Severe Depression Symptoms: Symptoms Of Severe Depression

Every one of us goes through phases of feeling low, sad or unhappy with our circumstances or life in general.

We say we are feeling 'down' or having the 'blues' - loosely referring to being in low spirits or feeling depressed.

However, depression in the clinical sense of the word, is much more than an occasional feeling of sadness.

It is a serious condition which can be quite debilitating and prevent people from normal, everyday functioning.

Depression takes on a variety of forms, depending on the number, intensity and duration of symptoms. According to DSM-IV-TR when people develop a depressive disorder, they typically have depression, along with specific symptoms for a certain period of time.

If depression is not treated properly or recognised in it's early stages, it can turn into a recurrent and prolonged problem, often having a serious impact on the psychological, emotional and physical health of the individual.


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The symptoms of depressive disorder can range from mild to severe. These symptoms can manifest themselves as cognitive (mental), emotional, somatic (physical) and motivational symptoms.

Following are some of the common symptoms of depressive disorder:

Cognitive Symptoms Of Depression:

Negative expectation

Negative self-concept

Emotional Symptoms:

Sadness

Loss of pleasure or joy

Hopelessness

Feelings of guilt

Feelings of worthlessness

Negative view of the world and future

Attribution of self blame

Impaired focus or attention

Difficulty making decisions

Suicidal ideation

Thoughts about death

Abnormal preoccupation with bodily illness

Somatic Symptoms Of Depression:

Disturbance in appetitive behaviour - changes in eating or drinking

Disturbance in weight - increase or decrease

Motivational Symptoms:

Increased depression

Low energy

Fatigue

Apathy

Loss of interest

Diurnal variation in mood - altered daily rhythm

Amenorrhoea - cessation of menstrual cycle

Constipation

Disturbance in libido - increase or decrease

Disturbance in sleep patterns - difficulty falling asleep, frequently waking up, excessive sleep during daytime.


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DSM-IV-TR defines two categories of depressive disorder. These are Major depressive disorder and Dysthymic disorder. Major depressive disorder - as the name conveys - is severe in intensity whereas Dysthymia is a milder form of depression.

Major Depressive Disorder:

This include a single depressive episode or recurring depressive disorder. The DSM-IV-TR criteria for Major Depressive Disorder is characterized by a sad mood or loss of pleasure for 2 weeks, along with at least 4 other symptoms of depression experienced in the absence of manic episodes.

The symptoms are present nearly every day, most of the day, for at least 2 weeks. The symptoms outweigh those of normal bereavement.

MDD is called an episodic disorder because symptoms are present for a certain period of time and then clear away. However, if the episode is not treated, it may stretch on for 5 months or even longer than that.

Moreover, MDD has a tendency to recur i.e. once the symptoms dissipate, they tend to return. A small percentage of episodes may turn into chronic depression.


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Symptoms Of Major Depressive Episode:

Five or more of the following symptoms need to be present during a two week period.

  • Depressed mood (Feeling sad)
  • Loss of interest
  • Poor or increased appetite
  • Weight gain or weight loss (Fluctuations in weight)
  • Psychomotor agitation or retardation (Hyperactivity or total slowing down)

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  • Insomnia or Hyper-somnia (Poor sleep patterns)
  • Loss of energy or motivation
  • Fatigue
  • Feelings of worthlessness
  • Guilt or self-reproach
  • Poor concentration (inability to stay focused)
  • Indecisiveness
  • Thoughts of death or suicide (including suicidal attempts)


Dysthymic Disorder:

Dysthymia is chronic but mild depression over a period of time, not less than 2 years. No major depressive episode is present during the first two years of symptoms.

Depression is experienced for either most of the day, on more days than not, without a break for more than 2 months over a period of two years. In short, the symptoms do not clear for more than 2 months at a stretch.

Individuals suffering from dysthymia feel sad and depressed or find little pleasure in every day activities, along with two of the other symptoms of depression.

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Symptoms Of Dysthymia:

The DSM-IV-TR criteria for Dysthymic disorder is a depressed mood for more than half of the time for 2 years, with at least 2 of the following symptoms:

  • Poor appetite
  • Sleeping too much or too little
  • Poor self-esteem
  • Trouble concentrating
  • Inability to make decisions
  • Hopelessness

Thus DSM-IV-TR differentiates between Dysthymic disorder and Major depressive disorder by the duration, type and number of symptoms.

As a rule, dysthymia has less symptoms than MDD. However, symptoms of dysthymia become worse if it goes untreated.


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Sub-types Of Depression:


Seasonal Affective Disorder (SAD): This is a sub-type of Major Depressive Disorder. It is depression that is brought at the onset of a particular time of the year e.g. depression during two consecutive winter seasons (winter depression).

The symptoms clear by the advent of summer season. However, some individuals experience a seasonal pattern, with depressive episodes in the autumn which clear by spring.

Secondary Depression: This refers to depression that results due to a medical condition, mental disorder, chronic disease (like cancer) or alcohol or drug use.

In short, secondary depression occurs if the individual is suffering from one or more illnesses (primary illness) and is diagnosed with depression as a result of it.

Melancholic Depression: This is characterized by a depressed mood which is often worse in the mornings, loss of pleasure and an inability to react to pleasurable stimuli, psycho-motor retardation, feelings of guilt and excessive weight loss.

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Catatonic depression: This is a form of severe depression with disturbed voluntary movements and motor behaviour.

These include strange poses, mute or immobile stances, awkward bodily positions held for long periods as well as repetitive, excited or purposeless movements.

Catatonia is also associated with some schizophrenia. Individuals with depression and least two symptoms of catatonia are diagnosed with catatonic depression.

Double depression: This form of depression is marked by episodes of major depression and lasts for at least two years.

Double depression occurs when both the symptoms of Major depression and Dysthymia are experienced together by the individual.

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Postpartum depression (PPD): This is usually referred to as Post-natal Depression.

It is a type of depression related to hormones and bodily changes and occurs in a mother soon after the birth of her baby or even three months after labor.

It is a much more serious condition than the fatigue and exhaustion typically experienced by mothers with a newly born baby.

Postpartum depression is severe, prolonged and debilitating and can impair the mother's every day functioning.

Not only can it negatively impact her relationships with family and partner, but is intense enough to make bonding with the newborn quite difficult. Postpartum depression is more common than we recognise and is treatable with proper care and support.


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Depression With Mania:


Psychotic Depression (PMD): This is a severe manifestation of depression characterised by pervasive depressed mood, feelings of guilt or unworthiness and poor concentration, memory or cognitive deficit.

This is accompanied by extreme agitation (psychomotor agitation) or extreme slowing down (psychomotor retardation) and speech with long pauses.

There is also sleep disturbance and suicidal ideation with definite murderous plans to kill self or others. Psychotic depression is marked with delusions such as ideas about being wicked, having a disease or believing that one is nothing or rotting from within.

Hallucinations are also common, usually as voices speaking in the secondary person in an accusatory manner. This type of severe depression does not respond well to medication and often needs specialised treatment and care.


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Cyclothymia: This is the bipolar equivalent of dysthymia. It refers to persistent instability of mood and depression lasting for more than two years.

The individual has frequent but mild symptoms of depression and mania. This is characterised by ups and downs. In the low phase, the individual feels sad, inadequate or withdrawn and sleeps excessively.

During high phases, the person may become socially uninhibited, over confident, boisterous and unmanageable.

Bipolar Affective Disorder: This refers to depression with mania (also called Manic Depression). It involves a period of persistently elevated, expansive or irritable mood lasting at least a week and severe enough to disrupt work or social activities.

Symptoms of Bipolar Affective disorder are increased activity or restlessness, rapid or inflated speech and grandiosity.

The individual also experiences distractibility and loss of attention, lack of restrain, reckless behaviour and excessive involvement in pleasurable activities. There is usually a decrease in the need for sleep.


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Overview On Symptoms Of Severe Depression:

To conclude, it is important to recognize the exact form of depression by closely examining the symptoms manifested by the individual.

One has to differentiate between the mild and severe forms of depression and suggest appropriate care and treatment accordingly. Your local GP should be able to do this.

Specialist care is needed in cases of severe depression. Severe depression which has been chronic, prolonged or recurrent is a serious problem and must be treated properly. If it goes on unchecked, it can have devastating implications for the individual.

With timely and correct diagnosis, followed by proper treatment and support, it is possible for people to be on their way to recovery.


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