Signs of Severe Depression: When to Get Help

Depression is something most of us are aware of. What many don’t know is it can be mild, moderate, or severe. It’s important to know the differences between the three. Severe depression can be dangerous, so watching for warning signs is important. Mild or moderate stages may progress at any time.

The Difference Between Mild, Moderate, and Severe Depression

Mild depression often develops following a crisis, prolonged stress, major transition, or change. A person struggling with mild depression can go about their day-to-day life. It should not interfere with daily activities.

A few signs are a lack of interest in activities and/or lack of motivation, appetite changes (often including weight changes), irritability, feelings of sadness or anger, sleeplessness and insomnia, difficulty focusing and/or brain fog, and negative self-image/ self talk. While these impact life to an extent, the person is able to do the tasks they need to and take care of themselves. For support, San Diego Christian Counseling can offer guidance.

These feelings may come and go during the day but do not persist 24/7. In most cases. This stage lasts a short amount of time and goes away on its own. Counseling is helpful and medication is rarely used in these cases. Counselors may teach meditation and relaxation techniques. They can also help provide a way for people to process their feelings. Diet, lifestyle, and exercise changes may be involved in treatment as well.

Moderate depression begins to impact daily life. It can begin as mild and progress to moderate over time. Anxiety often comes alongside other symptoms. Moderate can be debilitating at times. A lack of motivation will come at this level as well.

Individuals may no longer be able to complete daily tasks. Work or school may become affected, and a lack of interest or drive is seen. Cognitive impacts are common. Increased difficulty with decision making, solving problems, and focus often appear. These individuals might also show physical signs such as distant or sad-looking eyes, frowning, hunching over, and not making eye contact. Personal hygiene or appearance may be unkempt as well.

These feelings may persist all day long, and thoughts become increasingly negative and/or dark. Moderate feelings can last weeks, months, or years. This is the stage at which professional help needs to become involved. Most people who seek treatment are at this stage. Counseling, and sometimes medication, are common treatment approaches.

Severe depression is debilitating. In the mild and moderate phases, others may not know anything is wrong. In severe depression, the sadness and pain inside have progressed to the point where individuals cannot hide it anymore. Severe symptoms include most, if not all, of the mild and moderate symptoms.

Signs of Severe Depression Include:

• Major difficulty functioning in daily life: Basic tasks such as eating, hygiene, self-care, and interactions with others are neglected or seem to be impossible.
• Persevering thoughts: Often there is an inability to change the train of thought. Individuals may come back to the same thoughts again and again without being able to let them go. Thoughts center around death, harm, illness, punishment, and other similar themes.
• Self-harm: Mild and moderate stages may see self-harm as well. In severe cases, it can become uncontrollable. The individual may not realize the negative impacts of self-harm where other phases will acknowledge it’s an unhealthy expression of pain.
• Psychosis: Hallucinations, delusions, and other psychosis symptoms frequently appear. These can be constant during the day or come and go. Often the individual is not aware they’re experiencing these moments of psychosis.
• Sleep impacts: Periods of prolonged insomnia are not uncommon. Sometimes individuals will be awake for days or only sleep a few hours each night. They may not be tired at all and may not even realize how sleep-deprived they are. In other cases, a desire to constantly sleep shows up. 18+ hours a day of sleep may still result in feeling tired and people may say it’s impossible to get enough rest.

• Addiction: New addictions may develop or previous addictions may resurface. These are often a coping skill that is out of control. Drug, alchohl, sex, pornography, and other addictions are not uncommon in severely depressed individuals. Addiction may also lead to depression and serve as a self-defeating cycle. The individual will be unable to break an addiction and as the addiction progresses so does the depression. Anytime addiction is involved, care should go to monitoring for depression as well.
• Extreme anxiety: Consistent panic attacks, feelings of dread and debilitating anxiety are almost always seen in severe depression. Irrational and delusional thoughts may go with this anxiety. The individual may go to extreme or unusual lengths to avoid sources of anxiety or scenarios they fear.
• Lack of social interaction: Extreme isolation may occur. Even interactions with family members are decreased. When social interaction does occur, the conversations are most often centered around something negative, sad, and often on themes related to illness or death. Since individuals may isolate themselves, it may become necessary to involve local authorities in wellness checks.
• Hypochondria: Individuals often think they are sick. Self-diagnosis of illnesses is not uncommon. People might even self-treat for illnesses and diseases they do not have. In some cases, individuals will tell relatives and friends about having an illness that they’ve self-diagnosed.
• Suicide is prevalent in this phase. Individuals may obsess over their death, plan their death, or even attempt suicide. It’s not uncommon for someone to have a plan or two in their mind of how they would end their life. They may even buy a weapon or get pills to use. You should always call 911 or a suicide hotline if you are worried about suicide in yourself or a loved one.

Severe Depression Treatment

Professional help is required. Starting with a counselor is a good first step. They can then refer you to more professionals for help. Family counseling often takes place to provide support for loved ones. Support groups and group therapy can be added to a treatment plan too.

Medication is almost always involved in treatment. SSRI medications may be used, at least short-term. Sometimes electroconvulsive shock therapy is helpful for individuals as well. Antidepressants may be used alongside other medications. Sleep medication is commonly involved as well.

It is not uncommon for treatment to involve medical treatment. Overeating or undereating and malnourishment are common side-effects of a lack of self-care. This in combination with a sedentary lifestyle can result in health issues. Every system of the body may be affected and secondary medical concerns are not uncommon. Those who engage in self-harm need medical treatment as well.

In-patient care is also often needed as part of treatment. Stays can range from a 72 hour hold in a psychiatric care facility to a long-term care facility for weeks or months of treatment. In-patient care can be helpful to monitor medical status as well as provide intensive counseling and medication adjustments, as needed.

Drug and alcohol recovery might need to be part of treatment as well. It must be done carefully as the individual is already in a volatile situation. In-patient management for addiction may occur after the immediate threat of safety concerns lifts. Ongoing addiction management and support may need to remain part of one’s life for decades, if not a lifetime.

Diet, exercise, and lifestyle changes will be made as well. Increasing sunshine and fresh-air are often part of treatment. Herbal remedies might also be used alongside other alternative care options.

In most cases, a combination of treatment modalities will be used. It can take time to find the type of mediation or treatment a person responds best to. Don’t be discouraged if the first thing you or a loved one, tries doesn’t work. Recovery will take time and commitment but it is possible. For support, Counselors at San Diego Christian Counseling are here to help.