If they no longer enjoy the company of people who were once important to them, professional attention is needed.
Significant changes in appetite or weight
They eat significantly less than usual or, in some cases, turn to food for comfort. There may be noticeable weight loss with no apparent medical cause, or conversely, significant weight gain. Unlike the natural decline in appetite that can accompany ageing, depressive changes are abrupt: the person goes from eating normally to rejecting meals they once liked, or systematically leaves food.
Unintentional weight loss of more than 5% in a single month without dieting or illness warrants immediate medical attention. It should also concern you if they regularly skip one or more meals a day for more than two weeks.
Sleep disturbances
They struggle to fall asleep, wake up in the early hours unable to get back to sleep, or sleep excessively during the day. Their sleep patterns shift noticeably compared to their usual routine. Unlike the age-related insomnia that many older adults experience, the classic depressive awakening occurs in the small hours accompanied by negative thoughts and a sense of hopelessness that makes falling.
If insomnia or excessive sleeping lasts more than three weeks and affects their energy and daily functioning, or if they consistently wake between three and five in the morning with bleak, repetitive thoughts.
Constant fatigue and lack of energy
They feel exhausted even without physical activity. Everyday tasks such as getting dressed, washing, or preparing a meal require disproportionate effort. They may spend long periods sitting or lying down doing nothing. Unlike tiredness caused by a chronic illness or poor sleep, depressive fatigue does not improve with rest and is present from the moment they wake up.
When fatigue prevents them from carrying out basic daily activities, cannot be explained by a known medical condition, and has persisted for more than two weeks. If the person spends more than half the day in bed or sitting without activity, an assessment is needed.
Frequent physical complaints with no clear cause
Headaches, digestive discomfort, back pain, constipation, or other somatic complaints that do not respond to standard medical treatment. In older adults, depression often expresses itself through the body rather than through emotions, a phenomenon known as masked depression. Unlike familiar chronic aches, these complaints are new, shift in location or intensity, and the person insists something.
If physical complaints keep recurring, doctors cannot find an organic cause, and the person has attended multiple consultations in the past three months. It is worth exploring an emotional component, particularly if the complaints are accompanied by sadness or loss of interest.
Irritability or sudden mood changes
They get upset over things that never used to bother them, react disproportionately to minor setbacks, or become impatient and touchy with those closest to them. Unlike occasional bad temper, depressive irritability is persistent, appears without clear provocation, and the person may feel overwhelmed by stimuli they once handled with ease.
If irritability causes frequent conflicts, damages relationships with family members or carers over more than three weeks, and the person expresses feeling overwhelmed or unable to control their reactions.
Expressions of hopelessness or guilt
They make comments such as 'I am a burden', 'I am no use to anyone', or 'I wish I would not wake up'. They express feelings of worthlessness, excessive guilt about the past, or a complete lack of hope for the future. Unlike occasional reflections on the passage of time, these statements are recurrent, laden with suffering, and reflect a distorted self-image.
Any mention of not wanting to live, feeling like an unbearable burden, or wishing for death should be taken seriously and requires immediate professional attention. Do not wait for it to be repeated: a single instance is sufficient reason to act.
Withdrawal and rejection of social contact
They stop answering the phone, make excuses to avoid visits, or refuse to leave the house even though they once enjoyed company. This is not introversion but an active retreat from human contact driven by a feeling of not deserving attention or that their company is a nuisance to others.
If they have systematically rejected social contact for more than two weeks and are not answering calls or opening the door to regular visitors. If they live alone and there is no way to verify their condition, the situation requires immediate intervention.
Neglect of hygiene and personal appearance
They stop showering, changing clothes, combing their hair, or maintaining their appearance in ways that were previously unthinkable. The home may reflect it too: unwashed dishes, accumulated rubbish, or piles of dirty laundry. Unlike self-care difficulties caused by physical limitations, depressive neglect affects tasks the person is physically capable of performing but has lost all motivation to.
If the neglect of self-care is evident, persists for more than two weeks, and cannot be explained by physical or mobility limitations. If the person seems indifferent when it is pointed out, the situation is concerning.
Visible psychomotor slowing
They speak more slowly than usual, take longer to answer questions, and move with a slowness that does not correspond to their physical capabilities. Gestures are sparse, facial expression is flat, and conversational pauses become noticeably longer. Unlike slowness linked to known joint or neurological problems, depressive psychomotor retardation affects both body and speech and fluctuates with.
If the slowing is progressive, affects everyday communication, and is accompanied by other signs of depression for more than two weeks. If the person takes significantly longer to respond to simple questions, a medical assessment is advisable.
Increased alcohol consumption or unprescribed medication use
They drink more than they used to or begin drinking at unusual times of day. They may also turn to sleeping pills or painkillers without medical supervision to try to ease emotional pain. Unlike moderate social drinking, the depressive increase happens alone, serves as an escape from suffering, and tends to be hidden from family members.
If you notice empty bottles, medication disappearing faster than expected, or behavioural changes after consumption. Any significant increase in alcohol or self-medication in the context of persistent sadness requires professional intervention.