Thoughts are related to experiences or beliefs of one’s inadequacy, powerlessness, or helplessness in dealing with the demands of the environment. These beliefs reflect a personal judgment concerning self-esteem – one involving a sense of personal incompetence or low-self efficacy. Individuals feel hopeless and as having failed at most important life tasks. They tend to habitually attribute negative events in their life to their incompetence or inadequacy. In contrast, any positive events are minimised or attributed to some external source, such as good luck or assistance from others. They feel helpless and powerless to bring about positive changes in their life. Concentration problems and indecisiveness are also likely to be present.

Individuals feel distressed, unhappy, sad, and down in the dumps. There is a loss of interest in normal activities and a loss of pleasure in things that were previously enjoyed. Sometimes significant dissatisfaction with current circumstances can serve as a motivator for change.

Physiological or bodily symptoms of depression are shown in the vegetative signs of depression. These include sleep problems, appetite problems, and lack of energy or drive. There is a change in the overall level of physical functioning usually with a disturbance in sleep pattern, a decrease in energy and level of sexual interest, and a loss of appetite and/or weight loss or weight gain. Motor slowing may also be present.