Depression is a common mental health condition that ranges widely in severity. If you have a milder case, you may struggle with symptoms that include sadness, irritability, anger, and fatigue that last weeks or longer. Such depression interferes with your daily life and relationships.
But some cases of depression are more severe, with intense symptoms that may include significant appetite and weight loss, sleep problems, and frequent thoughts of death or suicide. Such depression can be paralyzing. It's important to get treatment quickly if you notice any of these warning signs.
Severe Depression Symptoms
Symptoms of severe depression include:
Trouble sleeping (insomnia). People with depression have more trouble sleeping than those without it. When you’re depressed, your worries keep you up at night. A lack of sleep could make you feel even more sad.
Sleeping too much. Sleep can be a way to escape your feelings and you might find yourself staying in bed longer than normal. Depression can also make you feel tired for no physical reason. And, people with depression are also more likely to have sleep disorders such as sleep apnea, which can cause sleepiness during the day.
Irritability. Feeling grumpy or angry is one of the main symptoms of depression in children and teens. Irritability during episodes of sadness is probably depression. On its own, irritability is more likely to be from something else, like anxiety or disruptive mood dysregulation disorder (DMDD).
Depression and irritability could have the same causes, which include genes or family history. Irritability can also lead to depression if it causes trouble in school, work, or relationships.
Loss of interest in activities that used to be enjoyable. Anhedonia is the medical term for not getting pleasure or enjoyment out of life. It’s a common symptom of depression. Scientists don’t know what causes anhedonia. It may stem from too little dopamine, the brain chemical that creates feelings of pleasure and satisfaction.
Hopelessness. Being depressed can make you feel hopeless. Losing hope leads to more episodes of depression and increases the risk for suicide. People who feel hopeless may be less likely to get treatment for depression, or they may stop going to therapy because they feel so negative.
Persistent thoughts of something bad happening. Worry is a normal emotion, but in depression, it can be excessive. When you constantly dwell on the thought that something bad is going to happen, it will make you very anxious and more depressed.
Thoughts of death or suicide or suicide attempts. Most people who are depressed never think about suicide. But feeling hopeless, worthless, and sad can make some people want to die. If you have thoughts of suicide, reach out for help right away. Call 911, or call or text the Suicide & Crisis Lifeline at 988.
Inability to take care of yourself. When you’re depressed, you may not feel like doing activities of daily living, such as eating, bathing, working, or taking care of your family.
Psychotic symptoms. Rarely, people with severe depression have psychotic episodes. Symptoms include hallucinations — seeing or hearing things that aren’t there, and delusions — having thoughts or beliefs that aren’t true.
Severe depression symptoms in teens
Depression can look different in teens than it does in adults. Watch for symptoms such as:
- Irritability and/or aggression
- Eating or sleeping too much
- Physical complaints such as headaches and stomachaches
- Threatening to run away from home
- Sensitivity to criticism or failure
- Drug or alcohol use
Severe depression physical symptoms
These depression symptoms may not be obvious because they often happen with medical conditions:
- Constipation
- Backache, stomachache, and other unexplained aches and pains
- Low sex drive
- Weight loss or gain
- Moving or speaking more slowly than usual
Risk Factors for Suicide
Not all people with risk factors will be suicidal. In addition to depression or other mental illness, risk factors for suicide include:
- Current or past history of substance abuse or suicide attempts
- Family history of suicide
- Chronic pain or serious illness
- Long-term stress such as legal problems, job loss, bullying, harassment, or discrimination
- History of abuse, violence, or other trauma in childhood or relationships
- Access to guns or other methods to attempt suicide
When Severe Depression Symptoms Are an Emergency
For people who are severely depressed, suicide is a real threat. In 2022, more than 49,000 people in the U.S. died by suicide, which equaled one suicide every 11 minutes. Some suicides go unrecognized because they're classified as accidents, drug overdoses, or shootings. Almost half of people who die by suicide have depression or another mental health condition.
Warning signs of suicide include:
- Talking about wanting to die or wanting to kill yourself
- Looking for a way to kill yourself, such as searching online for methods or buying a gun
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or in unbearable emotional or physical pain
- Talking about being a burden to others
- Increasing use of alcohol or drugs
- Acting anxious, angry, or agitated
- Behaving recklessly, like driving too fast
- Sleeping too little or too much
- Pulling away from friends, saying goodbye, or giving away belongings
Getting Help for Severe Depression Symptoms
If you’ve had symptoms of depression almost every day for 2 weeks or more, talk to your primary care doctor, or a mental health provider such as a psychiatrist or therapist. If your symptoms are severe, you should reach out sooner. Once you get a diagnosis, you can start treatment to relieve your symptoms.
Treatment for severe depression usually involves taking antidepressant medication. You may also need talk therapy to change the thoughts that are causing you distress.
Antidepressants take 4 to 8 weeks to start working. In the meantime, your doctor can add another type of medicine, such as an antipsychotic or anti-seizure drug, to relieve your symptoms faster.
Dealing with suicidal thoughts
Often, suicidal behavior is impulsive. Remove any weapons, medications, or other things you might use to harm yourself from your home. Ask a trusted person to keep any guns or other weapons away from you. Put extra pills into a bag filled with cat litter or dirt and throw out the whole package. By getting rid of harmful items, you may buy enough time to overcome a suicidal impulse and consider other ways to deal with your pain.
Avoid using alcohol or illegal drugs, or get treatment to break your dependence on these substances. They can worsen your depression and lead to thoughts of suicide. Among people who died by suicide, 22% had alcohol in their blood and 20% had opioids in their blood.
If you feel the urge to harm yourself, or if you've already taken steps to harm yourself, call 911 or go to the emergency room. Or call or text the Suicide & Crisis Lifeline anytime at 988. You may need to stay in a hospital for supervised treatment to reduce the risk of suicide.
Takeaways
Severe depression causes symptoms such as hopelessness, irritability, loss of interest in activities you once loved, and thoughts of death. For treatment, see your primary care doctor or a mental health provider. If you are thinking about suicide, get help right away at an emergency room or by calling the Suicide and Crisis Lifeline at 988.
Severe Depression Symptoms FAQs
What is the most severe form of depression?
Major depressive disorder is the most severe form of depression. Other names for it are major depression and clinical depression.
What happens when a person suffers from severe depression?
People with severe depression may feel worthless, guilty, irritable, and hopeless. They may have thoughts of harming themselves.
What is the strongest stage of depression?
Some researchers refer to depression in four stages that increase in severity. Stage four is the most severe stage when people have repeated episodes of severe depression that doesn’t respond well to treatment.
What is the survival rate of severe depression?
Untreated severe depression could shorten your lifespan. One study found that a diagnosis of depression cut the life expectancy by 14 years in men and by 10 years in women.
What are the symptoms of the last stage of depression?
Symptoms of major depression include:
- Feeling sad, empty, hopeless, or worthless
- Losing interest in things and activities you once enjoyed
- Eating more or less than usual
- Sleeping more or less than usual
- Slow speech and movement
- Having trouble thinking or concentrating
- Having thoughts of death or suicide
