Warning Signs of Severe Depression: How to Help a Loved One Recognize Symptoms and Get Help

Any diagnosis of major depression can be considered severe. The criteria indicate someone who is experiencing more than the normal, occasional sadness or depression. Their symptoms persist. No matter what they try, they can’t shake the low mood.

For someone who is not a clinician, seeing the signs of this mental illness is not necessarily easy. You may see some signs your loved one is depressed or sad, but it may be difficult to recognize if it is a normal mood or a severe case of depression.

In addition to the official criteria for diagnosing depression, there are some important signs you can look for in a loved one. If you see these clues or warning signs, it may indicate their feelings of sadness and depression are becoming overwhelming and that they may qualify for a diagnosis:

• Your loved one is having problems in close relationships because of persistent depression and related symptoms.
• The symptoms are causing them to have difficulties at work or school, such as missed time or diminished performance.
• Recent passions, like a hobby, exercise, or even work, are now diminished. They show no interest in these things anymore.
• They may have physical symptoms that can’t be explained by an illness or injury: aches and pains, indigestion, headaches, and back pain.
• Most people don’t associate anger with depression, but men in particular with depression may have angry outbursts and be extremely irritable.
• Your loved one may have more severe mental illness with co-occurring disorders. Watch for signs of anxiety, compulsive behaviors, substance use, and any other troubling symptoms or behaviors.

Depression also predisposes your loved one to think about suicide and self-harm. This doesn’t mean they will act on those thoughts, but this severe outcome is more common in people with depression. Signs someone may be at risk for suicide include:

• Talking about killing or harming themselves
• Getting their affairs in order
• Behaving in dangerous, reckless ways
• Talking about being desperate for relief or people being better off without them
• Having a preoccupation with death
• Suddenly changing from severe depression to a sense of calm and peace

Major depression is just one diagnosis in the family of depressive disorders. Your loved one may have specific circumstances, such as just having a baby, or particular symptoms that indicate a different diagnosis. Many of these types can also be severe and dangerous if untreated:

Perinatal and postpartum depression

One in seven women who are pregnant or recently gave birth develops this type of depression. Hormones may play a role in the onset, but new mothers also face anxiety, stress, and worry associated with such a big change.

These can lead to severe depression in some cases that may cause anger, extreme worry, difficulty caring for or bonding with the baby, and even self-harm or thoughts of harming the baby. If you see a new mom struggling to cope or showing worrying signs like these, getting help is essential.

Depressive psychosis

If someone you care about with depression begins to show signs of psychosis, they may be going through a severe type of this mental illness. Psychosis is losing touch with reality and causes symptoms like hallucinations and delusions.

Bipolar depression

Bipolar disorder causes changes in mood between periods of depression, which have the same symptoms as major depression, and mania. People with bipolar disorder can exhibit severe symptoms that make normal functioning impossible.

Look for signs of mania, which are often the opposite of depression: high energy, decreased need for sleep, racing thoughts, high self-esteem, frenzied activity and attempts to get a lot done, and impulsive, dangerous behaviors.

For the person experiencing depression, it can be difficult to ask for help. There is shame and guilt involved, but also the sense of being so overwhelmed that it feels as if there is no way out. Severe depression can feel like being in a hole that you can never climb out of, no matter who tries to help.

When dealing with someone you care about, it’s important to push for help in a calm, supportive, and non-judgmental way. Don’t be afraid to talk to your friend or family member about your concerns. It may be just what they were waiting for: someone to show they care and offer some solutions or advice.

If your loved one doesn’t listen or denies they need help, enlist other people who care about them. With enough caring family and friends pushing for treatment, they will be more likely to recognize that their symptoms have become severe and they can’t go it alone.