Mild, Moderate or Severe Depression?

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Q.  Often when I read about herbal depression treatments such as St. John's wort it mentions that they are believed to be effective for mild to moderate depression.  Just what is mild, moderate or severe depression and how would I know if I am a good candidate for these non-prescription remedies?  I would love to use something more natural for my depression, but I don't want to waste time trying it if I what I really need is a prescription antidepressant.

A.  Depression can vary from person to person in how intensely the person experiences it.  Intensity can also vary over time.  Many natural treatments are recommended for people with mild to moderate depression because these are the types of cases in which they have been evaluated and shown to be effective.

There are certain diagnostic tools, such as the Beck Depression Inventory, that try to quantify the severity of depression; however, what is considered to be mild, moderate or severe is in many ways a judgment call, based upon education and clinical experience, that is made by the doctor who is evaluating the patient.  However, there are some generalizations which can be made in how doctors differentiate between levels of severity. 

People with mild to moderate depression have depression symptoms which are more than simply "feeling blue," but they do not experience the same level of disability as those with severe depression, who might need to be hospitalized in order to cope with their symptoms.

Symptoms which are typical of mild to moderate depression include:

  • Depressed mood
  • Low energy
  • Sleep difficulties
  • Anxiety
  • Changes in appetite
  • Problems with concentration
  • Low tolerance for stress
  • Irritability

Psychologist Jerry Kennard further distinguishes the difference between mild and moderate by describing mild depression as a depression in which day-to-day functioning is a struggle, but the person is rarely affected in any significant way.

  People with mild depression can get by without medication and will find that their symptoms get better in time even without treatment.

Moderate depression, he goes on to say, has a greater chance of affecting a person in his daily life.  A person with moderate depression may neglect his personal hygiene and generally look as miserable as he feels.  When a person exhibits this degree of depression, it becomes more likely that treatment with an antidepressant or perhaps psychotherapy or counseling will be necessary.

Once depression becomes severe, Kennard notes, a person basically ceases to function beyond the most basic activities.  A person with severe depression will exhibit such symptoms as:

  • More severe depressed mood
  • Slowed speech or movements
  • Agitation
  • Extreme memory and concentration problems
  • Sleeping too much or too little
  • Significant weight loss or gain
  • Strong feelings of worthlessness or guilt
  • Strong thoughts of suicide
  • Loss of interest in activities once enjoyed

In some cases, severe depression might also involve psychotic symptoms such as delusions and hallucinations.

Severe depression is, in a nutshell, depression which is more disabling and dangerous to the person who is going through it and requires prompt professional assistance in order for the person to deal with it.  Herbal remedies would not be wise in such a case when time is of the essence in order to prevent the person from harming himself and/or others.

Sources:

"Depression (Mild to Moderate).NYU Langone Medical Center.  Last reviewed:  September 2014.  NYU Langone.  Accessed:  January 29, 2015.

Kennard, Jerry.  "Mild, Moderate or Severe Depression? How to Tell the Difference."   HealthCentral. January 10, 2011.  Remedy Health Media, LLC.  Accessed:  January 29, 2015.

Pélissolo, A. "Severe depression : which concept, which criteria?" Encephale 35.Suppl 7 (Dec. 2009): S243-9.

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