Signs and Symptoms of Severe Depression: What to Know, and When to Get Help

We’ve all felt down at some point in our lives. In our society, people often use the word “depressed” to describe feeling extreme sadness or having “a case of the blues.” But major depressive disorder is much more than feeling sad or having a low mood. 

In the U.S., major depression is one of the most common mental health conditions. This mood disorder can lead to chronic sadness, hopelessness, and loss of interest in daily activities and hobbies. If you have severe depression (or “deep” depression), it can significantly disrupt your day-to-day functioning and overall quality of life.

What are the symptoms of severe depression?

Severe depression is just major depression — but with more severe symptoms.

The basic symptoms of major depression are: 

• Low mood, which can include feelings of emptiness or sadness that last for more than 2 weeks

• Significant changes to your eating patterns or weight

• Getting too little or too much sleep 

• Restlessness, or feeling as if you're moving slowly

• Feelings of worthlessness or guilt

• Low energy or fatigue

• Difficulty concentrating 

• Loss of pleasure or interest in daily activities

• Recurring thoughts of death or suicide 

To be diagnosed with major depression, you need to have at least 5 of these symptoms for at least 2 weeks. And just like many other health conditions, major depression can be classified as mild, moderate, or severe. 

EXPERT PICKS: WHAT TO READ NEXT

• How is major depressive disorder treated? Here’s what you need to know about treatment options for depression, including medications, therapy, and home remedies. 

• What’s it like to have major depressive disorder? Three people with clinical depression share their journeys, including the lessons they’ve learned along the way. 

• What’s it like to take fluoxetine (Prozac) for depression? Three people who take fluoxetine for depression share their personal experiences.

Compared with mild or moderate depression, people with severe depression have: 

• An excessive number of symptoms. When you have severe depression, you have many more symptoms than the five minimum needed for a depression diagnosis. This means you might have seven, eight, or even all of the symptoms listed above. 

• Especially intense symptoms. In severe depression, your symptoms are extremely distressing and hard to manage. 

• Symptoms that have a major impact on daily life. To be diagnosed with severe depression, your symptoms must also significantly affect your life. For example, you might struggle to function at home, work, or school. Or you might have trouble maintaining relationships or taking care of your personal hygiene. 

In some cases, people with severe depression also experience physical symptoms such as headaches or body pain. 

What causes severe depression?

There isn’t one single cause of severe depression. Researchers have identified several factors that may play a role. These include: 

• Trauma and stressful life events

• Substance use 

• Bereavement

• Sleep disorders

• Family history of depression

• Medical conditions that cause chronic illness

What’s the best way to treat severe depression?

Depression is treatable, even when your symptoms are severe. Recognizing the signs can help you seek help before a crisis. Here are some steps you can take to start feeling better. 

Seek professional help

The best treatment for most people with severe depression is antidepressants plus therapy. 

That’s why it’s important to check in with a healthcare professional or psychiatrist if you’re concerned about severe depression. They can assess your symptoms to determine if medication or other approaches might help you. 

There are many types of therapy that can be beneficial, including: 

• Cognitive behavioral therapy (CBT)

• Interpersonal therapy

• Mindfulness-based cognitive therapy (MBCT)

In addition to medication and therapy, treatment options that may help severe depression include:

• Transcranial magnetic stimulation (TMS)

• Electroconvulsive therapy (ECT)

• Esketamine (Spravato), a nasal spray similar to ketamine

Know your personal warning signs

Everyone experiences depression in their own way. Take note of your symptoms and what depression looks like for you. Knowing how you experience depression can help you communicate when you need help. 

Don’t forget self-care

Severe depression can affect your eating habits, sleep schedule, and daily self-care routines. If you can, eat regular meals. Stick to a consistent sleep schedule. Keeping an eye on basic self-care when possible can make a significant difference in how you feel. 

Start small

It can be hard to muster up the energy or motivation to do even the smallest tasks when you’re in the midst of depression. But doing activities that are easy and bring you pleasure can improve your mood. This is a strategy known as behavioral activation. 

Here’s an example of how to put this strategy into action. Say you’re having trouble getting exercise because it’s difficult to get out of bed. Your goal may be to go for a 15-minute walk. But start with smaller steps and build up to it:

1. Get out of bed and walk to a different room in the house. 

2. Walk outside and spend 5 minutes sitting outside your house.

3. Walk to the end of your driveway and back.

4. Go for a 5-minute walk.

5. Go for a 10-minute walk.

6. Go for a 15-minute walk.

Connect with your loved ones

Depression often leads to isolation. Stay in contact with friends and loved ones, even if it’s just to check in. This can increase feelings of social support. 

When does severe depression become an emergency?

Severe depression is an emergency any time a person’s safety and well-being is at risk. 

Here are some warning signs that you should talk to a healthcare professional as soon as possible: 

• Actively engaging in self-harm 

• Having more thoughts about death or suicide 

• Planning to or seeking ways to end your life

• Thinking about harming other people 

• Struggling to complete daily tasks, even those that feel like they should be manageable. (i.e., getting out of bed, brushing your teeth, or eating a meal might feel overwhelming)

• Using substances like drugs or alcohol to cope with or manage your symptoms 

• Experiencing auditory or visual hallucinations (psychosis) 

If you notice any of these signs, it’s important not to ignore them. Seek help immediately, especially if you’re at risk of harming yourself or others. Take action by contacting a loved one, 911, or a crisis hotline. 

If you already have a mental health professional, follow your safety plan and call them. In emergencies, call 988 or 911, or ask a loved one to help you get to the emergency room for immediate help. 

Resources and support for severe depression

If you or a loved one are experiencing severe depression, reach out for help. You can find a mental health professional by calling the National Helpline, which is run by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357). 

The SAMHSA helpline is open 24/7 and can assist with referrals for treatment. You can also visit the agency’s online Behavioral Health Treatment Services Locator to search for local treatment options. 

Other helpful resources for depression include: 

• Depression and Bipolar Support Alliance: This advocacy organization provides education and peer support. They also offer local and online support groups for people living with mood disorders. 

• National Alliance on Mental Illness (NAMI): NAMI is a national organization that provides support and education. They also offer support groups, resources, and a mental health blog. 

• Anxiety and Depression Association of America (ADAA): This online community offers virtual peer-to-peer groups. On their website, you can find free webinars, blogs, and reading recommendations. 

• American Psychological Association: This is a professional organization for psychologists that also provides information and resources on depression and other mental health conditions. 

• American Psychiatric Association: The organization’s website includes a directory to help you find a psychiatrist. 

• Crisis Text Line: The Crisis Text Line allows you to text with a crisis counselor 24/7. You can contact the text line by texting “home” to 741741.

Frequently asked questions

Why trust our experts?

Written by:

Geralyn Dexter, PhD, LMHC

Geralyn Dexter, PhD, LMHC, is an adjunct professor of psychology at Southern New Hampshire University. She is also an expert mental health writer.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Our editorial standards

Meet our experts

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the 988 Suicide & Crisis Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.