There are several types of depression and while they may share some common symptoms, each person’s experience with depression will be different. One way depression can vary from person to person is symptom severity.
The degree to which a person’s symptoms interfere with their day-to-day life, such as causing them to miss school or work, also helps doctors determine which type of depression a person has.
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 several.
Some types of depression respond well to commonly prescribed treatments, such as antidepressant medications and therapy. Other forms of depression can be debilitating and resistant to medication, making them more challenging to treat.
If someone has severe depression, they may self-harm, have suicidal thoughts, or be at risk for attempting suicide. If you are severely depressed, you can get support to manage your symptoms and ensure your safety and wellbeing.
What Can Severe Depression Look Like?
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, including:
Psychosis: Symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. Psychotic depression symptoms may include:
- Extreme anxiety
- Physical immobility
- Trouble falling asleep
- Intellectual impairment
- Delusions or hallucinations
- Believing that one is ill despite evidence to the contrary
Melancholia: Feelings of profound sadness are common in depression and may be persistent and intense.
Physical effects of depression: Depression has symptoms felt in the body, such as sleep disturbance, appetite changes, poor concentration or memory, and a loss of interest in sex.
Psychomotor changes: Noticeable slowing down of mental and physical activity can occur in mental illnesses and neurological conditions.
Suicide risk: Strong signs of suicidality include talking about wanting to die, making plans, self harming, or attempting to take one’s own life.
Warning signs of suicidal intention include:
- Extreme agitation or anxiety
- Withdrawal from friends or family
- Changes in eating or sleeping habits
- Intense changes in mood/mood swings
- Talking a lot about death, dying and violence
- Engaging in risky or self-destructive behavior
- Increase use/abuse of substances (drugs, alcohol)
- Seeming or feeling trapped or hopeless in one’s situation
- Talking about suicide or wishing that one hadn’t been born
- Saying goodbye to friends and family as though for the last time
- Getting one’s affairs in order (drawing up a will, giving away possessions)
- Acquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills)
What You Can Do
If you are severely depressed and suicidal, there are resources that can help, including:
- Your doctor or psychotherapist
- Suicide hotlines including the National Suicide Prevention Lifeline, which you can call at: 1-800-273-TALK (1-800-273-8255)
- 911 or local emergency services where you live
If you are concerned that someone will harm themselves or someone else, is suicidal, or is experiencing psychosis, stay with the person and call 911 or the number for emergency services where you live.
Diagnosing Severe Depression
Guidelines such as those found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 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.
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.
Researchers have been using such scales since the 1960s. One of the first, the Hamilton Depression Rating Scale, is still sometimes used today. However, in current clinical practice 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 the 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.
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.
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.
Some of the most popular depression scales include:
- Carroll Rating Scale (CRS)
- Children’s Depression Inventory
- Geriatric Depression Scale (GDS)
- Major Depression Inventory (MDI)
- Rome Depression Inventory (RDI)
- Beck Depression Inventory (BDI-II)
- Zung Self-Rating Depression Scales (SDS)
- Clinically Useful Depression Outcome Scale (CUDOS)
- Quick Inventory of Depressive Symptomatology (QIDS)
- Plutchik-Van Praag Self-Report Depression Scale (PVP)
- Center for Epidemiological Studies Depression (CES-D)
- Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9
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). However, some inventories, scales, and questionnaires are in the public domain.
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.
Coping With Severe Depression
Research has suggested that there are several factors that influence the severity of depression, such as how long symptoms have lasted, whether the condition has been treated, and how well a specific treatment worked.
Individual risk factors for depression, such as one’s environment, genetics, and other health conditions, can also influence how prone to depression someone is.
If someone has severe depression that has not responded well to medication or psychotherapy, there are other types of treatment they can try, including:
- Electroconvulsive therapy (ECT)
- Cognitive-behavioral therapy (CBT)
- Transcranial magnetic stimulation (TMS)
Your doctor and mental health care team can help you evaluate all the different depression treatment options.
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 several (such as antidepressants and therapy) at the same time to effectively manage your symptoms.
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 as well.
A Word From Verywell
While there is no set definition of severe depression, it’s clear that the condition 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 therapy.
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 for suicide.
While it may take more 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 other 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.