The Struggle of Debilitating Depression

Depression is a clinical mental health diagnosis, also called major depression and major depressive disorder. There are some different types of depression, but major depression is one condition that can vary in terms of how severe the symptoms are. A typical bout of sadness or low mood, sometimes triggered by a life change or situation, is not depression. To be diagnosed, you must have at least five of these symptoms for at least two weeks:

• A low, depressed mood with sadness and hopelessness, sometimes irritability or anger
• A loss of interest in activities or inability to get pleasure from normal activities
• Major, unplanned changes in eating and weight
• Insomnia or sleeping more than normal
• Agitation or retardation of movements and affect
• Fatigue and low energy
• Feeling worthless, guilty, and ashamed
• Struggling to think, make decisions, and focus on tasks
• Persistent thoughts about death or suicide, with or without suicidal behaviors

For a diagnosis of major depression you must have one of the first two symptoms and five or more in total. The symptoms must be persistent and cause significant impairment in your life.

Within the criteria for a diagnosis of depression there is a lot of room for variation. Some people may have these symptoms and struggle with them but still be able to function to some degree. Others may have more than five symptoms or experience some symptoms so severely that they can no longer take care of themselves or their homes, go to work, function at school, or manage their relationships.

Some signs that your depression has become debilitating include:

• Not showering or bathing for days or weeks
• Neglecting all types of hygiene, wearing dirty clothes, not brushing hair
• Forgetting to eat or eating only whatever junk food is available
• Being completely unable to function at work or in school
• Noticeable slowing of the ability to think or do anything remotely active, even just getting up and walking around the house
• Psychotic symptoms, like delusions or hallucinations, becoming physically immobile

This severe, debilitating depression must be addressed because it can cause serious complications, like substance abuse, physical injuries from self-harm, malnutrition, loss of a job or failing at school, damaged relationships, physical illnesses, and social isolation.

Another very serious potential complication of debilitating depression is suicide. Depression can actually kill, because you may get to the point where you see no other way to get relief than to take your own life. One out of five people with depression will attempt suicide, and those with severe symptoms are at a greater risk.

Treatment interventions can significantly reduce the risk of suicide. It is important to understand the warning signs of suicide to be able to help someone get treatment before it’s too late. If you are struggling it may be difficult to see the signs in yourself, but if you do think about death and suicide often, reach out for help. Some troubling signs include:

• Talking about death, being hopeless, feeling trapped, having no reasons to live, or pain and suffering that is unbearable
• Increasing risky behaviors, including substance use
• Actively looking for ways to commit suicide
• Worsening social isolation
• Saying goodbye to people
• Giving away items
• A sudden positive change in mood, or sense of relief

Depression can be severe all on its own, but it often co-occurs with other conditions, and these can make it even worse. You may have depression with one or more of any other mental illnesses. Some common conditions that occur with depression are anxiety disorders and trauma-based disorders, like post-traumatic stress disorder (PTSD).

Also common is the co-occurrence of a substance use disorder with depression. Some people may use drugs or alcohol to try to get relief from low moods and negative thoughts, while others may find that substance use precedes and triggers depression. Regardless, the outcome is the same in that one makes the other worse.

If you struggle with severe and debilitating depression it is essential that you get screened for substance use disorders and for other mental illnesses. Even if you are getting good treatment for depression, if you ignore other co-occurring disorders, your depression will persist. It may get better initially, but the substance use or additional mental illness symptoms will likely pull you back into a depression relapse.