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Severe depression: warning signs and treatment options

Sultan AlmuhasinMedical review: Tatmeen team9 min read
رسم بقلم رصاص لامرأة تجلس على حافة سرير، تسند رأسها بيد وتترك يدها الأخرى متدلية.
Article contents
  1. When should you get help immediately?
  2. How is the type of depression different from its severity?
  3. What does psychotic depression mean?
  4. How does a doctor assess severity?
  5. How is severe depression treated?
  6. How can you start care and follow it up?
  7. Frequently Asked Questions
  8. Sources and references
  9. Writer and reviewer

A diagnosis name alone does not tell you how severe depression is. Two people with the same diagnosis may have very different symptoms1. A doctor considers their intensity, how long they have lasted and how they affect daily life, while also assessing whether there is an immediate risk to safety2.

When should you get help immediately?

Seek emergency help immediately for current danger to yourself or someone else, being unable to keep yourself safe, or a current suicidal intention or plan. Also seek it for a recent suicide attempt or serious injury3 that has not been medically assessed, or suspected harmful overdose12 or exposure to a harmful substance4 through swallowing, breathing in or touching it. Do not wait for symptoms or confirmation of the substance or intention.

In Saudi Arabia, call an ambulance on 997 or go to the nearest emergency department; elsewhere, use your local emergency number. Do not drive yourself. Someone you trust may help if they can do so safely, but do not delay help while waiting for them or a reply from 937. A previous assessment does not remove the need for emergency help if danger or an urgent medical need continues, or a new urgent need develops. If you are unsure whether a substance or dose you were exposed to is harmful, seek medical advice immediately4, such as through 937 in Saudi Arabia. Do not wait for symptoms to clarify it.

If you are thinking about killing yourself right now, seek an immediate professional assessment, even without a plan. Go to an emergency department if an immediate assessment is unavailable or you cannot wait safely.

Seek an urgent medical assessment today if:

If you cannot obtain a suitable assessment promptly, go to an emergency department12. Do not wait for a distant routine appointment. You do not need to wait two weeks or receive a diagnosis of “severe depression” before seeking this help.

How is the type of depression different from its severity?

Some terms name a diagnosis; others describe how long symptoms last or when they appear. They cannot all be placed on a single scale of severity:

  • Major depressive disorder: Symptoms can range from mild to severe1. The word “major” does not mean every case is at the most severe end of the range.
  • Persistent depressive disorder: The name describes symptoms that continue for a long time6. Their persistence can affect a person's life even when the symptoms are less intense.
  • Postpartum depression: The term relates to symptoms after childbirth; the symptoms and their impact need assessment. New hallucinations, beliefs that are out of touch with reality, a marked unusual rise in mood and activity, or confusion after childbirth may indicate postpartum psychosis, which requires emergency help immediately. In Saudi Arabia, call 997 or go to the nearest emergency department7; elsewhere, use your local emergency number13. Do not wait for a routine appointment.

Depressive episodes can also occur as part of bipolar disorder, a different diagnosis with different treatment considerations2. Tell the doctor if you have previously had a period of unusually high activity or impulsiveness6 with less need for sleep; do not assume it was simply recovery from depression.

What does psychotic depression mean?

Depression can occur with hallucinations8, such as hearing voices that are not there, or firmly held beliefs that do not match reality. These symptoms need assessment and specialist care. The person may not recognise them as symptoms of illness; sometimes someone close to them is the first to notice the change and seek help. Depression can also be severe without psychotic symptoms.

How does a doctor assess severity?

The doctor discusses your symptoms and changes in your ability to work, study, look after yourself and maintain relationships. A questionnaire may help9, but its result does not replace talking with you and understanding your circumstances and health history.

Try to describe specific changes. How long has preparing food been difficult? Have you stopped going out? Are you sleeping for most of the day? What do you need help with? You can write down these observations and ask someone you trust to help9 if talking or remembering details is difficult.

The doctor also reviews your physical health and any medicines or substances you use, because some health conditions or medicines1 can contribute to the symptoms.

How is severe depression treated?

Effective treatments for severe depression10 are available. A plan may include psychological therapy, such as cognitive behavioural therapy, and an antidepressant, with close follow-up to assess response and side effects. You may need a specialist team if symptoms significantly disrupt your life or have not improved with previous treatment.

When depression includes psychosis, treatment may combine an antidepressant with an antipsychotic8, alongside monitoring and support, with access to psychological therapy after the acute psychotic symptoms improve. The team chooses the plan with the person's condition and preferences2 in mind.

If your safety or basic needs cannot be adequately supported outside hospital, inpatient care may be appropriate2. Admission depends on the protection, treatment and monitoring you need, rather than simply having the word “severe” in a diagnosis.

Another option is electroconvulsive therapy (ECT). It may be considered when a rapid response is necessary2, such as when not eating or drinking puts someone's life at risk, or when other treatments have not worked. ECT is given under general anaesthesia11. The team discusses its benefits and risks, including possible effects on memory. It is not required for everyone with severe depression.

How can you start care and follow it up?

If symptoms disrupt your day or are difficult to manage, arrange an assessment with a primary care doctor or psychiatrist. In Saudi Arabia, you can seek medical guidance through 937, around the clock. If booking or getting to an appointment feels beyond what you can manage now, ask someone you trust to help with that step. (Ministry of Health)

When treatment begins, agree with the team on when you will be seen again, which changes should prompt earlier contact, and where to get help if your condition worsens between appointments. Tell them what has improved, what remains difficult and any side effects. Do not stop medication or change its dose on your own; stopping suddenly can cause withdrawal symptoms2.

Frequently Asked Questions

When does depression need emergency help?

Seek emergency help immediately for current danger to yourself or someone else, inability to keep yourself safe, or a current suicidal intention or plan. Also seek it for a recent suicide attempt or serious injury not yet medically assessed, or suspected harmful overdose or exposure to a harmful substance. Do not wait for symptoms or confirmation of the substance or intention.

In Saudi Arabia, call an ambulance on 997 or go to the nearest emergency department; elsewhere, use your local emergency number. Do not drive yourself. Someone you trust may help if they can safely, but do not wait for them or a reply from 937. A previous assessment does not remove the need for emergency help if danger or an urgent need continues, or a new one develops.

When should I get an urgent medical assessment for depression?

If you are thinking about killing yourself right now, seek an immediate professional assessment, even without a plan. Go to an emergency department if an immediate assessment is unavailable or you cannot wait safely.

Seek an urgent medical assessment today for thoughts of death, suicide or self-harm, even without a plan: contact your treating team, or an available doctor or urgent-care service. Seek it too if you begin hearing voices or seeing things others do not, or can no longer eat or drink enough. If voices tell you to harm yourself or someone else, or you suddenly become confused, call an ambulance immediately. If you cannot obtain a suitable assessment promptly, go to an emergency department; do not wait two weeks.

Does major depressive disorder mean severe depression?

Not necessarily. Major depressive disorder is a diagnosis whose symptoms can range from mild to severe, and the word “major” does not mean every case is at the most severe end of the range. A diagnosis name alone does not tell you how severe depression is. A doctor considers the intensity of symptoms, how long they have lasted and how they affect daily life, while also assessing whether there is an immediate risk to safety.

How is severe depression treated?

Effective treatments for severe depression are available. A plan may include psychological therapy, such as cognitive behavioural therapy, and an antidepressant, with close follow-up. You may need a specialist team if symptoms significantly disrupt your life or have not improved with previous treatment, or inpatient care if your safety cannot be adequately supported outside hospital. Electroconvulsive therapy (ECT) is another option, but it is not required for everyone. Do not stop medication on your own.

What is psychotic depression?

It is depression with hallucinations, such as hearing voices that are not there, or with firmly held beliefs that do not match reality. These symptoms need assessment and specialist care. The person may not recognise them as symptoms of illness; sometimes someone close to them is the first to notice the change and seek help. Treatment may combine an antidepressant with an antipsychotic, alongside monitoring and support. Depression can also be severe without psychotic symptoms.

Writing and article review

Sultan AlmuhasinWritten bySultan Almuhasin

Content writer and researcher at Tatmeen, working on Arabic and English articles across mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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