Signs of Severe Depression to Be Aware Of

Would you know depression if you felt its symptoms?

What if your friend started showing signs? 

Depression is not an invisible illness, but it becomes one when we don’t know the signs and symptoms to watch for. And while you may think you know what the early warning signs and physical signs of depression are, it turns out, you may be likely to miss a few important ones.

Nearly 50% of people surveyed by the GeneSight® Mental Health Monitor said they were “very confident” that they could and would recognize the signs of depression in a loved one. But just 1 in 7  people could correctly identify all the possible signs and symptoms of depression. 

Missing a symptom of depression is serious, and it can have devastating effects on the person who may not recognize their symptoms. In addition, any form of untreated mood disorder or mental illness can affect the people around them. 

Untreated depression and mental disorders will only get worse. Untreated depression is deadly depression. Knowing the signs (and how they change based on factors like age and gender identity) is vital to being mentally and physically healthy and maintaining healthy relationships – even in the midst of a depressive episode. 

Signs of depression

There are many signs of depression.

Some signs of depression show up in the way a person is acting or behaving but other times the signs may be largely internal or taking place within the person’s body and mind. 

Other signs may not happen at all because every person experiences depression differently. That’s why it’s really best to view the signs and symptoms of depression as existing on a scale (extremes on either end and a healthy, happy balance in the middle).

Common warning signs of depression

Each of these signs are normal feelings and sensations people experience from time to time, but when any of the below symptoms persist for about two weeks, or progress from moderate depression to severe depression or manic depression, it’s cause for concern.

Feeling fatigued 

You may feel as though you just don’t have the same energy, motivation, or “oomphf” you used to and don’t really know why. 

Feeling fatigued also means feeling:

• Drained
• Drowsy 
• Tired
• Burned out
• Lethargic
• Like your sleep is not restful 

There is also a connection between depression and chronic fatigue syndrome that may be influencing your overall energy levels, too. Sometimes chronic fatigue syndrome is even misdiagnosed as depression because the two are so commonly characterized by feeling drained. 

Feeling heavy or weighed down

You may feel as though your ankles have anchors attached to them or that your limbs are filled with lead. Maybe it feels like the weight of the world is on your shoulders. 

These physical sensations can also play into how fatigued you feel. 

Being weighed down slows you down even when your mind wants you to move or work or talk more quickly. This internal vs. external battle between body and mind can be exhausting and anguishing.

For some, this feeling leaves them rather sloth-like and can make getting things done (even everyday things like showering) very difficult. 

Losing motivation or passion

While this can certainly happen even when you don’t have depression, it’s different when the cause is a clinical disorder. 

When depression steals your motivation or passion, some people can actually feel it leaving their body. Some people wake up and what was a thriving mission yesterday now seems like a waste of time and a waste of increasingly limited energy. 

Negative thinking patterns may also spike and tell you the things you’re working towards are pointless, impossible, or impractical. It’s like you have someone doubting your every move.

Helplessness and hopelessness

Having clinical depression or a persistent depressive disorder (depression that keeps coming back despite treatment) can make a person feel helpless and hopeless. It can feel as though nothing they do is good enough and that they’re beyond being helped. This is what severe depression feels like. 

Along with these feelings often come feelings of being a burden to others and wanting to pretend like everything is okay since you feel no one can help you anyway. It can start to feel like since you can’t help yourself (helplessness) you shouldn’t bother letting anyone else try because it won’t work anyway (hopelessness).

No matter how bad depression becomes, you are never beyond help. Different treatment options exist for different types of depression and mental health conditions, and different levels of depression severity and resistance will be affected by treatments like typical antidepressants. 

Anger and irritability

People don’t think about anger as a symptom of depression, and that’s a real problem. It can be a significant issue standing in the way of a loved one recognizing signs of depression in men, especially. 

Anger can look like and manifest itself in the following ways. These are the signs of anger to watch for:

• Getting frustrated more easily
• Keeping others at an emotional distance
• Yelling, intimidating, threatening
• Muttering insults and being more critical of everyone and everything
• Feeling rage and not knowing why 
• Crying
• Slamming doors and hitting or punching, kicking, and biting
• Self harm

Irritability can look a lot like anger and also anxiety – both of which can also spike around a woman’s menstrual cycle. Irritability is often overlooked as a sign of depression but can actually be one of the first signals something is wrong. 

Body pains that can’t be otherwise explained

If you have new body pains or physical symptoms that aren’t better explained by another diagnosis, it could be a sign of depression. It can be particularly difficult to tell if your pain is from depression or some of the other common causes like stress, trauma, injury, chronic pain, bad posture, poor sleep or bed position, arthritis, or simply from being tense and working seated in an office. 

Put your body pain into perspective with your lifestyle and see about making some adjustments like gentle stretching and increasing your overall movement, posture, etc.

Noticeable sleep changes

Some people with depression will sleep much more during depressive episodes, others may not. Your sleep health is made up of so many contributing factors that it can be rather difficult to say for sure if depression is causing sleep issues or if sleep issues are contributing to depression and, truth be told, it’s almost always a combination of both because humans are complex like that!

Pay attention to:

• Hitting the alarm more than usual, setting multiple alarms, sleeping through alarms (trying to sleep in as much as possible) 
• Thinking too much to fall asleep, becoming anxious about bedtime because you just lay there
• Tossing and turning feeling guilty or worrying 
• Not sleeping as much as you used to
• Increased use of sleep aids
• Increased substance abuse, or use of drugs or alcohol to help you fall asleep (pass out)

Concentration issues 

Depression can get so bad that a person starts struggling to focus and be present enough to actually read, write, or even string sentences together. 

This can create school and work-related issues as well as severe distress for the person experiencing it. If you’ve noticed a change (or even if you just don’t seem to want to put the effort into reading books or watching movies anymore, for example), it’s either a sign of moderate to severe depression or another condition that needs treatment. 

Passive or active suicidal thinking 

Passive suicidal thinking can be explained as intrusive thoughts that involuntarily pop into someone’s head, saying things in first person (“I” statements) or second person (“You” statements) that can be extremely upsetting. 

These thoughts can occur at any time and passive suicidal thinking can happen to anyone with depression – even people who are being treated for depression. 

If passive suicidal thoughts are returning after being in remission for some time, talk to your treatment provider. There are ever-increasing options to help you reach remission again.

Take thoughts of suicide seriously. Depression is a major risk factor for suicide. 

Active suicidal thinking is a medical emergency. It means there is a plan in place. If you are experiencing these dangerous symptoms of depression, reach out for immediate help (drop everything) and fight through the feelings with the support of people at The National Suicide Prevention Lifeline. 

Ask a mental health professional: Is it depression, bipolar disorder, a major depressive disorder?

Only you and your mental health care provider can determine whether or not you’re experiencing bipolar disorder or if this is just what depression feels like when you come out of it. 

Bipolar disorder is depression plus mania. That’s why it’s also called manic depression or manic depressive disorder. When you have bipolar disorder, you can experience periods of depression and periods of mania but some people may be more prone to the depression side of bipolar disorder or to the mania side of bipolar disorder. 

Bipolar stereotypes make it seem like people swing from one extreme to the next, when really, mania can be a lot less dramatic and even so mild that it goes unnoticed. Experiencing any level of mania after depression can also feel like such a gift that the person doesn’t dare question it.

Signs of mania in bipolar disorder

• Heightened energy
• Increased feelings of creativity 
• Euphoria or feeling high on life (so grateful to be alive)
• Hyperactivity
• Feeling like you need less sleep
• Sleeping few hours and feeling fine
• Talking very quickly
• Buzzing around or racing from one idea or project to the next
• Easily distracted and unable to concentrate

Manic episodes can cause reckless behavior, but then again, so can depression.  When you do reckless things as a result of depression, it’s more likely because you’re feeling those symptoms of helplessness and hopelessness. 

The difference is that when you experience mania, you feel powerful, in charge, and even invincible or destined for greatness. In manic episodes, these increased feelings of self-esteem post-depression can be a catalyst for impulsive or foolish decisions including gambling, cheating, or engaging in unprotected sex with a stranger. 

A person with bipolar disorder, in severe cases, may also experience psychosis in the form of delusions (false beliefs) or hallucinations. 

What is Hypomania?

Hypomania is the less severe (hypo) form of mania in manic depression. People with this type of bipolar disorder (bipolar disorder II) may not know they have it because they can still carry on with everyday living. They may only seek help for depressive episodes. People around them may think they’re “finally” having a good mental health day or period of time.

You can see how having this type of mania makes it even harder to get an accurate diagnosis (and to accept it) because the changes are much less obvious and even at times desirable in comparison to symptoms of depression. You will still feel euphoric and increase in energy and motivation but they will not be as extreme and will not lead to as big of emotional and behavioral changes.

More on being diagnosed with depression

“Depression” is a broad diagnosis that can change based on the type of medical professional or mental health professional you see. 

For example, your general practitioner may begin pharmaceutically treating you for depression but give you little insight into what’s causing it or what type of depression it is. In all fairness, specifying depression types isn’t your doctor’s area of expertise. While your GP can help you access prescription medication that can help with symptoms, you will do best in also seeing a mental health professional.

Your therapist or other mental health professional can help you understand how certain life events are contributing to your feelings of depression. They can also discuss how life factors like your gender, age, sexual orientation, ability status, and more impact your experience of depression.

How symptoms of depression vary by gender and age

Anyone can experience depression. This means you are never too young (or “too” anything for that matter) to have clinical depression.

Data from the 2016 National Survey of Children’s Health (NSCH) shows:

• Over 3% of American children aged 3-17 years had current depression
• Over 7% had anxiety 
• Close to 7.5% had a current behavioral/conduct problem

But girls are more likely to be diagnosed with depression and boys are more likely to be diagnosed with a behavioral or conduct (attention or hyperactivity disorder).

There are many studies that when taken together demonstrate these rather stereotypical differences in major depression diagnoses,  and that gender differences in depression symptoms emerge earlier in life than previously thought but peak in adolescence. 

Larger gender differences in major depression have been found in nations with greater gender equity and in more recent studies. 

Life stages and their impact on mental health

There are different kinds of depression, and some of them will only take place during certain time periods or after certain triggers. Common examples include seasonal affective disorder (SAD) which is depression related to seasonal changes and postpartum depression which is the type of depression a person experiences after giving birth. Any gender identity (queer, non-binary, fluid, woman, man) can experience postpartum depression after the birth of a baby.

Premenstrual dysphoric disorder (PMDD) is a form of severe premenstrual syndrome that brings with it a monthly dose of pretty severe depression and depressive symptoms like appetite and sleep changes. It occurs in people who experience a monthly menstrual cycle (ie. cisgender women of childbearing years). 

Hidden depression is also a very real thing that can occur in anyone but can also be tied to certain life stages. This can happen in times of trump or tribulation, too. You can experience depression during times that you’d hope would be happy life moments and major milestones like graduations, engagements, pregnancies, retirement, and more. 

Not talking about depression keeps it hidden – and when it’s hidden depresion it has more power over a person.

There are also certain traumatic life events that can occur that trigger depressive symptoms or suicidal thoughts. These include adverse childhood experiences (ACEs) like parental divorce, neglect, and other anytime traumas like sexual assault and rape.

Given the gender disparity in depressive disorder diagnoses, it’s important to always consider how past or ongoing trauma may be playing a current role in your mental health and in what depression feels like in your body (ie., Maybe the back pain is from being tense in a hyper vigilant position all day (ie., effects of PTSD rather than clinical depression). 

Feeling depressed? Here are the best ways to treat depression

The good news is that you don’t need an official diagnosis to start strengthening your mental health.

Just like someone with heart disease going to the doctor, someone with depression can and should start making changes to help support your mental health and decrease symptoms of depression while you work toward getting an accurate diagnosis with a trained professional. 

Depression is a serious mental health concern because it prevents self-actualization or reaching your full potential and it can become deadly. If you have any of the signs or symptoms of depression, you need to tell someone you trust and seek treatment. The best treatments for depression will ultimately depend on your:

• Current medications
• Drug allergies
• Comfort level 
• Financial ability
• Family support
• Follow-through

Options for depression treatment

Talk therapy

Psychotherapy or talk therapy options include cognitive behavioral therapy (CBT) where you learn about depression, how it’s impacting your thought processes and behaviors, and steps to change your underlying beliefs and actions. 

Common CBT strategies include reframing how you see the world and yourself as well as understanding your personal triggers.

Family-based therapy is also available in addition to CBT to help the whole family heal from depression.

Support groups moderated by facilitators can also be helpful for understanding how others experience depression, what they struggle with, how they cope, and, most importantly, that you are not alone with depression. 

Prescription medications

Medications for depression include several classes of antidepressants that work on different brain chemicals responsible for your moods and other things like sleep and energy levels. 

These medications do not cure depression, but they can treat the symptoms of depression. Your doctor may discuss short-term use during a crisis depressive episode or longer term use if you have severe depression, persistent depressive disorder, manic depression, or if you suffer with suicidal thinking when you stop taking antidepressants. 

It’s crucial to be patient with medication (and yourself as you adjust to new medication). If side effects are intolerable, talk to your doctor to discuss alternative options. It often takes some trial and error before finding the right mental health medication for your condition. 

Lifestyle changes that support mental health against depression 

The best approach to treatment is always the holistic one. This means you blend the benefits of conventional depression treatment (go to talk therapy, take any medications as prescribed) but that you also make lifestyle changes to complement your overall health and improve your feelings of wellbeing.

Healthy ways of coping with depression

• Exercise for 30 minutes a day, three to five times a week. The Mayo Clinic says this can help alleviate depression without medication.
• Meditate for 10 minutes or more a day. Deep breathing meditations can help calm your nervous system (body and mind). It can also help you get to sleep, practice gratitude, and let go of past trauma. Search for specific meditations for depression relief online or simply get into the daily habit of meditating for several minutes per day. 
• Maintain a sleep schedule. Even adults need bedtimes so we don’t get cranky! We also need set wake up times and it’s really best to keep these times consistent even when working from home, during the weekend and on holidays. When you have depression, sleep is all the more important to maintaining your moods.
• Don’t sweat the small stuff: We’re all juggling a few too many balls these days but we can help ourselves out mood-wise by not focusing our energy on insignificant stressors (minor, daily things that have no real impact on your present or future). Practice the art of letting go to release yourself from feeling so much tension all the time! 
• Spend time with animals: This doesn’t have to be a formal emotional support animal or therapy animal, either. You can find mood-boosting and stress-relieving benefits from spending time with pets, especially those with whom you have a deep bond.

Don’t despair

We won’t pretend to tell you that depression doesn’t suck. It does. But depression doesn’t need to take anymore away from you, and you can regain your mental health. By getting treatment and making some healthy lifestyle changes, you can begin your journey to feeling better. 

Remember that depression can wear many masks and if you feel yourself slipping back under one, reach out for help. Don’t stop reaching out for help. Fight for yourself because you matter and you are here for a reason!