Severe Depression

                Severe Depression

    Depression is a common but serious disease that ranges widely in severity. If you have a milder case, you may struggle with symptoms that include sadness, irritability, anger, and fatigue that lasts for weeks or longer. Such depression 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. Such depression can be paralyzing. You may isolate yourself and have trouble getting out of bed or leaving the house.

Types:

- Major depressive disorder

- Persistent depressive disorder 

- Bipolar disorder

- Postpartum depression 

- Premenstrual dysphoric disorder 

- Seasonal affective disorder

- Atypical depression 

Symptoms of severe depression:

• Persistent thoughts of something bad happening
• Thoughts of death or suicide or suicide attempts

• Insomnia or excessive sleeping
• Irritability
• Loss of interest in activities that used to be enjoyable
• Hopelessness
• In very severe cases, psychotic symptoms 
• (hallucinations or delusions)
• • Inability to take care of oneself, such as eating, bathing, or fulfilling family or work responsibilities

  Risk Factors for Suicide

  Not all people with risk factors will be suicidal. In addition to depression or other mental illness, risk factors for suicide include:

  • Current or past history of substance abuse
  • Past history of suicide attempt
  • Family history of suicide
  • Family history of mental illness or substance abuse
  • Firearms in the home
  • Incarceration
  • Feelings of hopelessness

  Suicidal Thoughts: An Emergency

  For people who are severely depressed, suicide is a real threat. Each year, about 30,000 people in the U.S. take their own lives, although the true number may be higher. Some suicides go unrecognized because they're classified as accidents, drug overdoses, or shootings. Among people whose depression remains untreated, up to 15% will kill themselves.

  What are the warning signs of suicide? According to the National Suicide Prevention Lifeline, they include:

  • Talking about wanting to die or wanting to kill yourself
  • Looking for a way to kill yourself, such as searching online for methods or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

Diagnosing Severe Depression

  Guidelines such as those found in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases (ICD) helps doctors and mental health professionals systematically assess a person's symptoms. These criteria can be changed and are periodically updated when new research findings become available.

   Quantitative scales help researchers measure and organize symptoms, as well as designate a “cutoff point” for what’s considered “severe depression” for the purpose of a specific study. However, methodologies vary between studies and researchers, meaning there isn’t a single definition of severe depression across the board. 

    Researchers have been using such scales since the 1960s. One of the first, the Hamilton Depression Rating Scale is still sometimes used today. However, in current clinical practice, there are many more scales available that are better suited for doctors to use with patients. There are even scales patients can use on their own to track or self-report depression symptoms. 

  While scales can offer key insights, they tend to

 be quiet different from one another. The way 

they are administered, the questions they ask,

 and the way the answers are interpreted may 

not be the same from one scale to the next. 

  A lack of standardization means that if a person’s depression symptoms are assessed with different scales by different providers, the diagnosis may not be consistent. Some providers don’t use them in clinical practice unless a patient is taking medications, whereas others use them regularly. 

    The inconsistencies of the tools, their use, and interpretation can make it challenging to determine the severity of someone’s depression, as different scales may provide different (even conflicting) results.  

Some of the most popular depression scales include:

• Carroll Rating Scale (CRS)
• Geriatric Depression Scale (GDS)
• Major Depression Inventory (MDI)
• Rome Depression Inventory (RDI)
• Beck Depression Inventory (BDI-II)
• Zung Self-Rating Depression Scales (SDS)
• Clinically Useful Depression Outcome Scale (CUDOS)
• Quick Inventory of Depressive Symptomatology (QIDS)
• Plutchik-Van Praag Self-Report Depression Scale (PVP)
• Center for Epidemiological Studies Depression (CES-D)
• Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9 

Self- treatment:

 Major depression is a medical condition that is best treated by a health professional. Getting physical exercise, reducing alcohol intake, avoiding substance abuse, and engaging with friends and family may also help. 

Seeking medical care

Seek emergency help if you

Have suicidal thoughts

Might harm yourself or others

Make an appointment to see a doctor if you

Feel depressed.

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