Symptoms of Severe Depression

Table of ContentsView AllTable of ContentsDepression SpectrumSymptoms of Severe DepressionDiagnosisTreatmentCoping

Table of ContentsView All

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 theNational Suicide Prevention Lifelineat988for 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 ourNational Helpline Database.

For more mental health resources, see ourNational Helpline Database.

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 severaltypes of depressionand while they may share some common symptoms, each person’s experience can be different.

Symptoms of depressioncan occur along a spectrum both in duration and severity:

Mild Depression

Mild depressioncan 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 depressioncauses chronic symptoms and usually requires at least oneform of treatment, if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration.

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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.

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Psychosis

Psychosissymptoms such as delusions and hallucinations indicate a person has experienced a break from reality.Psychotic depressionsymptoms may include:

Suicidal Thoughts and Behaviors

Strongsigns of suicidalityinclude talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include:

Melancholia

What Is Melancholic Depression?

Physical Effects of Depression

Depression can appear physically via symptoms felt in the body. Examples ofphysical effects of depressioninclude 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.

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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.

Types of Diagnostic Tools

Researchers have been using such scales since the 1960s. One of the first, theHamilton 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:

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.

ThePHQ, for example, isavailable for free onlineand 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,psychotherapycan often help ease depressive disorder symptoms.Different types of psychotherapy include:

Many clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search theAmerican Psychological Association’s siteto find out which ones are available in your area. It may also be helpful to ask local therapists if they specialize in severe depression.

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Medication

Medication is frequently prescribed to treat severe depression. The most common type of medication used isselective serotonin reuptake inhibitors(SSRIs). This includes antidepressants such asProzac(fluoxetine),Zoloft(sertraline), andPaxil(paroxetine).

Other medications used to treat depression include:

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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. Beinghospitalized for depressiondoesn’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 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:

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 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J.Antidepressant drug effects and depression severity: A patient-level meta-analysis.JAMA. 2010 Jan 6;303(1):47-53. doi:10.1001/jama.2009.1943American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013. doi:10.1176/appi.books.9780890425596NHS Choices.Psychotic depression. Updated December 10, 2019.National Institute of Mental Health.Suicide warning signs.Parker G, Fink M, Shorter E, et al.Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.Am J Psychiatry. 2010;167(7):745-747. doi:10.1176/appi/ajp.2010.09101525Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E.Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications.Biomed Res Int. 2013;2013. doi:10.1155/2013/158746Gautam S, Jain A, Gautam M, et al.Clinical practice guidelines for the management of depression.Indian J Psychiatry. 2017;59(Suppl 1):S34-S50. doi:10.4103/0019-5545.196973National Alliance on Mental Illness.Depression. Updated August 2017.Cleveland Clinic.Alternative therapies for depression. Published 2014.Additional ReadingKriston 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.2010.07.011Zimmerman M.Medscape education psychiatry & mental health. Tools for depression: standardized rating scales. Medscape. Published September 21, 2011.

10 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J.Antidepressant drug effects and depression severity: A patient-level meta-analysis.JAMA. 2010 Jan 6;303(1):47-53. doi:10.1001/jama.2009.1943American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013. doi:10.1176/appi.books.9780890425596NHS Choices.Psychotic depression. Updated December 10, 2019.National Institute of Mental Health.Suicide warning signs.Parker G, Fink M, Shorter E, et al.Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.Am J Psychiatry. 2010;167(7):745-747. doi:10.1176/appi/ajp.2010.09101525Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E.Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications.Biomed Res Int. 2013;2013. doi:10.1155/2013/158746Gautam S, Jain A, Gautam M, et al.Clinical practice guidelines for the management of depression.Indian J Psychiatry. 2017;59(Suppl 1):S34-S50. doi:10.4103/0019-5545.196973National Alliance on Mental Illness.Depression. Updated August 2017.Cleveland Clinic.Alternative therapies for depression. Published 2014.Additional ReadingKriston 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.2010.07.011Zimmerman M.Medscape education psychiatry & mental health. Tools for depression: standardized rating scales. Medscape. Published September 21, 2011.

National Institute of Mental Health.Depression. Nimh.nih.gov. Updated February 2018.Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J.Antidepressant drug effects and depression severity: A patient-level meta-analysis.JAMA. 2010 Jan 6;303(1):47-53. doi:10.1001/jama.2009.1943American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013. doi:10.1176/appi.books.9780890425596NHS Choices.Psychotic depression. Updated December 10, 2019.National Institute of Mental Health.Suicide warning signs.Parker G, Fink M, Shorter E, et al.Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.Am J Psychiatry. 2010;167(7):745-747. doi:10.1176/appi/ajp.2010.09101525Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E.Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications.Biomed Res Int. 2013;2013. doi:10.1155/2013/158746Gautam S, Jain A, Gautam M, et al.Clinical practice guidelines for the management of depression.Indian J Psychiatry. 2017;59(Suppl 1):S34-S50. doi:10.4103/0019-5545.196973National Alliance on Mental Illness.Depression. Updated August 2017.Cleveland Clinic.Alternative therapies for depression. Published 2014.

National Institute of Mental Health.Depression. Nimh.nih.gov. Updated February 2018.

Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J.Antidepressant drug effects and depression severity: A patient-level meta-analysis.JAMA. 2010 Jan 6;303(1):47-53. doi:10.1001/jama.2009.1943

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 2013. doi:10.1176/appi.books.9780890425596

NHS Choices.Psychotic depression. Updated December 10, 2019.

National Institute of Mental Health.Suicide warning signs.

Parker G, Fink M, Shorter E, et al.Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.Am J Psychiatry. 2010;167(7):745-747. doi:10.1176/appi/ajp.2010.09101525

Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E.Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications.Biomed Res Int. 2013;2013. doi:10.1155/2013/158746

Gautam S, Jain A, Gautam M, et al.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.

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.2010.07.011Zimmerman M.Medscape education psychiatry & mental health. Tools for depression: standardized rating scales. Medscape. Published September 21, 2011.

Zimmerman M.Medscape education psychiatry & mental health. Tools for depression: standardized rating scales. Medscape. Published September 21, 2011.

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The Depression Spectrum#

Mild Depression#

Moderate Depression#

Severe Depression#

Psychosis#

Suicidal Thoughts and Behaviors#

Melancholia#

Physical Effects of Depression#

Psychomotor Changes#

Diagnosis of Severe Depression#

A Lack of Standardization#

Types of Diagnostic Tools#

Most Common Depression Diagnosis Scales#

Treatment for Severe Depression#

Psychotherapy#

Medication#

Brain Stimulation Therapy#

Inpatient Depression Treatment#

Complementary Treatments#

Coping With Severe Depression#

A Word From Verywell#