Signs That You Are Severely Depressed

Severe Depression
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Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 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.

Signs of severe depression can include feelings of hopelessness, increased irritability, loss of pleasure, trouble concentrating or sleeping, or thoughts of death of suicide. Technically, severe depression isn't a formal mental health diagnosis. Rather, it refers to depression that is more debilitating in nature.

The degree to which your symptoms interfere with your day-to-day life, such as causing you to miss school or work, helps doctors determine the level of severity of your 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.  

Symptoms of depression can occur along a spectrum both in duration and severity. Mild depression can occur during periods of stress but resolve with time and may not require any specific treatment. Moderate to severe depression causes chronic symptoms and usually requires at least one form of treatment, if not multiple treatments. 

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.

Symptoms

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:

  • Agitation
  • Believing that one is ill despite evidence to the contrary
  • Delusions or hallucinations
  • Extreme anxiety
  • Intellectual impairment
  • Physical immobility
  • Trouble 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 habits
  • Engaging in risky or self-destructive behavior
  • Extreme agitation or anxiety
  • Getting one's affairs in order (drawing up a will, giving away possessions) 
  • Increased use of substances such as drugs and alcohol
  • Intense changes in mood/mood swings
  • Saying goodbye to friends and family as though for the last time
  • Feeling trapped or hopeless in one’s situation
  • Talking a lot about death, dying, and violence
  • Talking about suicide or wishing that one hadn't been born
  • Withdrawal 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.

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

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

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 considered when suggesting a treatment plan include your level of function and if you are considered a harm to yourself or others.

Psychotherapy

Also referred to as talk therapy, psychotherapy can often help with easing depressive disorder symptoms. Different types of psychotherapy include:

Many clinicians offer several types of therapies. You can ask your health care 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.

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:

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:

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:

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

There are also some steps you can take on your own as you are navigating depression treatment and learning to cope with and manage your symptoms. Creating a support network of caring people, eating well, getting enough sleep, exercising regularly, and avoiding drugs and alcohol are all lifestyle changes that can not only improve your mood but your 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. 

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Article Sources
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