🕷️ Crawler Inspector

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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 157 (from laksa074)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa157.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical, ml_categories_json AS ml_categories_json, ml_types_json AS ml_types_json, ml_intent_types_json AS ml_intent_types_json, meta_language AS meta_language, attrs_author AS attrs_author, ifNull(toUnixTimestamp(attrs_publish_time), 0) AS attrs_publish_time, ifNull(toUnixTimestamp(attrs_original_publish_time), 0) AS attrs_original_publish_time, ifNull(attrs_is_republished, 0) AS attrs_is_republished, ifNull(attrs_nr_words, 0) AS attrs_nr_words, ifNull(attrs_boilerpipe_nr_words, 0) AS attrs_boilerpipe_nr_words, ifNull(body_ext_links_number, 0) AS body_ext_links_number, ifNull(body_int_links_number, 0) AS body_int_links_number, ifNull(meta_nofollow, 0) AS meta_nofollow, ifNull(meta_noarchive, 0) AS meta_noarchive, ifNull(props_was_rendered, 0) AS props_was_rendered, ifNull(src_redirect, \'\') AS src_redirect, ifNull(download_time_msec, 0) AS download_time_msec, ifNull(download_ttfb_msec, 0) AS download_ttfb_msec, ifNull(download_size, 0) AS download_size FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883","crawl_time":1776990227,"first_indexed_time":1517868277,"http_code":200,"src_unparsed":"com,verywellmind!www,\/what-are-the-signs-that-you-are-severely-depressed-1066883 s443","src_root_hash":"10064058272378209957","history_drop_reason":null,"meta_title":"What Are the Signs That You Are Severely Depressed?","meta_descriptions":["Being severely depressed can lead to serious symptoms including psychosis and suicidal thinking. Learn the signs of severe depression and treatments that can help."],"attrs_boilerpipe_text":"Key Takeaways\nSevere depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts.\nTreatments like therapy, medication, and lifestyle changes can help manage severe depression. \nInformation presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the\nNational Suicide Prevention Lifeline\nat\n988\nfor support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.\nFor more mental health resources, see our\nNational Helpline Database\n.\nSevere depression is often characterized by symptoms of hopelessness, increased\nirritability\n, loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide.\nTechnically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression.\nThe severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition.\nThis 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.\nThe Depression Spectrum\nIt should be noted that there are several\ntypes of depression\nand while they may share some common symptoms, each person’s experience can be different.\nSymptoms of depression\ncan occur along a spectrum both in duration and severity:\nMild Depression\nMild depression\ncan 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.\n \nModerate Depression\nModerate depression\ncauses chronic symptoms and usually requires at least one\nform of treatment\n, if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration.\nSevere Depression\nGenerally speaking, severe depression requires some type of treatment to find some relief.\nAdditionally, depression severity can change over time, growing increasingly worse or alternating between mild and severe during the same depressive episode.\nIf someone has severe depression, they may self-harm, have suicidal thoughts, or be at risk for attempting suicide.\nIf you are severely depressed, help is available to help you manage your symptoms and ensure your safety and well-being.\nSymptoms of Severe Depression\nThere 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.\nPsychosis\nPsychosis\nsymptoms such as delusions and hallucinations indicate a person has experienced a break from reality.\nPsychotic depression\nsymptoms may include:\n\n\nAgitation\nBelieving that one is ill despite evidence to the contrary\nDelusions or hallucinations\nExtreme anxiety\nIntellectual impairment\nPhysical immobility\nTrouble falling asleep\nSuicidal Thoughts and Behaviors\nStrong\nsigns of suicidality\ninclude talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include:\nAcquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills, etc.)\nChanges in eating or sleeping habits\nEngaging in risky or self-destructive behavior\nExtreme agitation or anxiety\nGetting one's affairs in order (drawing up a will, giving away possessions) \nIncreased use of substances such as drugs and alcohol\nIntense changes in mood\/mood swings\nSaying goodbye to friends and family as though for the last time\nFeeling trapped or hopeless in one’s situation\nTalking a lot about death, dying, and violence\nTalking about suicide or wishing that one hadn't been born\nWithdrawal from friends or family\nMelancholia\nFeelings 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.\n\n\nPhysical Effects of Depression\nDepression can appear physically via symptoms felt in the body. Examples of\nphysical effects of depression\ninclude 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.\nPsychomotor Changes\nNoticeable 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.\n\n\nDiagnosis of Severe Depression\nGuidelines such as those found in the \"Diagnostic and Statistical Manual of Mental Disorders\" (\nDSM-5\n) 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.\nA Lack of Standardization\nQuantitative 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. \nA 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. \nTypes of Diagnostic Tools\nResearchers have been using such scales since the 1960s. One of the first, the\nHamilton Depression Rating Scale\n, 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. \nWhile 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. \nThe 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. \nMost Common Depression Diagnosis Scales\nSome of the most popular scales used to help clinicians diagnose depression include:\nBeck Depression Inventory (BDI-II)\nCarroll Rating Scale (CRS)\nCenter for Epidemiological Studies Depression (CES-D)\nChildren’s Depression Inventory\n (CDI)\nClinically Useful Depression Outcome Scale (CUDOS)\nDepression Anxiety Stress Scale (DASS-21)\nGeriatric Depression Scale (GDS)\nMajor Depression Inventory (MDI)\nPatient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9 \nPlutchik-Van Praag Self-Report Depression Scale (PVP)\nQuick Inventory of Depressive Symptomatology (QIDS)\nRome Depression Inventory (RDI)\nZung Self-Rating Depression Scales (SDS)\nSome 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. \nThe\nPHQ\n, for example, is\navailable for free online\nand in over 30 languages. It can be downloaded as a PDF or accessed as an interactive quiz on several reputable mental health websites. \nTreatment for Severe Depression\nFortunately, 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.\nPsychotherapy\nAlso referred to as talk therapy,\npsychotherapy\ncan often help ease depressive disorder symptoms.\nDifferent types of psychotherapy include:\nCognitive behavioral therapy\n(CBT)\n: This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression.\nInterpersonal therapy\n(IPT)\n: This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health.\nPsychodynamic therapy\n: This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed.\nMany clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the\nAmerican Psychological Association's site\nto find out which ones are available in your area. It may also be helpful to ask local therapists if they specialize in severe depression.\nMedication\nMedication is frequently prescribed to treat severe depression. The most common type of medication used is\nselective serotonin reuptake inhibitors\n(SSRIs).\n\n This includes antidepressants such as\nProzac\n(fluoxetine),\nZoloft\n(sertraline), and\nPaxil\n(paroxetine).\nOther medications used to treat depression include:\nNorepinephrine-dopamine reuptake inhibitors (NDRIs)\nTricyclic antidepressants\n(TCAs)\nMonoamine oxidase inhibitors\n(MAOIs)\nBrain Stimulation Therapy\nIf 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:\nElectroconvulsive therapy\n(ECT)\nTranscranial magnetic stimulation\n(TMS)\nVagus nerve stimulation (VNS)\nInpatient Depression Treatment\nIn some cases, inpatient treatment may be recommended for severe depression. Being\nhospitalized for depression\ndoesn't mean that you're weak. It simply means that your treatment may be more effective in a more controlled environment.\nGetting 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.\nComplementary Treatments\nThere 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.\nThe Cleveland Clinic shares that some of the remedies that have been found to help are:\n\n\nAcupuncture\nMassage\nGuided relaxation\nMeditation\nYoga\nYour 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. \nIt 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.\nCoping With Severe Depression\nYou 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: \nCreating a support network\nof caring people\nEating well\nGetting enough sleep\nExercising regularly\nAvoiding drugs and alcohol\nSuch lifestyle changes can improve your mood and overall health and well-being.\nWhen 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.","attrs_markdown":"[Skip to content](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#skip-to-content)\n\nMenu\n\n- [Conditions A-Z](https:\/\/www.verywellmind.com\/conditions-a-z-4797402)\n  - [Addiction](https:\/\/www.verywellmind.com\/addiction-overview-4581803)\n  - [Depression](https:\/\/www.verywellmind.com\/depression-4157261)\n  - [ADHD](https:\/\/www.verywellmind.com\/adhd-overview-4581801)\n  - [Anxiety](https:\/\/www.verywellmind.com\/anxiety-7508391)\n  - [Bipolar Disorder](https:\/\/www.verywellmind.com\/bipolar-disorder-4157274)\n  - [PTSD](https:\/\/www.verywellmind.com\/ptsd-4157229)\n  - [View All](https:\/\/www.verywellmind.com\/conditions-a-z-4797402)\n- [Therapy](https:\/\/www.verywellmind.com\/therapy-4581775)\n  - [Therapy Center](https:\/\/www.verywellmind.com\/therapy-7092217)\n  - [When To See a Therapist](https:\/\/www.verywellmind.com\/how-to-know-when-it-s-time-to-see-a-therapist-5077040)\n  - [Types of Therapy](https:\/\/www.verywellmind.com\/how-to-choose-the-best-type-of-therapy-for-you-6500320)\n  - [Best Online Therapy](https:\/\/www.verywellmind.com\/best-online-therapy-4691206)\n  - [Best Couples Therapy](https:\/\/www.verywellmind.com\/best-online-marriage-counseling-4691952)\n- [Living Well](https:\/\/www.verywellmind.com\/living-well-7510832)\n  - [Managing Stress](https:\/\/www.verywellmind.com\/stress-management-overview-4581770)\n  - [Meditation](https:\/\/www.verywellmind.com\/meditation-and-mindfulness-4581783)\n  - [Sleep and Dreaming](https:\/\/www.verywellmind.com\/sleep-and-dreaming-4157166)\n  - [Understanding Emotions](https:\/\/www.verywellmind.com\/emotions-4157165)\n  - [Self-Improvement](https:\/\/www.verywellmind.com\/self-improvement-4157212)\n- [Relationships](https:\/\/www.verywellmind.com\/relationships-4157190)\n  - [Healthy Relationships](https:\/\/www.verywellmind.com\/strengthening-relationships-4162997)\n  - [Dating](https:\/\/www.verywellmind.com\/dating-tips-and-strategies-7511571)\n  - [Intimacy](https:\/\/www.verywellmind.com\/sex-and-relationships-7511610)\n- [Psychology](https:\/\/www.verywellmind.com\/psychology-4157187)\n  - [Theories](https:\/\/www.verywellmind.com\/theories-of-psychology-4157184)\n  - [Student Resources](https:\/\/www.verywellmind.com\/student-resources-overview-4581768)\n  - [Personality Types](https:\/\/www.verywellmind.com\/the-myers-briggs-type-indicator-2795583)\n- [Trending](https:\/\/www.verywellmind.com\/news-latest-research-and-trending-topics-4846421)\n  - [Quizzes](https:\/\/www.verywellmind.com\/quizzes-8609222)\n  - [Guided Meditations](https:\/\/www.verywellmind.com\/guided-meditations-8609227)\n  - [Verywell Mind Insights](https:\/\/www.verywellmind.com\/mental-health-data-insights-5185693)\n  - [2024 Verywell Mind 25](https:\/\/www.verywellmind.com\/the-verywell-mind-25-2024-7484480)\n  - [Mental Health in the Classroom](https:\/\/www.verywellmind.com\/mental-health-in-the-classroom-survey-7569880)\n- [About Us](https:\/\/www.verywellmind.com\/about-us-5184564)\n  - [Editorial Process](https:\/\/www.verywellmind.com\/our-editorial-process-4778006)\n  - [Meet Our Review Board](https:\/\/www.verywellmind.com\/review-board-4796494)\n  - [Crisis Support](https:\/\/www.verywellmind.com\/crisis-support-6666353)\n\nSearch\n\n- [Conditions A-Z](https:\/\/www.verywellmind.com\/conditions-a-z-4797402)\n  - [Addiction](https:\/\/www.verywellmind.com\/addiction-overview-4581803)\n  - [Depression](https:\/\/www.verywellmind.com\/depression-4157261)\n  - [ADHD](https:\/\/www.verywellmind.com\/adhd-overview-4581801)\n  - [Anxiety](https:\/\/www.verywellmind.com\/anxiety-7508391)\n  - [Bipolar Disorder](https:\/\/www.verywellmind.com\/bipolar-disorder-4157274)\n  - [PTSD](https:\/\/www.verywellmind.com\/ptsd-4157229)\n  - [View All](https:\/\/www.verywellmind.com\/conditions-a-z-4797402)\n- [Therapy](https:\/\/www.verywellmind.com\/therapy-4581775)\n  - [Therapy Center](https:\/\/www.verywellmind.com\/therapy-7092217)\n  - [When To See a Therapist](https:\/\/www.verywellmind.com\/how-to-know-when-it-s-time-to-see-a-therapist-5077040)\n  - [Types of Therapy](https:\/\/www.verywellmind.com\/how-to-choose-the-best-type-of-therapy-for-you-6500320)\n  - [Best Online Therapy](https:\/\/www.verywellmind.com\/best-online-therapy-4691206)\n  - [Best Couples Therapy](https:\/\/www.verywellmind.com\/best-online-marriage-counseling-4691952)\n  - [View All](https:\/\/www.verywellmind.com\/therapy-4581775)\n- [Living Well](https:\/\/www.verywellmind.com\/living-well-7510832)\n  - [Managing Stress](https:\/\/www.verywellmind.com\/stress-management-overview-4581770)\n  - [Meditation](https:\/\/www.verywellmind.com\/meditation-and-mindfulness-4581783)\n  - [Sleep and Dreaming](https:\/\/www.verywellmind.com\/sleep-and-dreaming-4157166)\n  - [Understanding Emotions](https:\/\/www.verywellmind.com\/emotions-4157165)\n  - [Self-Improvement](https:\/\/www.verywellmind.com\/self-improvement-4157212)\n  - [View All](https:\/\/www.verywellmind.com\/living-well-7510832)\n- [Relationships](https:\/\/www.verywellmind.com\/relationships-4157190)\n  - [Healthy Relationships](https:\/\/www.verywellmind.com\/strengthening-relationships-4162997)\n  - [Dating](https:\/\/www.verywellmind.com\/dating-tips-and-strategies-7511571)\n  - [Intimacy](https:\/\/www.verywellmind.com\/sex-and-relationships-7511610)\n  - [View All](https:\/\/www.verywellmind.com\/relationships-4157190)\n- [Psychology](https:\/\/www.verywellmind.com\/psychology-4157187)\n  - [Theories](https:\/\/www.verywellmind.com\/theories-of-psychology-4157184)\n  - [Student Resources](https:\/\/www.verywellmind.com\/student-resources-overview-4581768)\n  - [Personality Types](https:\/\/www.verywellmind.com\/the-myers-briggs-type-indicator-2795583)\n  - [View All](https:\/\/www.verywellmind.com\/psychology-4157187)\n- [Trending](https:\/\/www.verywellmind.com\/news-latest-research-and-trending-topics-4846421)\n  - [Quizzes](https:\/\/www.verywellmind.com\/quizzes-8609222)\n  - [Guided Meditations](https:\/\/www.verywellmind.com\/guided-meditations-8609227)\n  - [Verywell Mind Insights](https:\/\/www.verywellmind.com\/mental-health-data-insights-5185693)\n  - [2024 Verywell Mind 25](https:\/\/www.verywellmind.com\/the-verywell-mind-25-2024-7484480)\n  - [Mental Health in the Classroom](https:\/\/www.verywellmind.com\/mental-health-in-the-classroom-survey-7569880)\n  - [View All](https:\/\/www.verywellmind.com\/news-latest-research-and-trending-topics-4846421)\n\n[More in Depression](https:\/\/www.verywellmind.com\/depression-4157261)\n\n- [Symptoms and Diagnosis](https:\/\/www.verywellmind.com\/depression-symptoms-and-diagnosis-4157260)\n- [Living With](https:\/\/www.verywellmind.com\/living-with-depression-7508413)\n- [Causes](https:\/\/www.verywellmind.com\/depression-causes-4157256)\n- [Treatment](https:\/\/www.verywellmind.com\/depression-treatment-4157258)\n- [Types](https:\/\/www.verywellmind.com\/depression-types-4157254)\n- [Childhood Depression](https:\/\/www.verywellmind.com\/childhood-depression-4157255)\n- [Suicide](https:\/\/www.verywellmind.com\/suicide-4157253)\n\n[View More](https:\/\/www.verywellmind.com\/depression-4157261)\n\n- [About Us](https:\/\/www.verywellmind.com\/about-us-5184564)\n- [Editorial Process](https:\/\/www.verywellmind.com\/our-editorial-process-4778006)\n- [Review Board](https:\/\/www.verywellmind.com\/review-board-4796494)\n- [Crisis Support](https:\/\/www.verywellmind.com\/crisis-support-6666353)\n\nVerywell Mind's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.\n\nⒸ 2026 People Inc. — All rights reserved\n\n# Symptoms of Severe Depression\nBy\n\n[Nancy Schimelpfening](https:\/\/www.verywellmind.com\/nancy-schimelpfening-ms-4781235)\n\n[Nancy Schimelpfening](https:\/\/www.verywellmind.com\/nancy-schimelpfening-ms-4781235)\n\nNancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.\n\nLearn about our  [editorial process](https:\/\/www.verywellmind.com\/our-editorial-process-4778006)\n\nUpdated on October 26, 2025\n\nMedically reviewed\n\nVerywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. [Learn more](https:\/\/www.verywellmind.com\/review-board-4796494).\n\nby\n\n[Daniel B. Block, MD](https:\/\/www.verywellmind.com\/daniel-block-md-4779186)\n\n![Block]()\n\n![Block](https:\/\/www.verywellmind.com\/thmb\/bqppKq4IVUTVsPMClzJADd5fs14=\/200x200\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/block-8924ca72ff94426d940e8f7e639e3942.jpg)\n\nMedically reviewed by [Daniel B. Block, MD](https:\/\/www.verywellmind.com\/daniel-block-md-4779186)\n\nDaniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.\n\nLearn about our  [Medical Review Board](https:\/\/www.verywellmind.com\/review-board-4796494)\n\n![Severe Depression](https:\/\/www.verywellmind.com\/thmb\/KByU_En6FVDWtg-JyXz9Zi5o5D4=\/1500x0\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/severe-depression-56af379d3df78cf772c1aa84.jpg)\n\n![Severe Depression](https:\/\/www.verywellmind.com\/thmb\/KByU_En6FVDWtg-JyXz9Zi5o5D4=\/1500x0\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/severe-depression-56af379d3df78cf772c1aa84.jpg)\n\nJamie Larsen \/ EyeEm \/ Getty Images\n\nTable of Contents\n\nView All\n\nTable of Contents\n\n- [Depression Spectrum](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-the-depression-spectrum)\n- [Symptoms of Severe Depression](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-symptoms-of-severe-depression)\n- [Diagnosis](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-diagnosis-of-severe-depression)\n- [Treatment](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-treatment-for-severe-depression)\n- [Coping](https:\/\/www.verywellmind.com\/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-coping-with-severe-depression)\n\nClose\n\n### Key Takeaways\n- Severe depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts.\n- Treatments like therapy, medication, and lifestyle changes can help manage severe depression.\n\nInformation presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the [National Suicide Prevention Lifeline](https:\/\/suicidepreventionlifeline.org\/) at **988** for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.\n\nFor more mental health resources, see our [National Helpline Database](https:\/\/www.verywellmind.com\/national-helpline-database-4799696).\n\nSevere depression is often characterized by symptoms of hopelessness, increased [irritability](https:\/\/www.verywellmind.com\/irritability-definition-symptoms-traits-causes-treatment-5088062), loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression.\n\nThe severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition.\n\nThis 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.\n\n## The Depression Spectrum\nIt should be noted that there are several [types of depression](https:\/\/www.verywellmind.com\/common-types-of-depression-1067313) and while they may share some common symptoms, each person’s experience can be different.\n\n[Symptoms of depression](https:\/\/www.verywellmind.com\/what-is-clinical-depression-1067309) can occur along a spectrum both in duration and severity:\n\n### Mild Depression\n[Mild depression](https:\/\/www.verywellmind.com\/what-is-mild-low-grade-depression-1066956) can 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.\n\n### Moderate Depression\n[Moderate depression](https:\/\/www.verywellmind.com\/what-is-moderate-depression-5072794) causes chronic symptoms and usually requires at least one [form of treatment](https:\/\/www.verywellmind.com\/treatments-for-depression-1065502), if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration.\n\n[The Best Online Therapy Services for Depression We Tried and Tested](https:\/\/www.verywellmind.com\/best-online-help-for-depression-4691259)\n\n### Severe Depression\nGenerally speaking, severe depression requires some type of treatment to find some relief.\n\nAdditionally, depression severity can change over time, growing increasingly worse or alternating between mild and severe during the same depressive episode.\n\nIf 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.\n\n[Depression Recovery: How to Know You're Making Progress](https:\/\/www.verywellmind.com\/how-do-i-know-if-my-depression-is-getting-better-1066881)\n\n## Symptoms of Severe Depression\nThere 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.\n\n### Psychosis\n[Psychosis](https:\/\/www.verywellmind.com\/what-is-psychosis-p2-379828) symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. [Psychotic depression](https:\/\/www.verywellmind.com\/psychotic-depression-1066607) symptoms may include:\n\n- Agitation\n- Believing that one is ill despite evidence to the contrary\n- Delusions or hallucinations\n- Extreme anxiety\n- Intellectual impairment\n- Physical immobility\n- Trouble falling asleep\n### Suicidal Thoughts and Behaviors\nStrong [signs of suicidality](https:\/\/www.verywellmind.com\/suicide-warning-signs-and-risk-factors-1067525) include talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include:\n\n- Acquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills, etc.)\n- Changes in eating or sleeping habits\n- Engaging in risky or self-destructive behavior\n- Extreme agitation or anxiety\n- Getting one's affairs in order (drawing up a will, giving away possessions)\n- Increased use of substances such as drugs and alcohol\n- Intense changes in mood\/mood swings\n- Saying goodbye to friends and family as though for the last time\n- Feeling trapped or hopeless in one’s situation\n- Talking a lot about death, dying, and violence\n- Talking about suicide or wishing that one hadn't been born\n- Withdrawal from friends or family\n### Melancholia\nFeelings 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.\n\n[What Is Melancholic Depression?](https:\/\/www.verywellmind.com\/what-is-melancholia-379852)\n\n### Physical Effects of Depression\nDepression can appear physically via symptoms felt in the body. Examples of [physical effects of depression](https:\/\/www.verywellmind.com\/physical-effects-of-depression-1066890) 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.\n\n[What It Means to Have Clinical Depression](https:\/\/www.verywellmind.com\/clinical-depression-symptoms-types-and-treatments-8713946)\n\n### Psychomotor Changes\nNoticeable 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.\n\n## Diagnosis of Severe Depression\nGuidelines such as those found in the \"Diagnostic and Statistical Manual of Mental Disorders\" ([DSM-5](https:\/\/www.verywellmind.com\/what-is-the-dsm-5-379955)) 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.\n\n### A Lack of Standardization\nQuantitative 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.\n\nA 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.\n\n### Types of Diagnostic Tools\nResearchers have been using such scales since the 1960s. One of the first, the [Hamilton Depression Rating Scale](https:\/\/www.verywellmind.com\/phq-9-patient-healthcare-questionnaire-for-depression-4149685), 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.\n\nWhile 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.\n\nThe 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.\n\n### Most Common Depression Diagnosis Scales\nSome of the most popular scales used to help clinicians diagnose depression include:\n\n- [Beck Depression Inventory (BDI-II)](https:\/\/www.verywellmind.com\/what-is-the-beck-depression-inventory-5294126)\n- Carroll Rating Scale (CRS)\n- Center for Epidemiological Studies Depression (CES-D)\n- [Children’s Depression Inventory](https:\/\/www.verywellmind.com\/the-childrens-depression-inventory-cdi-1066780) (CDI)\n- Clinically Useful Depression Outcome Scale (CUDOS)\n- [Depression Anxiety Stress Scale (DASS-21)](https:\/\/www.verywellmind.com\/dass-21-depression-anxiety-scale-8697715)\n- Geriatric Depression Scale (GDS)\n- Major Depression Inventory (MDI)\n- Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9\n- Plutchik-Van Praag Self-Report Depression Scale (PVP)\n- Quick Inventory of Depressive Symptomatology (QIDS)\n- Rome Depression Inventory (RDI)\n- Zung Self-Rating Depression Scales (SDS)\n\nSome 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.\n\nThe [PHQ](https:\/\/www.verywellmind.com\/phq-9-patient-healthcare-questionnaire-for-depression-4149685), for example, is [available for free online](https:\/\/www.apa.org\/pi\/about\/publications\/caregivers\/practice-settings\/assessment\/tools\/patient-health) and in over 30 languages. It can be downloaded as a PDF or accessed as an interactive quiz on several reputable mental health websites.\n\n## Treatment for Severe Depression\nFortunately, 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.\n\n### Psychotherapy\nAlso referred to as talk therapy, [psychotherapy](https:\/\/www.verywellmind.com\/psychotherapy-4157172) can often help ease depressive disorder symptoms. Different types of psychotherapy include:\n\n- **[Cognitive behavioral therapy](https:\/\/www.verywellmind.com\/what-is-cognitive-behavior-therapy-2795747) (CBT)**: This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression.\n- **[Interpersonal therapy](https:\/\/www.verywellmind.com\/interpersonal-therapy-1067404) (IPT)**: This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health.\n- [**Psychodynamic therapy**](https:\/\/www.verywellmind.com\/psychodynamic-therapy-for-depression-5085728): This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed.\n\nMany clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the [American Psychological Association's site](https:\/\/locator.apa.org\/) 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.\n\n[The Best Online Therapy Programs](https:\/\/www.verywellmind.com\/best-online-therapy-4691206) We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.\n\n### Medication\nMedication is frequently prescribed to treat severe depression. The most common type of medication used is [selective serotonin reuptake inhibitors](https:\/\/www.verywellmind.com\/list-of-ssris-380594) (SSRIs).  This includes antidepressants such as [Prozac](https:\/\/www.verywellmind.com\/how-is-prozac-used-to-treat-social-anxiety-disorder-3024962) (fluoxetine), [Zoloft](https:\/\/www.verywellmind.com\/zoloft-sertraline-2584329) (sertraline), and [Paxil](https:\/\/www.verywellmind.com\/paxil-paroxetine-2584337) (paroxetine).\n\nOther medications used to treat depression include:\n\n- Norepinephrine-dopamine reuptake inhibitors (NDRIs)\n- [Tricyclic antidepressants](https:\/\/www.verywellmind.com\/tricyclic-antidepressants-379652) (TCAs)\n- [Monoamine oxidase inhibitors](https:\/\/www.verywellmind.com\/monoamine-oxidase-inhibitors-maois-2584303) (MAOIs)\n\n[The Best Online Psychiatry Services, According to a Therapist](https:\/\/www.verywellmind.com\/best-online-psychiatrists-5119854)\n\n### Brain Stimulation Therapy\nIf 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:\n\n- [Electroconvulsive therapy](https:\/\/www.verywellmind.com\/electroconvulsive-therapy-2795172) (ECT)\n- [Transcranial magnetic stimulation](https:\/\/www.verywellmind.com\/transcranial-magnetic-stimulations-vs-ect-380646) (TMS)\n- Vagus nerve stimulation (VNS)\n### Inpatient Depression Treatment\nIn some cases, inpatient treatment may be recommended for severe depression. Being [hospitalized for depression](https:\/\/www.verywellmind.com\/what-happens-when-you-are-hospitalized-for-depression-1067262) doesn't mean that you're weak. It simply means that your treatment may be more effective in a more controlled environment.\n\nGetting 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.\n\n### Complementary Treatments\nThere 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.\n\nThe Cleveland Clinic shares that some of the remedies that have been found to help are:\n\n- [Acupuncture](https:\/\/www.verywellmind.com\/alternative-therapies-types-and-uses-5207962)\n- Massage\n- [Guided relaxation](https:\/\/www.verywellmind.com\/use-guided-imagery-for-relaxation-3144606)\n- [Meditation](https:\/\/www.verywellmind.com\/mindfulness-meditation-88369)\n- [Yoga](https:\/\/www.verywellmind.com\/how-yoga-can-help-reduce-stress-3567211)\n\nYour 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.\n\nIt 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.\n\n## Coping With Severe Depression\nYou 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:\n\n- [Creating a support network](https:\/\/www.verywellmind.com\/social-support-for-psychological-health-4119970) of caring people\n- Eating well\n- Getting enough sleep\n- Exercising regularly\n- Avoiding drugs and alcohol\n\nSuch lifestyle changes can improve your mood and overall health and well-being.\n\nWhen 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.\n\nRead more:\n\n- [Conditions A-Z](https:\/\/www.verywellmind.com\/conditions-a-z-4797402)\n- [Depression](https:\/\/www.verywellmind.com\/depression-4157261)\n- [Symptoms and Diagnosis](https:\/\/www.verywellmind.com\/depression-symptoms-and-diagnosis-4157260)\n\n10 Sources\n\nVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our [editorial process](https:\/\/www.verywellmind.com\/our-editorial-process-4778006) to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.\n\n1. National Institute of Mental Health. [Depression](https:\/\/www.nimh.nih.gov\/health\/topics\/depression\/index.shtml). Nimh.nih.gov. Updated February 2018.\n2. 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](https:\/\/doi.org\/10.1001\/jama.2009.1943). *JAMA*. 2010 Jan 6;303(1):47-53. doi:10.1001\/jama.2009.1943\n3. American Psychiatric Association. [*Diagnostic and Statistical Manual of Mental Disorders (DSM-5)*](https:\/\/doi.org\/10.1176\/appi.books.9780890425596). 2013. doi:10.1176\/appi.books.9780890425596\n4. NHS Choices. [Psychotic depression](https:\/\/www.nhs.uk\/conditions\/clinical-depression\/psychotic-depression\/). Updated December 10, 2019.\n5. National Institute of Mental Health. [Suicide warning signs](https:\/\/www.nimh.nih.gov\/health\/publications\/warning-signs-of-suicide\/index.shtml).\n6. Parker G, Fink M, Shorter E, et al. [Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3733615\/). *Am J Psychiatry*. 2010;167(7):745-747. doi:10.1176\/appi\/ajp.2010.09101525\n7. Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. [Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications](https:\/\/doi.org\/10.1155\/2013\/158746). *Biomed Res Int*. 2013;2013. doi:10.1155\/2013\/158746\n8. Gautam S, Jain A, Gautam M, et al. [Clinical practice guidelines for the management of depression](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5310101\/). *Indian J Psychiatry*. 2017;59(Suppl 1):S34-S50. doi:10.4103\/0019-5545.196973\n9. National Alliance on Mental Illness. [Depression](https:\/\/www.nami.org\/About-Mental-Illness\/Mental-Health-Conditions\/Depression\/Treatment). Updated August 2017.\n10. Cleveland Clinic. [Alternative therapies for depression](https:\/\/my.clevelandclinic.org\/health\/treatments\/9303-depression-alternative-therapies). Published 2014.\n\nAdditional Reading\n\n- Kriston L, von Wolff A. [Not as golden as standards should be: Interpretation of the Hamilton Rating Scale for Depression](https:\/\/doi.org\/10.1016\/j.jad.2010.07.011). *Journal of Affective Disorders*. 2011;128(1-2):175-177. doi:10.1016\/j.jad.2010.07.011\n- Zimmerman M. [Medscape education psychiatry & mental health. Tools for depression: standardized rating scales](https:\/\/login.medscape.com\/login\/sso\/getlogin?urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUub3JnL3ZpZXdhcnRpY2xlLzc0OTkyMQ==&ac=401). Medscape. Published September 21, 2011.\n\nBy [Nancy Schimelpfening](https:\/\/www.verywellmind.com\/nancy-schimelpfening-ms-4781235)   \n Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.\n\n[See Our Editorial Process](https:\/\/www.verywellmind.com\/our-editorial-process-4778006)\n\n[Meet Our Review Board](https:\/\/www.verywellmind.com\/review-board-4796494)\n\nShare Feedback\n\nWas this page helpful?\n\nThanks for your feedback\\!\n\nWhat is your feedback?\n\nHelpful\n\nReport an Error\n\nOther\n\nRelated Articles\n\n[![Pensive young woman lying in bed]() ![Pensive young woman lying in bed](https:\/\/www.verywellmind.com\/thmb\/Bkl7FbBtPKJVaxc2N5Tplg6tOT4=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/GettyImages-1474174895-f2f67bd54f2945a3bbb4321765378ec3.jpg) What Causes Mood Swings?](https:\/\/www.verywellmind.com\/what-are-mood-swings-1067178)\n\n[![White woman lying down appearing sad]() ![White woman lying down appearing sad](https:\/\/www.verywellmind.com\/thmb\/zkGEkQ16yZ6bCn19EGSpIBIuga4=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/GettyImages-1252672800-a321c3217785425f8b87b1a559dd60af.jpg) Is It Confidence or an Inferiority Complex?](https:\/\/www.verywellmind.com\/understanding-the-inferiority-complex-5186892)\n\n[![Person taking blood]() ![Person taking blood](https:\/\/www.verywellmind.com\/thmb\/_3uSum_46lDekpgh411_uGxN_8U=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/GettyImages-1031049882-ac31dafab3434424a8c64f02f1bd9042.jpg) Is There a Depression Blood Test?](https:\/\/www.verywellmind.com\/is-there-a-blood-test-for-depression-1066915)\n\n[The Relationship Between Asperger's and Depression](https:\/\/www.verywellmind.com\/the-relationship-between-aspergers-and-depression-4773763)\n\n[![woman talking to female doctor in office]() ![woman talking to female doctor in office](https:\/\/www.verywellmind.com\/thmb\/uJftc8Cgw17UXVMWcjRtrGziUTU=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/GettyImages_108463420-56af362c3df78cf772c19a9a.jpg) Should You See a Doctor, Psychiatrist, or Therapist for Depression?](https:\/\/www.verywellmind.com\/i-think-im-depressed-now-what-1066902)\n\n[![Diagnosis words laid out in a circle]() ![Diagnosis words laid out in a circle](https:\/\/www.verywellmind.com\/thmb\/24ffry8xbp_uPuC4I_A7wxHtZxg=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/diagnosis-569695095f9b58eba49dd551.jpg) Provisional Diagnosis vs. Differential Diagnosis](https:\/\/www.verywellmind.com\/provisional-diagnosis-vs-differential-diagnosis-1067284)\n\n[![Illustration outlining reasons someone may feel like something is wrong with them]() ![Illustration outlining reasons someone may feel like something is wrong with them](https:\/\/www.verywellmind.com\/thmb\/YhlA9J9WN1hWqoRLD5Z5eCp5tzU=\/400x250\/filters:no_upscale\\(\\):max_bytes\\(150000\\):strip_icc\\(\\)\/what-is-wrong-with-me-5094673_final2-b1fbada4cfb442c8b6ba83ae57be2adb.png) 'What Is Wrong With Me?' 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Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.\n\nⒸ 2026 People Inc. — All rights reserved\n\nVerywell Mind is part of the [People Inc.](https:\/\/www.people.inc\/) publishing family.","attrs_readable_markdown":"### Key Takeaways\n- Severe depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts.\n- Treatments like therapy, medication, and lifestyle changes can help manage severe depression.\n\nInformation presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the [National Suicide Prevention Lifeline](https:\/\/suicidepreventionlifeline.org\/) at **988** for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.\n\nFor more mental health resources, see our [National Helpline Database](https:\/\/www.verywellmind.com\/national-helpline-database-4799696).\n\nSevere depression is often characterized by symptoms of hopelessness, increased [irritability](https:\/\/www.verywellmind.com\/irritability-definition-symptoms-traits-causes-treatment-5088062), loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression.\n\nThe severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition.\n\nThis 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.\n\n## The Depression Spectrum\nIt should be noted that there are several [types of depression](https:\/\/www.verywellmind.com\/common-types-of-depression-1067313) and while they may share some common symptoms, each person’s experience can be different.\n\n[Symptoms of depression](https:\/\/www.verywellmind.com\/what-is-clinical-depression-1067309) can occur along a spectrum both in duration and severity:\n\n### Mild Depression\n[Mild depression](https:\/\/www.verywellmind.com\/what-is-mild-low-grade-depression-1066956) can 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.\n\n### Moderate Depression\n[Moderate depression](https:\/\/www.verywellmind.com\/what-is-moderate-depression-5072794) causes chronic symptoms and usually requires at least one [form of treatment](https:\/\/www.verywellmind.com\/treatments-for-depression-1065502), if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration.\n\n### Severe Depression\nGenerally speaking, severe depression requires some type of treatment to find some relief.\n\nAdditionally, depression severity can change over time, growing increasingly worse or alternating between mild and severe during the same depressive episode.\n\nIf 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.\n\n## Symptoms of Severe Depression\nThere 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.\n\n### Psychosis\n[Psychosis](https:\/\/www.verywellmind.com\/what-is-psychosis-p2-379828) symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. [Psychotic depression](https:\/\/www.verywellmind.com\/psychotic-depression-1066607) symptoms may include:\n\n- Agitation\n- Believing that one is ill despite evidence to the contrary\n- Delusions or hallucinations\n- Extreme anxiety\n- Intellectual impairment\n- Physical immobility\n- Trouble falling asleep\n### Suicidal Thoughts and Behaviors\nStrong [signs of suicidality](https:\/\/www.verywellmind.com\/suicide-warning-signs-and-risk-factors-1067525) include talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include:\n\n- Acquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills, etc.)\n- Changes in eating or sleeping habits\n- Engaging in risky or self-destructive behavior\n- Extreme agitation or anxiety\n- Getting one's affairs in order (drawing up a will, giving away possessions)\n- Increased use of substances such as drugs and alcohol\n- Intense changes in mood\/mood swings\n- Saying goodbye to friends and family as though for the last time\n- Feeling trapped or hopeless in one’s situation\n- Talking a lot about death, dying, and violence\n- Talking about suicide or wishing that one hadn't been born\n- Withdrawal from friends or family\n### Melancholia\nFeelings 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.\n\n### Physical Effects of Depression\nDepression can appear physically via symptoms felt in the body. Examples of [physical effects of depression](https:\/\/www.verywellmind.com\/physical-effects-of-depression-1066890) 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.\n\n### Psychomotor Changes\nNoticeable 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.\n\n## Diagnosis of Severe Depression\nGuidelines such as those found in the \"Diagnostic and Statistical Manual of Mental Disorders\" ([DSM-5](https:\/\/www.verywellmind.com\/what-is-the-dsm-5-379955)) 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.\n\n### A Lack of Standardization\nQuantitative 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.\n\nA 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.\n\n### Types of Diagnostic Tools\nResearchers have been using such scales since the 1960s. One of the first, the [Hamilton Depression Rating Scale](https:\/\/www.verywellmind.com\/phq-9-patient-healthcare-questionnaire-for-depression-4149685), 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.\n\nWhile 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.\n\nThe 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.\n\n### Most Common Depression Diagnosis Scales\nSome of the most popular scales used to help clinicians diagnose depression include:\n\n- [Beck Depression Inventory (BDI-II)](https:\/\/www.verywellmind.com\/what-is-the-beck-depression-inventory-5294126)\n- Carroll Rating Scale (CRS)\n- Center for Epidemiological Studies Depression (CES-D)\n- [Children’s Depression Inventory](https:\/\/www.verywellmind.com\/the-childrens-depression-inventory-cdi-1066780) (CDI)\n- Clinically Useful Depression Outcome Scale (CUDOS)\n- [Depression Anxiety Stress Scale (DASS-21)](https:\/\/www.verywellmind.com\/dass-21-depression-anxiety-scale-8697715)\n- Geriatric Depression Scale (GDS)\n- Major Depression Inventory (MDI)\n- Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9\n- Plutchik-Van Praag Self-Report Depression Scale (PVP)\n- Quick Inventory of Depressive Symptomatology (QIDS)\n- Rome Depression Inventory (RDI)\n- Zung Self-Rating Depression Scales (SDS)\n\nSome 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.\n\nThe [PHQ](https:\/\/www.verywellmind.com\/phq-9-patient-healthcare-questionnaire-for-depression-4149685), for example, is [available for free online](https:\/\/www.apa.org\/pi\/about\/publications\/caregivers\/practice-settings\/assessment\/tools\/patient-health) and in over 30 languages. It can be downloaded as a PDF or accessed as an interactive quiz on several reputable mental health websites.\n\n## Treatment for Severe Depression\nFortunately, 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.\n\n### Psychotherapy\nAlso referred to as talk therapy, [psychotherapy](https:\/\/www.verywellmind.com\/psychotherapy-4157172) can often help ease depressive disorder symptoms. Different types of psychotherapy include:\n\n- **[Cognitive behavioral therapy](https:\/\/www.verywellmind.com\/what-is-cognitive-behavior-therapy-2795747) (CBT)**: This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression.\n- **[Interpersonal therapy](https:\/\/www.verywellmind.com\/interpersonal-therapy-1067404) (IPT)**: This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health.\n- [**Psychodynamic therapy**](https:\/\/www.verywellmind.com\/psychodynamic-therapy-for-depression-5085728): This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed.\n\nMany clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the [American Psychological Association's site](https:\/\/locator.apa.org\/) 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.\n\n### Medication\nMedication is frequently prescribed to treat severe depression. The most common type of medication used is [selective serotonin reuptake inhibitors](https:\/\/www.verywellmind.com\/list-of-ssris-380594) (SSRIs).  This includes antidepressants such as [Prozac](https:\/\/www.verywellmind.com\/how-is-prozac-used-to-treat-social-anxiety-disorder-3024962) (fluoxetine), [Zoloft](https:\/\/www.verywellmind.com\/zoloft-sertraline-2584329) (sertraline), and [Paxil](https:\/\/www.verywellmind.com\/paxil-paroxetine-2584337) (paroxetine).\n\nOther medications used to treat depression include:\n\n- Norepinephrine-dopamine reuptake inhibitors (NDRIs)\n- [Tricyclic antidepressants](https:\/\/www.verywellmind.com\/tricyclic-antidepressants-379652) (TCAs)\n- [Monoamine oxidase inhibitors](https:\/\/www.verywellmind.com\/monoamine-oxidase-inhibitors-maois-2584303) (MAOIs)\n### Brain Stimulation Therapy\nIf 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:\n\n- [Electroconvulsive therapy](https:\/\/www.verywellmind.com\/electroconvulsive-therapy-2795172) (ECT)\n- [Transcranial magnetic stimulation](https:\/\/www.verywellmind.com\/transcranial-magnetic-stimulations-vs-ect-380646) (TMS)\n- Vagus nerve stimulation (VNS)\n### Inpatient Depression Treatment\nIn some cases, inpatient treatment may be recommended for severe depression. Being [hospitalized for depression](https:\/\/www.verywellmind.com\/what-happens-when-you-are-hospitalized-for-depression-1067262) doesn't mean that you're weak. It simply means that your treatment may be more effective in a more controlled environment.\n\nGetting 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.\n\n### Complementary Treatments\nThere 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.\n\nThe Cleveland Clinic shares that some of the remedies that have been found to help are:\n\n- [Acupuncture](https:\/\/www.verywellmind.com\/alternative-therapies-types-and-uses-5207962)\n- Massage\n- [Guided relaxation](https:\/\/www.verywellmind.com\/use-guided-imagery-for-relaxation-3144606)\n- [Meditation](https:\/\/www.verywellmind.com\/mindfulness-meditation-88369)\n- [Yoga](https:\/\/www.verywellmind.com\/how-yoga-can-help-reduce-stress-3567211)\n\nYour 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.\n\nIt 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.\n\n## Coping With Severe Depression\nYou 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:\n\n- [Creating a support network](https:\/\/www.verywellmind.com\/social-support-for-psychological-health-4119970) of caring people\n- Eating well\n- Getting enough sleep\n- Exercising regularly\n- Avoiding drugs and alcohol\n\nSuch lifestyle changes can improve your mood and overall health and well-being.\n\nWhen 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.","meta_canonical":null,"ml_categories_json":"{\"\/Health\":996,\"\/Health\/Mental_Health\":991,\"\/Health\/Mental_Health\/Depression\":990}","ml_types_json":"{\"\/Article\":999,\"\/Article\/Tutorial_or_Guide\":506}","ml_intent_types_json":"{\"Informational\":999}","meta_language":"en","attrs_author":null,"attrs_publish_time":0,"attrs_original_publish_time":1517868277,"attrs_is_republished":0,"attrs_nr_words":"2857","attrs_boilerpipe_nr_words":"1868","body_ext_links_number":43,"body_int_links_number":105,"meta_nofollow":0,"meta_noarchive":1,"props_was_rendered":0,"src_redirect":"","download_time_msec":298,"download_ttfb_msec":217,"download_size":60893}

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What Are the Signs That You Are Severely Depressed?

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Being severely depressed can lead to serious symptoms including psychosis and suicidal thinking. Learn the signs of severe depression and treatments that can help.

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Key Takeaways Severe depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts. Treatments like therapy, medication, and lifestyle changes can help manage severe depression. Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 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 . Severe depression is often characterized by symptoms of hopelessness, increased irritability , loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression. The severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition. 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 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 Mild depression can 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 depression causes chronic symptoms and usually requires at least one form of treatment , if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration. 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. Symptoms of Severe Depression 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 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. 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) Depression Anxiety Stress Scale (DASS-21) 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 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, psychotherapy can often help ease depressive disorder symptoms. Different types of psychotherapy include: Cognitive behavioral therapy (CBT) : This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression. Interpersonal therapy (IPT) : This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health. Psychodynamic therapy : This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed. Many clinicians offer several types of therapies. You can ask your healthcare 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: Norepinephrine-dopamine reuptake inhibitors (NDRIs) Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) 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: Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS) Vagus nerve stimulation (VNS) 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: Acupuncture Massage Guided relaxation Meditation Yoga 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: Creating a support network of caring people Eating well Getting enough sleep Exercising regularly Avoiding drugs and alcohol 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.

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Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Ⓒ 2026 People Inc. — All rights reserved # Symptoms of Severe Depression By [Nancy Schimelpfening](https://www.verywellmind.com/nancy-schimelpfening-ms-4781235) [Nancy Schimelpfening](https://www.verywellmind.com/nancy-schimelpfening-ms-4781235) Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our [editorial process](https://www.verywellmind.com/our-editorial-process-4778006) Updated on October 26, 2025 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. [Learn more](https://www.verywellmind.com/review-board-4796494). by [Daniel B. Block, MD](https://www.verywellmind.com/daniel-block-md-4779186) ![Block]() ![Block](https://www.verywellmind.com/thmb/bqppKq4IVUTVsPMClzJADd5fs14=/200x200/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/block-8924ca72ff94426d940e8f7e639e3942.jpg) Medically reviewed by [Daniel B. Block, MD](https://www.verywellmind.com/daniel-block-md-4779186) Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our [Medical Review Board](https://www.verywellmind.com/review-board-4796494) ![Severe Depression](https://www.verywellmind.com/thmb/KByU_En6FVDWtg-JyXz9Zi5o5D4=/1500x0/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/severe-depression-56af379d3df78cf772c1aa84.jpg) ![Severe Depression](https://www.verywellmind.com/thmb/KByU_En6FVDWtg-JyXz9Zi5o5D4=/1500x0/filters:no_upscale\(\):max_bytes\(150000\):strip_icc\(\)/severe-depression-56af379d3df78cf772c1aa84.jpg) Jamie Larsen / EyeEm / Getty Images Table of Contents View All Table of Contents - [Depression Spectrum](https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-the-depression-spectrum) - [Symptoms of Severe Depression](https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-symptoms-of-severe-depression) - [Diagnosis](https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-diagnosis-of-severe-depression) - [Treatment](https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-treatment-for-severe-depression) - [Coping](https://www.verywellmind.com/what-are-the-signs-that-you-are-severely-depressed-1066883#toc-coping-with-severe-depression) Close ### Key Takeaways - Severe depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts. - Treatments like therapy, medication, and lifestyle changes can help manage severe depression. Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the [National Suicide Prevention Lifeline](https://suicidepreventionlifeline.org/) at **988** 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](https://www.verywellmind.com/national-helpline-database-4799696). Severe depression is often characterized by symptoms of hopelessness, increased [irritability](https://www.verywellmind.com/irritability-definition-symptoms-traits-causes-treatment-5088062), loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression. The severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition. 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 several [types of depression](https://www.verywellmind.com/common-types-of-depression-1067313) and while they may share some common symptoms, each person’s experience can be different. [Symptoms of depression](https://www.verywellmind.com/what-is-clinical-depression-1067309) can occur along a spectrum both in duration and severity: ### Mild Depression [Mild depression](https://www.verywellmind.com/what-is-mild-low-grade-depression-1066956) can 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 depression](https://www.verywellmind.com/what-is-moderate-depression-5072794) causes chronic symptoms and usually requires at least one [form of treatment](https://www.verywellmind.com/treatments-for-depression-1065502), if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration. [The Best Online Therapy Services for Depression We Tried and Tested](https://www.verywellmind.com/best-online-help-for-depression-4691259) ### 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. [Depression Recovery: How to Know You're Making Progress](https://www.verywellmind.com/how-do-i-know-if-my-depression-is-getting-better-1066881) ## Symptoms of Severe Depression 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](https://www.verywellmind.com/what-is-psychosis-p2-379828) symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. [Psychotic depression](https://www.verywellmind.com/psychotic-depression-1066607) 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](https://www.verywellmind.com/suicide-warning-signs-and-risk-factors-1067525) 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. [What Is Melancholic Depression?](https://www.verywellmind.com/what-is-melancholia-379852) ### Physical Effects of Depression Depression can appear physically via symptoms felt in the body. Examples of [physical effects of depression](https://www.verywellmind.com/physical-effects-of-depression-1066890) 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. [What It Means to Have Clinical Depression](https://www.verywellmind.com/clinical-depression-symptoms-types-and-treatments-8713946) ### 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](https://www.verywellmind.com/what-is-the-dsm-5-379955)) 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](https://www.verywellmind.com/phq-9-patient-healthcare-questionnaire-for-depression-4149685), 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)](https://www.verywellmind.com/what-is-the-beck-depression-inventory-5294126) - Carroll Rating Scale (CRS) - Center for Epidemiological Studies Depression (CES-D) - [Children’s Depression Inventory](https://www.verywellmind.com/the-childrens-depression-inventory-cdi-1066780) (CDI) - Clinically Useful Depression Outcome Scale (CUDOS) - [Depression Anxiety Stress Scale (DASS-21)](https://www.verywellmind.com/dass-21-depression-anxiety-scale-8697715) - 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](https://www.verywellmind.com/phq-9-patient-healthcare-questionnaire-for-depression-4149685), for example, is [available for free online](https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health) 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 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, [psychotherapy](https://www.verywellmind.com/psychotherapy-4157172) can often help ease depressive disorder symptoms. Different types of psychotherapy include: - **[Cognitive behavioral therapy](https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747) (CBT)**: This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression. - **[Interpersonal therapy](https://www.verywellmind.com/interpersonal-therapy-1067404) (IPT)**: This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health. - [**Psychodynamic therapy**](https://www.verywellmind.com/psychodynamic-therapy-for-depression-5085728): This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed. Many clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the [American Psychological Association's site](https://locator.apa.org/) 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. [The Best Online Therapy Programs](https://www.verywellmind.com/best-online-therapy-4691206) We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. ### Medication Medication is frequently prescribed to treat severe depression. The most common type of medication used is [selective serotonin reuptake inhibitors](https://www.verywellmind.com/list-of-ssris-380594) (SSRIs). This includes antidepressants such as [Prozac](https://www.verywellmind.com/how-is-prozac-used-to-treat-social-anxiety-disorder-3024962) (fluoxetine), [Zoloft](https://www.verywellmind.com/zoloft-sertraline-2584329) (sertraline), and [Paxil](https://www.verywellmind.com/paxil-paroxetine-2584337) (paroxetine). Other medications used to treat depression include: - Norepinephrine-dopamine reuptake inhibitors (NDRIs) - [Tricyclic antidepressants](https://www.verywellmind.com/tricyclic-antidepressants-379652) (TCAs) - [Monoamine oxidase inhibitors](https://www.verywellmind.com/monoamine-oxidase-inhibitors-maois-2584303) (MAOIs) [The Best Online Psychiatry Services, According to a Therapist](https://www.verywellmind.com/best-online-psychiatrists-5119854) ### 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: - [Electroconvulsive therapy](https://www.verywellmind.com/electroconvulsive-therapy-2795172) (ECT) - [Transcranial magnetic stimulation](https://www.verywellmind.com/transcranial-magnetic-stimulations-vs-ect-380646) (TMS) - Vagus nerve stimulation (VNS) ### Inpatient Depression Treatment In some cases, inpatient treatment may be recommended for severe depression. Being [hospitalized for depression](https://www.verywellmind.com/what-happens-when-you-are-hospitalized-for-depression-1067262) 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: - [Acupuncture](https://www.verywellmind.com/alternative-therapies-types-and-uses-5207962) - Massage - [Guided relaxation](https://www.verywellmind.com/use-guided-imagery-for-relaxation-3144606) - [Meditation](https://www.verywellmind.com/mindfulness-meditation-88369) - [Yoga](https://www.verywellmind.com/how-yoga-can-help-reduce-stress-3567211) 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: - [Creating a support network](https://www.verywellmind.com/social-support-for-psychological-health-4119970) of caring people - Eating well - Getting enough sleep - Exercising regularly - Avoiding drugs and alcohol 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. Read more: - [Conditions A-Z](https://www.verywellmind.com/conditions-a-z-4797402) - [Depression](https://www.verywellmind.com/depression-4157261) - [Symptoms and Diagnosis](https://www.verywellmind.com/depression-symptoms-and-diagnosis-4157260) 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our [editorial process](https://www.verywellmind.com/our-editorial-process-4778006) to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. 1. National Institute of Mental Health. [Depression](https://www.nimh.nih.gov/health/topics/depression/index.shtml). Nimh.nih.gov. Updated February 2018. 2. 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](https://doi.org/10.1001/jama.2009.1943). *JAMA*. 2010 Jan 6;303(1):47-53. doi:10.1001/jama.2009.1943 3. American Psychiatric Association. [*Diagnostic and Statistical Manual of Mental Disorders (DSM-5)*](https://doi.org/10.1176/appi.books.9780890425596). 2013. doi:10.1176/appi.books.9780890425596 4. NHS Choices. [Psychotic depression](https://www.nhs.uk/conditions/clinical-depression/psychotic-depression/). Updated December 10, 2019. 5. National Institute of Mental Health. [Suicide warning signs](https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide/index.shtml). 6. Parker G, Fink M, Shorter E, et al. [Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733615/). *Am J Psychiatry*. 2010;167(7):745-747. doi:10.1176/appi/ajp.2010.09101525 7. Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. [Psychomotor retardation in depression: A systematic review of diagnostic, pathophysiologic, and therapeutic implications](https://doi.org/10.1155/2013/158746). *Biomed Res Int*. 2013;2013. doi:10.1155/2013/158746 8. Gautam S, Jain A, Gautam M, et al. [Clinical practice guidelines for the management of depression](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310101/). *Indian J Psychiatry*. 2017;59(Suppl 1):S34-S50. doi:10.4103/0019-5545.196973 9. National Alliance on Mental Illness. [Depression](https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Treatment). Updated August 2017. 10. Cleveland Clinic. [Alternative therapies for depression](https://my.clevelandclinic.org/health/treatments/9303-depression-alternative-therapies). Published 2014. Additional Reading - Kriston L, von Wolff A. [Not as golden as standards should be: Interpretation of the Hamilton Rating Scale for Depression](https://doi.org/10.1016/j.jad.2010.07.011). *Journal of Affective Disorders*. 2011;128(1-2):175-177. doi:10.1016/j.jad.2010.07.011 - Zimmerman M. [Medscape education psychiatry & mental health. Tools for depression: standardized rating scales](https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUub3JnL3ZpZXdhcnRpY2xlLzc0OTkyMQ==&ac=401). Medscape. Published September 21, 2011. By [Nancy Schimelpfening](https://www.verywellmind.com/nancy-schimelpfening-ms-4781235) Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. 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### Key Takeaways - Severe depression can cause symptoms like extreme sadness, psychosis, and suicidal thoughts. - Treatments like therapy, medication, and lifestyle changes can help manage severe depression. Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the [National Suicide Prevention Lifeline](https://suicidepreventionlifeline.org/) at **988** 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](https://www.verywellmind.com/national-helpline-database-4799696). Severe depression is often characterized by symptoms of hopelessness, increased [irritability](https://www.verywellmind.com/irritability-definition-symptoms-traits-causes-treatment-5088062), loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn't a formal mental health diagnosis. Instead, it refers to more debilitating depression. The severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition. 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 several [types of depression](https://www.verywellmind.com/common-types-of-depression-1067313) and while they may share some common symptoms, each person’s experience can be different. [Symptoms of depression](https://www.verywellmind.com/what-is-clinical-depression-1067309) can occur along a spectrum both in duration and severity: ### Mild Depression [Mild depression](https://www.verywellmind.com/what-is-mild-low-grade-depression-1066956) can 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 depression](https://www.verywellmind.com/what-is-moderate-depression-5072794) causes chronic symptoms and usually requires at least one [form of treatment](https://www.verywellmind.com/treatments-for-depression-1065502), if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration. ### 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. ## Symptoms of Severe Depression 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](https://www.verywellmind.com/what-is-psychosis-p2-379828) symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. [Psychotic depression](https://www.verywellmind.com/psychotic-depression-1066607) 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](https://www.verywellmind.com/suicide-warning-signs-and-risk-factors-1067525) 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](https://www.verywellmind.com/physical-effects-of-depression-1066890) 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 of Severe Depression Guidelines such as those found in the "Diagnostic and Statistical Manual of Mental Disorders" ([DSM-5](https://www.verywellmind.com/what-is-the-dsm-5-379955)) 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](https://www.verywellmind.com/phq-9-patient-healthcare-questionnaire-for-depression-4149685), 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)](https://www.verywellmind.com/what-is-the-beck-depression-inventory-5294126) - Carroll Rating Scale (CRS) - Center for Epidemiological Studies Depression (CES-D) - [Children’s Depression Inventory](https://www.verywellmind.com/the-childrens-depression-inventory-cdi-1066780) (CDI) - Clinically Useful Depression Outcome Scale (CUDOS) - [Depression Anxiety Stress Scale (DASS-21)](https://www.verywellmind.com/dass-21-depression-anxiety-scale-8697715) - 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](https://www.verywellmind.com/phq-9-patient-healthcare-questionnaire-for-depression-4149685), for example, is [available for free online](https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health) 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 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, [psychotherapy](https://www.verywellmind.com/psychotherapy-4157172) can often help ease depressive disorder symptoms. Different types of psychotherapy include: - **[Cognitive behavioral therapy](https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747) (CBT)**: This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression. - **[Interpersonal therapy](https://www.verywellmind.com/interpersonal-therapy-1067404) (IPT)**: This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health. - [**Psychodynamic therapy**](https://www.verywellmind.com/psychodynamic-therapy-for-depression-5085728): This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed. Many clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the [American Psychological Association's site](https://locator.apa.org/) 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](https://www.verywellmind.com/list-of-ssris-380594) (SSRIs). This includes antidepressants such as [Prozac](https://www.verywellmind.com/how-is-prozac-used-to-treat-social-anxiety-disorder-3024962) (fluoxetine), [Zoloft](https://www.verywellmind.com/zoloft-sertraline-2584329) (sertraline), and [Paxil](https://www.verywellmind.com/paxil-paroxetine-2584337) (paroxetine). Other medications used to treat depression include: - Norepinephrine-dopamine reuptake inhibitors (NDRIs) - [Tricyclic antidepressants](https://www.verywellmind.com/tricyclic-antidepressants-379652) (TCAs) - [Monoamine oxidase inhibitors](https://www.verywellmind.com/monoamine-oxidase-inhibitors-maois-2584303) (MAOIs) ### 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: - [Electroconvulsive therapy](https://www.verywellmind.com/electroconvulsive-therapy-2795172) (ECT) - [Transcranial magnetic stimulation](https://www.verywellmind.com/transcranial-magnetic-stimulations-vs-ect-380646) (TMS) - Vagus nerve stimulation (VNS) ### Inpatient Depression Treatment In some cases, inpatient treatment may be recommended for severe depression. Being [hospitalized for depression](https://www.verywellmind.com/what-happens-when-you-are-hospitalized-for-depression-1067262) 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: - [Acupuncture](https://www.verywellmind.com/alternative-therapies-types-and-uses-5207962) - Massage - [Guided relaxation](https://www.verywellmind.com/use-guided-imagery-for-relaxation-3144606) - [Meditation](https://www.verywellmind.com/mindfulness-meditation-88369) - [Yoga](https://www.verywellmind.com/how-yoga-can-help-reduce-stress-3567211) 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: - [Creating a support network](https://www.verywellmind.com/social-support-for-psychological-health-4119970) of caring people - Eating well - Getting enough sleep - Exercising regularly - Avoiding drugs and alcohol 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.

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