Severe Depression: What You Need to Know


Depression, in any of its manifestations, is painful. For some, however, the pain can be almost unbearable.

Severe depression is powerful. It can bring the most active, engaged individual to a halt. It can ruin sleep, wreak havoc with diets, or cause a person to behave in ways that are unexpected and unhealthy. It can leave the sufferer in a dark place, disabled, and unable to protect their own interests. Finally, the hopelessness it brings can lead to thoughts of suicide.


Depression presents with sadness, lack of interest in formerly enjoyed activities, sleep problems, irritability and appetite changes. The vast majority of people who develop depression have a mild to moderate experience which will last weeks or months.

A small percentage of those with depression have a more intense experience. Symptoms can include:

  • Sadness that becomes despair or hopelessness;
  • Slowed or confused thinking, inability to concentrate;
  • Intense feelings of inappropriate guilt or worthlessness;
  • Impaired ability to face or meet daily responsibilities;
  • Lethargy, lack of energy
  • Major appetite changes that result in gain or loss of 5% of body weight within a month;
  • Onset of, or increased, alcohol or drug abuse;
  • Frequent thoughts about death and suicide;
  • In extreme cases, hearing voices or having hallucinations.

The risk of suicide attempts is real in these cases, and should not be discounted.

Treatment Options

A recent meta-analysis, published in the September 2015 issue of JAMA Psychiatry, endorsed the belief that cognitive-behavioral therapy and use of antidepressant medications are equally effective as first-line remedies for severe depression. This is contrary to the existing industry standard, which recommends antidepressants as the initial therapy in these cases.

Severe cases that do not respond to psychotherapy or medication might respond to electro-convulsive therapy (ECT). ECT causes a mild electric current to pass through the brain, inducing a seizure. These currents change the chemistry of the brain, quickly reversing symptoms of depression.


Severe depression does respond to treatment, or a combination of treatments, although it might take some time. Those with loved ones who suffer with severe depression should encourage them not to give up hope for relief from their symptoms.

Many who experience severe depression will find themselves relapsing at some future point. They should be made aware of this possibility so they can seek treatment at the earliest signs.

Sources:, MAD in America, and National Institute of Mental Health


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