Severe Depression: Five Signs

Katelyn Hagerty

Reviewed by Katelyn Hagerty, FNP

Written by Rachel Sacks

Published 10/06/2022

Updated 10/07/2022

Everyone feels sad or down throughout their life. Sadness is a normal reaction to an emotional or upsetting situation.

But while the term depression has become commonly used, depression as a diagnosed condition is a serious but common mood disorder that can be treated.

There are even different types of depression, which can all affect your life in different ways.

Depression can typically be classified as mild depression, moderate depression or severe depression.

Below, we discuss what severe depression is, signs of severe depression to look for, what causes this type of depression and treatment for severe depression.

Severe depression — also known as clinical depression or major depression — is a type of major depressive disorder.

Major depression is defined as someone experiencing a depressed mood or loss of interest in daily activities nearly every day for at least two weeks. These symptoms generally affect your daily life.

Someone going through a depressive episode will experience specific symptoms, such as problems with sleep, concentration, energy or self-esteem.

Mental health professionals use a guide established by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine if someone is dealing with severe depression.

While criteria from the DSM-5 are used as guidelines for diagnosing depressive symptoms, there are no strict depression scales or guidelines for what constitutes mild, moderate or severe depression. 

Instead, a health care provider will assess your depressed mood and other symptoms you may have to determine if you have severe depression.

What makes a diagnosis of severe depression different from moderate or mild depression is that someone with severe depression will experience a majority of depressive symptoms laid out by the DSM-5.

The different types of depression are also classified by the severity of depression symptoms that a person experiences.

Major depression is a complex mental disorder that doesn’t have one cause. Instead, there can be a variety of factors that cause someone to develop signs of severe depression. Environmental, biological, genetic and psychological factors may all affect your risk of developing severe depression.

Some specific factors that can increase the risk of developing severe depression are:

  • Brain chemicals. Current thinking is that brain chemicals called neurotransmitters are related to depression. The levels of certain chemicals like serotonin and norepinephrine in your brain can affect your mood, thoughts, behavior and more.

  • Family history. Genetics can be a cause of depression. Your risk could increase if you have a family member who has or had depression.

  • Events in life. Feeling isolated or lonely, being stressed, lacking support or going through emotional events like the death of a loved one can all be risk factors for severe depression.

  • Medical illness. Long-term medical conditions or chronic pain can also cause depression. Those with cancer, diabetes or Parkinson’s disease often have depression.

  • Inability to cope. If you struggle to cope with stress or emotional life events, you may be more prone to depression.

Depression may be caused by one of these factors or a combination. 

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Severe depression symptoms can look different for each person, but there are signs you or your healthcare provider can look for.

Common symptoms of depression include:

  • Feeling unworthy or hopeless

  • A low or depressed mood

  • Loss of interest in typical activities

  • Tiredness or low energy (fatigue)

  • Physical symptoms like stomach aches or headaches

  • Weight gain or weight loss

  • Noticeably slower speech or movement

  • Insomnia or sleepiness during the day

  • Difficulty concentrating or making decisions

  • Thoughts of self-harm or suicide

Our guide to the symptoms of depression in women goes into more detail about what you can look for if you think you might be dealing with depression.

Severe depression can sometimes also occur with symptoms of psychosis, which is when a person experiences hallucinations or delusions.

The severity of a depressive disorder is determined by how many depressive symptoms someone is experiencing and how frequent those symptoms are. Severe depression symptoms can be similar to symptoms of mild or moderate depression, but what differentiates this particular depressive disorder is experiencing symptoms more frequently and intensely.

A 2018 study suggested that those with severe depression experience specific depression symptoms — such as feeling unworthy or guilty, experiencing a depressed mood and suicidal thoughts — more often than people with other forms of depression.

In addition, five signs may indicate a more severe depression: feelings of unworthiness, depressed mood, loss of pleasure, psychosis and suicidal thoughts.

Your healthcare provider will determine whether or not you’re dealing with severe depression, as well as help you put together a treatment plan.

Whether you have severe depression, mild depression or another type of depression, talking to a healthcare provider will help you figure out the best treatment options for you.

Typical treatments for depression include medications, therapy, changes in lifestyle or a combination of the three, depending on your symptoms and severity of depression.


Antidepressant medications are a common treatment for depression that can increase the brain chemicals (called neurotransmitters) associated with depression.

The FDA has approved several medications for treating major depression, such as:

  • Selective serotonin reuptake inhibitors (SSRIs). These medications increase the levels of serotonin in the brain and generally cause fewer side effects than other antidepressants. SSRIs used to treat severe depression include fluoxetine (Prozac®), sertraline (Zoloft®), citalopram (Celexa®), escitalopram (Lexapro®) and paroxetine (Paxil®).

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs work similarly to SSRIs but instead increase serotonin and norepinephrine. Medications prescribed for depression are venlafaxine (Effexor®), duloxetine (Cymbalta®), desvenlafaxine (Pristiq®) and levomilnacipran (Fetzima®).

  • Tricyclic antidepressants (TCAs). Tricyclic antidepressants are a class of older antidepressants typically only prescribed if SSRIs or SNRIs aren’t effective. Some examples of TCAs include amitriptyline (Elavil®), amoxapine (Asendin®) and doxepin (Sinequan®).

  • Monoamine oxidase inhibitors (MAOIs). Another class of older antidepressants, MAOIs work to block the enzyme monoamine oxidase and increase levels of serotonin, norepinephrine and dopamine in the brain.

Antidepressants can take anywhere from four to eight weeks to work, so patience is necessary if you start medication to treat severe depression.


Therapy for major depression can involve two methods: psychotherapy like cognitive-behavioral therapy (CBT) or brain stimulation therapy like electroconvulsive therapy.

Cognitive-behavioral therapy is a type of “talk therapy” that helps you identify negative thought patterns and behaviors and learn to correct them.

This type of therapy has been proven to be incredibly effective and is considered the “gold standard,” or the best type of therapy currently available, for treating depression.

However, those with severe depression who show signs of psychosis or who are suicidal may not benefit as much from cognitive-behavioral therapy alone.

For severe depression treatment with cognitive-behavioral therapy alone, you may need a therapist with a high level of experience, as one study found.

Another type of therapy that has been found effective for treating major depression is electroconvulsive therapy.

Electroconvulsive therapy (ECT) is a brain stimulation therapy most often used for people with treatment-resistant depression — depressive disorders that don’t improve with other treatments.

ECT involves brief electrical stimulation to the brain while the patient is under anesthesia, to produce changes in the areas of the brain associated with depression.

This type of therapy can also be the first line of treatment if other medications can’t be used safely.

ECT typically lasts for a few weeks, with multiple sessions per week, and may cause short-term side effects like disorientation, confusion and memory loss.

Your healthcare provider can determine if electroconvulsive therapy is the right course of treatment for you, depending on how you respond to other treatments.

Lifestyle Changes

Although medication and psychotherapy are often the recommended options for severe depression treatment, making certain lifestyle changes can help improve your mood.

Physical activity is especially effective as an all-natural treatment for depression. Start small, with activities like walking or yoga, if you’re just beginning to incorporate exercise into your routine.

Making sure you get enough rest can also be helpful when dealing with depression, as one can affect the other (or vice versa). Aim to wake up and go to sleep around the same time each day.

Staying connected with friends and family and confiding in a trusted group of peers can also provide support if you’re dealing with major depression.

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While severe depression is determined by a healthcare provider looking at how frequent and intense your depressive symptoms are, five signs may indicate you’re dealing with severe depression.

These signs of severe depression could include:

  • Psychosis (experiencing hallucinations or delusions)

  • Loss of pleasure or interest in activities

  • Depressed mood

  • Feeling unworthy

  • Suicidal thoughts

These signs are not always indicative of severe depression. However, if you’re experiencing any of the above or any of the other common symptoms of depression, a healthcare provider or mental health professional can help figure out what’s going on.

You can connect with a licensed psychiatrist through our online mental health services to discuss your symptoms and severe depression treatment that is right for you.

15 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Katelyn Hagerty, FNP

Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.

She received her undergraduate degree in nursing from the University of Delaware and her master's degree from Thomas Jefferson University. You can find Katelyn on Doximity for more information.

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