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Sadness and or irritability Loss of interest or pleasure in everyday activities Loss of appetite—or increase in appetite Sleep disturbances—either insomnia or excessive sleeping Agitation or slowing in behavior Fatigue Feelings of worthlessness or guilt Problems with thinking or concentration Persistent thoughts of death or suicide People who are depressed often want to withdraw from activities, and the resulting lack of stimulation further reduces their quality of life, creating a downward spiral.