Understanding Severe Depression & Warning Signs

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. Suchdepression 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. Suchdepression can be paralyzing. It’s important to get treatment quickly if you notice any of these warning signs.

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.

Depression can look different in teens than it does in adults. Watch for symptoms such as:

These depression symptoms may not be obvious because they often happen with medical conditions:

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.

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