Symptoms of Depression: A Comprehensive Clinical Guide to Identifying Them

Maybe you're not sure what's going on with you. You just know that you're not yourself anymore. That the things that used to matter to you don't mean anything anymore, that your fatigue doesn't go away even when you rest, that one day feels too much like the one before, and that the future seems bleak for no specific reason. The depression It is one of the most common disorders in Spain—it affects 30% of the adult population, according to recent data—and also one of the most misunderstood. Recognizing its symptoms can be the first step toward seeking help. At MadridPsicoterapia, with a practice in Chamberí, we help identify and treat the depression with clinical rigor and professional support.

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Symptoms of depression

What are the main symptoms of depression?

The symptoms of depression They are defined by core symptoms and are organized into three major groups.

Core symptoms (at least 2–3 must be present for at least 2 weeks): 1) Depressed mood most of the day, nearly every day. 2) Loss of interest or pleasure in activities that were previously enjoyable (anhedonia). 3) Loss of energy or increased fatigue (asthenia).

Cognitive symptoms: difficulty concentrating, indecisiveness, slowed thinking, recurrent thoughts about death, suicidal ideation, excessive feelings of worthlessness or guilt, and a negative view of oneself, the world, and the future (Beck’s cognitive triad).

Physical or somatic symptoms: changes in appetite (loss or increase), changes in weight, sleep disturbances (difficulty falling asleep, early awakening, or hypersomnia), agitation or psychomotor retardation observable by others, headaches, muscle aches, digestive disorders, loss of libido.

A particularly important symptom is the loss of the ability to experience pleasure (anhedonia), which many patients describe as a “gray world”: it is not active sadness, but rather a kind of emotional numbness. Another common but little-known symptom is the so-called depression Smiling or masked: the person puts on a facade of normality or even good humor in public, while suffering on the inside.

At MadridPsicoterapia (Calle Santa Engracia 141, Chamberí, Madrid, and online), we conduct a comprehensive diagnostic evaluation that includes a clinical interview and, when necessary, the administration of standardized scales such as the Inventory of Depression Beck's Depression Inventory (BDI-II), the PHQ-9, or the Hamilton Depression Rating Scale, all of which have been validated in the Spanish population.

Symptoms

Types

Treatment

When to Ask for Help

Depression in Adolescents

Depression Test

You know exactly what you're paying from day one

How much do the sessions cost?

€ 55

Price per session

Comprehensive Evaluation
Weekly sessions*
Online and In-Person Services **

€220

€ 199

Monthly

Comprehensive Evaluation
Weekly sessions*
20% discount**

Popular

Why Choose Us

Why Choose MadridPsicoterapia?

✓

Licensed and Specialized Psychologists

Our Team consists of licensed health psychologists at the COP in Madrid, with specialized training and proven experience in treating depressive disorders. We work with professional rigor and stay up to date with the latest scientific developments to provide you with the best possible care.

✓

Evidence-Based Therapies

We use a variety of approaches, such as cognitive-behavioral therapy, ACT, exposure and emotional regulation techniques, and third-generation therapies, among others, because we believe you deserve treatment for depression that has proven its effectiveness in rigorous clinical research—not fads or empty promises.

✓

Personalized Treatment Plan

We don't follow rigid protocols. After a detailed initial evaluation, we design a treatment plan tailored to your specific situation, your goals, and your schedule. Because we understand that everyone experiences the depression in a unique way, and the approach must respect that uniqueness

✓

Central location in Chamberí

Our office is located at 141 Santa Engracia Street, in the Chamberí neighborhood, with excellent Metro and bus connections. We also offer treatment for depression in Chamberí, both in person and online for those who prefer the convenience of joining from home.

✓

Compassionate and non-judgmental support

We know that taking the step to ask for help isn’t always easy. That’s why at MadridPsicoterapia you’ll find a warm, confidential, and judgment-free space where you are our top priority. We’re committed to supporting you with honesty, empathy, and absolute respect for your journey.

Prices with no surprises and no pressure

Making decisions is also part of the process.

We offer you an initial session—either online or in person—so we can get to know each other.

From there, you should only continue if you feel you've established a connection with the professional you've met. The rest of the process is flexible, tWe explain how it works and the terms and conditions starting with the first session. No monthly fees, no long-term commitments, and fixed prices per session.

Individual Therapy

55 €

Couples Therapy

65 €

Individual Therapy

55 €

Therapy for couples

65 €

It's not how many, it's how

People who started individual therapy with us in Madrid

Juana, Carlos, Rocío, Almudena… We don't like to talk about numbers. We help real people with real names in real-life situations. It could be your neighbor, a friend, a mother, a coworker, your child… every name holds a different story. And every story deserves to be truly heard.

I came because my wife asked me to. I thought there was nothing wrong with me, but I was impossible to be around. Here, I've been able to talk about things I'd never talked about with anyone before. I've come to understand where all that anger was coming from. Things at home have improved a lot.

I started this after my partner suddenly broke up with me. The first few months were awful. Here, I've been able to let go of all that pain without feeling like I was burdening anyone. I've also worked on patterns I kept repeating in my relationships. It's helped me a lot.

I lost my mother years ago, and I was still having a really hard time. Here, I've learned that grief takes its own time. I still miss her every day, but it's different now.

I was on sick leave due to stress, headaches, insomnia, digestive problems… The usual stuff. Here, I’ve been working on setting boundaries at work. It’s not like I’m a completely different person now, but at least I’ve learned to say no every once in a while. To be honest, it’s still incredibly hard for me.

My kids and I were in a terrible place after the divorce. All we did was argue. I've worked on improving our communication, and well, now at least we can talk without ending up yelling at each other.

I started online therapy because my work schedule made it impossible to attend in-person sessions. At first, I thought it wouldn't be the same, but it's worked out really well for me—I do it from home after I get back from work, when everyone else is asleep.

My job requires me to travel constantly, and online therapy has been the only way I've been able to stay in therapy. It doesn't matter if I'm in Madrid, Barcelona, or anywhere else. I just log in, and that's it.

I felt trapped in a life that wasn't my own. I was doing what was expected of me, not what I wanted to do. I've been working on connecting with what I truly want. I'm making some major changes.

After becoming a mother, I felt invisible. I was just “the mother of.” I’ve worked on my identity beyond motherhood and have reclaimed parts of myself that I had lost.

I live in a small town where everyone knows each other. Online therapy has allowed me to find a professional outside of town without anyone seeing me go in or out of anywhere. I've worked through some very personal issues that I would never have talked about here. I highly recommend it.

I started online during the lockdown and just stuck with it. I like being able to do it from home, without wasting time commuting. I've been working on my social anxiety, and starting online actually took that pressure off me.

Online therapy seemed a little strange to me at first, but with my shift work, it was impossible to fit in in-person appointments. Being able to log in at 10 p.m. after work has been key. If it had been in person, I would have quit right away.

I used to have uncontrollable outbursts of anger. I'd fly off the handle over the slightest thing and say terrible things. I'd lost friends because of this. I've worked on identifying what triggers me. My relationships have improved a lot.

I tried online therapy because I was too embarrassed to go to an in-person session. I know it sounds silly, but that's just how it is. From my room, where no one can see me, I've found it easier to open up. So far, this is working for me, and I feel comfortable this way.

I've been doing online therapy ever since I moved abroad. I wanted to continue seeing my longtime therapist, and this has made that possible. We've been doing this for two years now. The screen can sometimes be a barrier, but being able to maintain that therapeutic connection despite the distance is priceless.

I have two young children, and getting out of the house is a nightmare. Online therapy has been a lifesaver. While they’re napping, I log on. No commuting, no having to find someone to watch the kids. It’s been the only way I’ve been able to take care of myself, too.

My father has Alzheimer's, and I take care of everything. I was completely overwhelmed, juggling my own life and taking care of him. Here, I've been able to let off some steam without feeling guilty for being tired. I've learned to ask for help. It was either that or end up completely worn out myself.

My partner and I hadn't had sex in over a year. We were too embarrassed to even talk about it. Working on this here has helped us communicate better in general. We've regained that connection.

Online therapy made me a little nervous at first. I thought it would be weird to talk about my personal stuff in front of a screen. But it’s actually even more comfortable. I’m in my safe space, on my couch, with my blanket.

After I was dumped, I felt terrible. A friend recommended that I come here. It helped me a lot during the first few months—I could cry and let it all out. Then I stopped coming because I was feeling better. A few months later, I started feeling bad again, so I came back.

I was diagnosed with a chronic illness and it really got me down. I've been in therapy for six months. Some days I leave the session thinking, "That was great—really helpful." Other days I leave thinking, "Why am I even coming here if this isn't going to cure me?" But I'm grateful to the team.

We went to couples therapy. After four months, we broke up anyway. I don't know if it helped at all or if it just delayed the inevitable. But hey, at least we broke up without killing each other—that's something, at least.

Total apathy. A friend told me to come. I've been coming for three months. I don't know if I've noticed any changes. I still wake up without any motivation. But hey, at least for one hour a week I'm doing something other than lying on the couch. My psychologist says that just coming here is already a step forward.

Some very dark thoughts brought me here two years ago. I've improved a lot—I won't deny it. My psychologist explained to me that it's not like that, that there can be relapses. It bothered me to hear that, to be honest. But anyway, I'm still working on it.

I've been dealing with depression for two years. I've tried medication, gone to therapy, exercised—I've tried everything. There are times when I feel better, and other times when I slip back into it. I'm grateful that I've been able to stick it out, and I recommend reaching out for help.

I worry about everything: work, anxiety—which causes me horrible physical symptoms. Dizziness, rapid heartbeat, sweating. I’ve gone to the emergency room about five times thinking I was dying. It’s always anxiety. I’m doing online therapy because I’m terrified of leaving the house.

I've tried everything—yoga, meditation, pills. Nothing works for me. I've been doing online therapy for six months now. The other day, I had a panic attack during the session. I felt ridiculous. My therapist told me it was okay, that it was a good time to work through it.

I have a really hard time socializing with people. Just the thought of meeting up with friends makes me anxious days in advance. I started therapy a year ago. I've improved in some ways: I can go shopping without feeling so bad, and I can talk on the phone.

My anxiety started a couple of years ago. At first, I thought it was just work-related stress. I started online therapy because, with my schedule, it's impossible to go to in-person sessions. Sometimes it helps me to log in from home; other times, having the computer in front of me distracts me.

I felt constantly overwhelmed by work, by life, by everything. I couldn't stop mulling things over. A friend recommended online therapy to me. At first I was skeptical; I thought talking through a screen wouldn't do any good.

I have pretty severe social anxiety. Online therapy was perfect for me because being able to start without having to physically go anywhere took a lot of the pressure off. I've improved quite a bit in some areas—thank you!

I was diagnosed with depression a year ago. The first thing I thought was, “But I’m not sad all the time.” I started online therapy because I didn’t even have the energy to leave the house. It’s been seven months, and I’m starting to notice some changes.

Depression caught me by surprise. I had always been an active, energetic person. Suddenly, I found myself not wanting to do any of the things I used to enjoy. Going to the gym, hanging out with friends—everything felt like too much trouble. I felt empty.

I started online therapy six months ago because, honestly, I didn't have the energy to leave the house. Progress has been slow. Some weeks I feel a little better; other weeks I'm back to square one. But I'm learning that depression isn't something you can just snap out of.

I've been dealing with depression for about two years. The hardest part is that it's invisible—people look at me and think I'm fine. But inside, I feel empty most of the time. Getting through the day feels like climbing a mountain. I started online.

Frequently Asked Questions

Frequently Asked Questions About the Symptoms of Depression

We know that many questions may arise before starting therapy. Here, we answer the most common questions we receive from people who contact our clinic.

Can I have depression if I don't feel sad?

Yes. One of the most common misconceptions is that depression always manifests as intense sadness. In reality, many people with depression do not feel sadness but rather a profound emotional numbness, indifference, emptiness, or irritability. Loss of interest and pleasure (anhedonia) is often the most prominent symptom: the person no longer enjoys the things they used to like, but they don’t experience this as sadness—rather, as apathy and a lack of motivation. This makes depression especially difficult to recognize in oneself. If you haven’t enjoyed anything for weeks and have low energy, consult a psychologist even if you don’t feel particularly sad.

Can physical symptoms be a sign of depression?

Absolutely. Depression has a very significant physical component that often leads people to consult their primary care physician or internal medicine specialists first. Frequent headaches, diffuse muscle pain, digestive problems, chronic fatigue, sleep disturbances, or unexplained weight loss can be physical manifestations of underlying depression. It is estimated that between 30% and 50% of patients who present to primary care with somatic complaints have an undiagnosed depressive or anxiety disorder. If medical tests fail to identify a cause, a psychological evaluation is recommended.

How does depression affect sleep?

Sleep disorders are one of the most common and distressing symptoms of depression. The most common forms are late-night insomnia (waking up early at 3–4 a.m. and being unable to fall back asleep, accompanied by negative thoughts) and initial insomnia (difficulty falling asleep due to rumination). However, in some types of depression—especially atypical depression and dysthymia—hypersomnia may occur: the person sleeps much more than usual without feeling rested. Non-restorative sleep is particularly characteristic of depression, and improvement in this area is often one of the first signs of a response to treatment.

Are thoughts about death always a serious warning sign?

Is it possible to have depression and anxiety at the same time?

Yes, and it’s very common. Comorbidity between depression and anxiety is the rule rather than the exception: the most common comorbid disorder in major depression is generalized anxiety disorder. It is estimated that between 45% and 60% of people with a depressive disorder also have an anxiety disorder. This combination worsens the prognosis if not properly addressed, but the psychological treatments with the strongest evidence (cognitive-behavioral therapy) are effective for both disorders simultaneously. At MadridPsicoterapia, we have a specific page on depression and anxiety that you may find helpful.

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