Severe depression means that a person’s depression symptoms are very intense, often enough to interfere with many daily functions.

Severe depression is not a distinct diagnosis from major depressive disorder. Rather, people tend to experience their depression as more severe when they have several symptoms of depression or when some depression symptoms are especially intense. Depression exists on a continuum, from symptoms that mildly disrupt daily life to those that are totally debilitating.

A 2020 study found that rates of severe depression in American adults increased between 2005 and 2016 and that significant increases in severe depression among those over the age of 65 played a significant role in this trend. A 2017 study reported that depression is the leading cause of disability worldwide.

People with severe depression may have thoughts of suicide or self-harm. They can feel extremely sad and unhappy, unable to focus on anything other than their unhappiness. Their depression may affect their relationships, their perceptions of the world, and their self-image. Some may experience unexplained aches and pains.

Keep reading to learn more about severe depression, including symptoms, treatment, and where to go in order to seek help.

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Severe depression is a type of major depressive disorder.

Major depressive disorder is a mood disorder that causes a person to feel very sad or unhappy much of the time. It is different from feeling sad due to negative life circumstances, although negative events may increase the risk of depression.

Severe depression is not a distinct diagnosis. Instead, it is a subjective judgment based on how significantly a person’s depression symptoms affect them.

A 2018 study found that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depression correlate with the severity of depression. People with severe depression may, therefore, have more symptoms and a wider variety of symptoms. The inability to feel happiness was a major predictor of severe depression.

Major depressive disorder primarily affects mood, causing a person to feel sad or negative for an extended period of time.

Some symptoms of depression include:

  • Depressed mood: A person may feel sad, unhappy, or angry much of the time, even when good things happen.
  • Sleep issues: A person may have trouble sleeping or sleep much more than usual.
  • Appetite issues: People with depression may have changes in appetite and can lose or gain weight without trying.
  • Changes in movement: Some people with depression feel very restless. Others feel unable to move or very slow.
  • Suicidality: People with depression may have thoughts of suicide or self-harm. Some may attempt suicide.
  • Loss of pleasure: People with major depression may have trouble getting pleasure from activities they once enjoyed.
  • Guilt and worthlessness: Depression can affect self-image and self-esteem, making a person feel guilty or worthless.

A 2018 study suggests certain symptoms are more common among people with severe depression. Those include:

  • suicidal thoughts
  • loss of pleasure
  • feelings of guilt or worthlessness
  • depressed mood

Although there are no formal stages of severe depression, a person’s experience of depression may get worse with time. This is especially true if depression makes it difficult to work or engage in meaningful relationships.

For some people, depression initiates a vicious cycle of life challenges, causing symptoms that are not a direct product of depression. A person could struggle to work and then lose their job, causing additional stress that intensifies their depression. A 2017 study reported that people with depression are more likely to get divorced.

Depression is a complex medical condition. It does not have a single cause. Instead, an interaction of biological, social, and psychological factors may cause depression. A person with a biological predisposition to depression may only become depressed in the right environment. Doctors call this the biopsychosocial model.

Some risk factors for depression include:

  • stress, such as living in a violent or unstable environment
  • trauma, such as being the victim of abuse or attack
  • biochemistry, with differences in brain chemicals potentially increasing the risk of depression
  • genetics, with some genes increasing the risk
  • family history, with a higher risk of depression when others in a family have it
  • alcohol or drug use
  • some medications
  • having certain medical conditions, including chronic and serious illnesses

One of the challenges of depression is that the negative outlook it causes may convince a person that treatment will not work or that the depression is their fault. Depression is a medical condition, not something a person causes or can think their way out of.

The earlier a person seeks help, the better their prognosis is. Early treatment reduces the length of time a person is depressed and can help prevent the depression from getting worse.

Any medical provider can diagnose depression, so treatment often begins with seeing a doctor. Mental health professionals such as psychiatrists and psychotherapists are experts at treating depression. Consider asking a doctor for a referral to a mental health clinician. While doctors can prescribe medication, therapy may improve outcomes.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

No blood test or exam can conclusively prove a person has severe depression. Instead, doctors diagnose based on symptoms. However, if a person has other medical issues or is at risk of certain diseases, a doctor may perform additional tests to rule out other causes, such as hypothyroidism.

A person should tell their provider about all symptoms to ensure that depression, and not some other condition, is the right diagnosis.

A number of treatments may help. For most people, the first line of treatment is an antidepressant. There are dozens of antidepressant options, each with its own risks and benefits. So a person considering antidepressants should talk with a doctor about their needs and ask about side effects.

Other treatments to complement antidepressants can also work. They include:

  • individual therapy
  • family or couples counseling
  • other drugs, such as mood stabilizers
  • electroconvulsive therapy (ECT) for treatment-resistant depression
  • transcranial magnetic stimulation, a kind of brain stimulation that may ease symptoms
  • vagus nerve stimulation, which stimulates the vagus nerve to ease symptoms

Depression can be difficult to treat. Depressive episodes may last 6–12 months if a person does not seek treatment or treatment does not work. Often, depression comes back, with or without treatment.

A 2019 study emphasizes that there are no good measures for assessing depression outlook but that early treatment correlates with better outcomes. Additionally, people who get positive results early in treatment tend to have a better outlook.

People with depression may need to try several treatments before one works. A 2021 study estimated that 30.9% of adults with major depression have treatment-resistant depression. So while treatment is important and early treatment is critical, it is common to continue struggling with depression.

Depression can make it difficult for a person to seek treatment. Some people may not realize they are depressed, while others find the prospect of calling a provider, seeking care, and making lifestyle changes daunting. Some ways to help include:

  • being supportive and caring — do not blame someone for their depression
  • trying to minimize demands as much as possible — extended family may need to relax expectations surrounding holidays and time together
  • being physically present if the person finds this comforting
  • taking threats of suicide seriously and contacting the National Suicide Prevention Lifeline at 800-273-8255 for help
  • offering to help the person access treatment by calling a care provider, finding treatment, or even going with them to a first appointment

To help support your mental well-being and that of your loved ones, visit our dedicated mental health hub for more research-backed information and resources.

Severe depression can be a very painful experience, both for the person who has depression and for those who love them. A person may struggle with daily tasks, experience more conflict in their relationships, and question their worth.

Depression may also increase behaviors that further compromise quality of life, making it difficult to eat healthily, exercise, or go to work.

Treatment can help. It may take time and experimentation to find the right treatment or combination of treatments, but with a supportive care provider, a person can find relief.

People should not ignore severe depression. Early treatment is more effective and can reduce suffering.