What Are the Signs That You Are Severely Depressed?

Severe Depression
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Question: What are the signs that you are severely depressed?

Answer:  Because there is no set definition of what severe depression is, it is in a very real sense a judgment call that a doctor makes based upon his training and experience. Signs and symptoms which clinicians may consider as they assess for severe depression include:

  • Psychotic symptoms - symptoms which indicate that a person has experienced a break from reality, such as delusions and hallucinations
  • Melancholia - profound sadness and depression
  • Physical signs and symptoms - includes sleep and appetite disturbance, poor concentration and memory and loss of interest in sex
  • Psychomotor retardation - noticeable slowing of both mental and physical activity
  • Risk of suicide - strong signs of suicidality, such as talking about wanting to die or making explicit threats of killing oneself

Doctors may use guidelines such as those set forth in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases to help them assess these symptoms in a systematic way. In addition, researchers may use quantitative scales based upon the presence of symptoms in order to designate a cut off point of what will be considered severe depression for the purposes of a study. These methodologies all vary from each other, however, and there is no one set way to define what will be considered as severe depression.

If you are severely depressed and suicidal, help can be obtained by contacting:

  • Your doctor or psychotherapist
  • A suicide hotline, such as the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
  • 911 or other emergency services

If you are concerned about someone who appears to be psychotic or is danger of hurting himself, stay with the person and immediately contact 911 or the appropriate emergency number for your area.

Some of the signs that someone may be feeling severely depressed and suicidal include:

  • Talking about suicide or wishing that one hadn't been born
  • Acquiring the means to commit suicide, such as purchasing a gun or accumulating a large number of pills
  • Withdrawal from friends or family
  • Extreme changes in mood
  • Talking a lot about death, dying and violence
  • Seeming to feel hopless or trapped in one's situation
  • Using drugs or alcohol as an escape
  • Changes in eating or sleeping habits
  • Engaging in risky or self-destructive behavior
  • Getting one's affairs in order
  • Saying goodbye as if for the last time
  • Extreme agitation or anxiety

Some of the signs of psychotic depression include:

  • Agitation
  • Extreme anxiety
  • Believing that one is ill despite evidence to the contrary
  • Problems with falling asleep
  • Intellectual impairment
  • Physical immobility
  • Delusions or hallucinations


Mayo Clinic Staff.  "Depression:   Major Depressive Disorder."  Mayo Clinic.  Mayo Foundation for Medical Education and Research.  Last updated:  August 6, 2015.  Accessed:  September 4, 2015.

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

"Psychotic Depression."  WebMD.  WebMD, LLC.  Reviewed by: Joseph Goldberg, MD on August 21, 2014.  Accessed:  September 4, 2015.

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