Depression Symptoms Symptoms of Severe Depression By Nancy Schimelpfening Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial process Updated on December 04, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Jamie Larsen / EyeEm / Getty Images Table of Contents View All Table of Contents Depression Spectrum Symptoms of Severe Depression Diagnosis Treatment Coping Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Severe depression is often characterized by symptoms of hopelessness, increased irritability, loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression. The severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition. This article discusses the spectrum of depression severity, the signs of severe depression, and how severity is assessed. It also explores some of the treatments that may be used to help relieve severe depression. The Depression Spectrum It should be noted that there are several types of depression and while they may share some common symptoms, each person’s experience can be different. Get Advice From The Verywell Mind Podcast Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares what it means to have 'existential depression,' featuring Melissa & Doug's co-founder Melissa Bernstein. Follow Now: Apple Podcasts / Spotify / Google Podcasts Symptoms of depression can occur along a spectrum both in duration and severity: Mild Depression Mild depression can occur during periods of stress but resolve with time and may not require any specific treatment. Around 20% of people with the condition experience mild depression. Moderate Depression Moderate depression causes chronic symptoms and usually requires at least one form of treatment, if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration. Severe Depression Generally speaking, severe depression requires some type of treatment to find some relief. Additionally, depression severity can change over time, growing increasingly worse or alternating between mild and severe during the same depressive episode. If someone has severe depression, they may self-harm, have suicidal thoughts, or be at risk for attempting suicide. If you are severely depressed, help is available to help you manage your symptoms and ensure your safety and well-being. Are There Stages of Depression? Symptoms of Severe Depression There is no set definition of severe depression. If you are diagnosed with a form of depression, the severity of the condition will be assessed by your doctor or a mental health professional based on their training and experience. When determining if depression is severe, there are some key signs and symptoms clinicians consider. Psychosis Psychosis symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. Psychotic depression symptoms may include: AgitationBelieving that one is ill despite evidence to the contraryDelusions or hallucinationsExtreme anxietyIntellectual impairmentPhysical immobilityTrouble falling asleep Suicidal Thoughts and Behaviors Strong signs of suicidality include talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include: Acquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills, etc.)Changes in eating or sleeping habitsEngaging in risky or self-destructive behaviorExtreme agitation or anxietyGetting one's affairs in order (drawing up a will, giving away possessions) Increased use of substances such as drugs and alcoholIntense changes in mood/mood swingsSaying goodbye to friends and family as though for the last timeFeeling trapped or hopeless in one’s situationTalking a lot about death, dying, and violenceTalking about suicide or wishing that one hadn't been bornWithdrawal from friends or family Melancholia Feelings of profound sadness are common with depression and may be persistent and intense. Melancholia is depression that rises to the level of losing interest in most everything in your life. Research reveals that melancholia is often worse in the morning hours and is typically accompanied by slow movement, trouble concentrating, and loss of appetite. An Overview of Melancholic Depression Physical Effects of Depression Depression can appear physically via symptoms felt in the body. Examples of physical effects of depression include sleep disturbance, appetite changes, poor concentration or memory, and a loss of interest in sex. Some people with depression may also feel chronic pain, experience gastrointestinal issues, or have a higher level of fatigue. Psychomotor Changes Noticeable slowing down of mental and physical activity can sometimes occur in mental illnesses such as depression. Clinically, this is often referred to as psychomotor retardation and can include impairment in fine motor behavior (such as having trouble when trying to pick a coin up from the floor), speech, and facial expressions. Diagnosis of Severe Depression Guidelines such as those found in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) and the International Classification of Diseases (ICD) help doctors and mental health professionals systematically assess a person's symptoms. These criteria can be changed and are periodically updated when new research findings become available. A Lack of Standardization Quantitative scales help researchers measure and organize symptoms, as well as designate a “cutoff point” for what’s considered “severe depression” for the purpose of a specific study. However, methodologies vary between studies and researchers, meaning there isn’t a single definition of severe depression across the board. A lack of standardization means that if a person’s depression symptoms are assessed with different scales by different providers, the diagnosis may not be consistent. Some providers don’t use them in clinical practice unless a patient is taking medications, whereas others use them regularly. Types of Diagnostic Tools Researchers have been using such scales since the 1960s. One of the first, the Hamilton Depression Rating Scale, is still sometimes used today. However, there are many more scales available that are better suited for doctors to use with patients. There are even scales patients can use on their own to track or self-report depression symptoms. While scales can offer key insights, they tend to be quite different from one another. The way they are administered, the questions they ask, and the way the answers are interpreted may not be the same from one scale to the next. The inconsistencies of the tools, their use, and interpretation can make it challenging to determine the severity of someone’s depression, as different scales may provide different (even conflicting) results. That said, when used along with other diagnostic measures and the judgment of an experienced clinician, the scales can be useful tools. Most Common Depression Diagnosis Scales Some of the most popular scales used to help clinicians diagnose depression include: Beck Depression Inventory (BDI-II) Carroll Rating Scale (CRS) Center for Epidemiological Studies Depression (CES-D) Children’s Depression Inventory (CDI) Clinically Useful Depression Outcome Scale (CUDOS) Geriatric Depression Scale (GDS) Major Depression Inventory (MDI) Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9 Plutchik-Van Praag Self-Report Depression Scale (PVP) Quick Inventory of Depressive Symptomatology (QIDS) Rome Depression Inventory (RDI) Zung Self-Rating Depression Scales (SDS) Some scales, such as the Beck Depression Inventory, are copyright protected and not available outside of a doctor’s office or mental health clinic (as they must be paid for). There are inventories, scales, and questionnaires that are in the public domain and, therefore, more accessible. The PHQ, for example, is available for free online and in over 30 languages. It can be downloaded as a PDF or accessed as an interactive quiz on several reputable mental health websites. Treatment for Severe Depression Fortunately, there are a number of treatment options for severe depression. Your doctor can help decide the best one for you based on your symptoms. Other factors also considered when suggesting a treatment plan include your level of function and if you pose a risk to yourself or others. Psychotherapy Also referred to as talk therapy, psychotherapy can often help ease depressive disorder symptoms. Different types of psychotherapy include: Cognitive behavioral therapy (CBT): This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression. Interpersonal therapy (IPT): This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health. Psychodynamic therapy: This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed. Many clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the American Psychological Association's site to find out which ones are available in your area. It may also be helpful to ask local therapists if they specialize in severe depression. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Medication Medication is frequently prescribed to treat severe depression. The most common type of medication used is selective serotonin reuptake inhibitors (SSRIs). This includes antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). Other medications used to treat depression include: Norepinephrine-dopamine reuptake inhibitors (NDRIs) Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) Brain Stimulation Therapy If someone has severe depression that has not responded well to first-line treatments like antidepressant medication or psychotherapy, brain stimulation treatments may be tried. Examples of these therapies used for depression include: Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS) Vagus nerve stimulation (VNS) Inpatient Depression Treatment In some cases, inpatient treatment may be recommended for severe depression. Being hospitalized for depression doesn't mean that you're weak. It simply means that your treatment may be more effective in a more controlled environment. Getting depression treatment as an inpatient also allows doctors to keep you safe as they closely monitor how well you are responding to the treatment protocol. It allows them to make any necessary changes should your depression not initially respond or become worse. Complementary Treatments There are a few additional things you can do, along with the other treatment options, to help ease your depression. Your doctor may recommend one or more to aid in your recovery. The Cleveland Clinic shares that some of the remedies that have been found to help are: Acupuncture Massage Guided relaxation Meditation Yoga Your doctor and mental health care team can help you evaluate all the different depression treatment options and find the one best suited for you, your type of depression, and its severity. It can take time to find the method that works best for you. You may need to try more than one form of treatment or use multiple treatments (such as antidepressants plus therapy) at the same time to effectively manage your symptoms. Coping With Severe Depression You can also take some steps on your own as you are navigating depression treatment and learning to cope with and manage your symptoms. These include: Creating a support network of caring people Eating well Getting enough sleep Exercising regularly Avoiding drugs and alcohol Such lifestyle changes can improve your mood and overall health and well-being. When people have chronic symptoms of depression that do not get better with time or common treatments, they may worry that they will never be able to cope. People who are severely depressed may be at an increased risk of suicide. A Word From Verywell While there is no set definition of severe depression, it’s clear that depression and its symptoms exist on a spectrum of severity. Some people have symptoms that get better with time and don’t disrupt their day-to-day lives. Others have symptoms that respond well to treatment, such as antidepressants and psychotherapy. While it may take some time to find the most effective way to manage symptoms of severe depression, know that the situation is not hopeless. If you are trying to find the right treatment, keep in mind that there are several ways you can support yourself through the process, such as focusing on eating a nutritious diet, adding in some physical activity, and trying your best to get enough sleep. 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Mental Health. Depression. Nimh.nih.gov. Updated February 2018. 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Clinical practice guidelines for the management of depression. Indian J Psychiatry. 2017;59(Suppl 1):S34-S50. doi:10.4103/0019-5545.196973 National Alliance on Mental Illness. Depression. Updated August 2017. Cleveland Clinic. Alternative therapies for depression. Published 2014. Additional Reading Kriston L, von Wolff A. Not as golden as standards should be: Interpretation of the Hamilton Rating Scale for Depression. Journal of Affective Disorders. 2011;128(1-2):175-177. doi:10.1016/j.jad.2010.07.011 Zimmerman M. Medscape education psychiatry & mental health. Tools for depression: standardized rating scales. Medscape. Published September 21, 2011. By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? 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