Working Well

Major or severe depression may include extreme feelings of depression, distress, agitation, uselessness and guilt. It is unlikely the person will be able to continue with work, social or domestic activities.

The World Health Organisation classifies major/severe depression as including all of the first three symptoms and at least five others.

- Two weeks of an abnormal depressed mood
- Loss of interest or pleasure in activities that used to be enjoyable
- Reduced energy, or feeling tired
- Loss of confidence and self-esteem
- Feeling guilty and unworthy
- Recurrent thoughts of death or suicide, or any suicidal/self-harming behaviour
- Reduced ability to think or concentrate
- Agitated or slow movements
- Disturbed sleep (not enough/too much/poor quality)
- Change in appetite (increase or decrease) with weight change
- Decreased libido
- Unexplained physical symptoms

Major depression usually causes severe enough symptoms for a change to be noticed by other people even if feelings are actively masked.  A person with major depression will usually experience most of the symptoms above.

Suicide is a distinct danger.  While a person with major depression may be managing one moment, they can plummet very quickly into feelings of hopelessness and despair.  It is common for people to feel that they are somehow responsible and 'to blame' for the way they are feeling.  It is easy to believe that others are better off without them.

It is vital that professional help and treatment is sought as soon as possible and that treatment is followed.  As with all major illnesses, during major depression we need additional support on a daily basis in managing the symptoms and help with treatment.

People with severe depressive episodes may also suffer from the following, although they are not very common:

- Delusions 
- Hallucinations 
- Depressive stupor

References:

National Alliance on Mental Illness (USA)

Depression: The way out of your prison
Dorothy Rowe
2003

The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organisation
1993