Negative Symptoms of Depression
Depression is characterized by a constellation of negative symptoms that represent a loss or diminution of normal functioning, including anhedonia (loss of interest or pleasure), psychomotor retardation, low energy, and diminished cognitive abilities. 1
Core Negative Symptoms
The primary negative symptoms that define major depressive disorder include:
Anhedonia: Markedly diminished interest or pleasure in most or all activities most of the day, nearly every day—this is one of the two cardinal symptoms required for diagnosis 1, 2
Psychomotor retardation: Observable slowing of physical movements, speech, and thought processes 1
Fatigue or loss of energy: Persistent lack of energy nearly every day, which can manifest as excessive late-night TV watching or refusal to wake for school/work in adolescents 1
Diminished ability to think or concentrate: Reduced cognitive function including indecisiveness, which may present as poor performance in school or work with frequent absences 1
Additional Negative Manifestations
Beyond the core symptoms, depression includes other negative features:
Low self-esteem and feelings of worthlessness: Inappropriate guilt and diminished self-view that interfere with daily functioning 1
Appetite disturbances: Significant weight loss or decreased appetite (though weight gain can also occur) 1
Sleep disturbances: Insomnia or hypersomnia nearly every day, representing disrupted normal sleep patterns 1
Social withdrawal: Loss of interest in previously enjoyed social activities, reduced participation in relationships and community engagement 1
Clinical Presentation in Different Populations
In adolescents, negative symptoms may manifest differently than in adults:
- Persistent boredom rather than overt sadness 1
- Loss of interest in sports, video games, and activities with friends 1
- Oppositional and negative behavior patterns 1
- Frequent physical complaints (headache, stomach ache) without clear medical cause 1
Screening and Assessment
The PHQ-9 assessment tool captures these negative symptoms systematically:
The two-item screening includes anhedonia ("Little interest or pleasure in doing things") and depressed mood 1
The remaining seven items assess: sleep problems, low energy, appetite changes, low self-view, concentration difficulties, motor retardation or agitation, and thoughts of self-harm 1
Important Clinical Distinctions
A critical caveat: In schizophrenia spectrum disorders, "negative symptoms" has a specific technical meaning referring to five domains (avolition, anhedonia, asociality, blunted affect, and alogia) that differ from depressive negative symptoms 1. The term in depression refers more broadly to symptoms representing loss or absence of normal function rather than this specific psychiatric construct.
Functional impact matters most: These negative symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning to meet diagnostic criteria 1. Symptoms that interfere moderately to markedly with functioning warrant referral to psychology and/or psychiatry for diagnosis and treatment 1