Severe depression is also commonly known as major depressive disorder (MDD) and can have profound emotional, physical, and behavioral symptoms.

The typical signs are:

1. Emotional symptoms

• • Persistent sadness or feeling empty.
  • Hopelessness or pessimism about the future.
  • Loss of interest or pleasure in activities once enjoyed (anhedonia).
  • Feelings of guilt, worthlessness, or helplessness.
  • Irritability or agitation.

2. Cognitive symptoms

• • Difficulty concentrating or making decisions.
  • Memory problems.
  • Frequent thoughts of death or suicide.

3. Physical symptoms
   
   

• • Major changes in appetite (eating too much or too little).
  • Unexplained weight loss or gain.
  • Fatigue or loss of energy.
  • Sleeping too much (hypersomnia) or too little (insomnia).
  • Physical aches and pains with no clear medical cause.

4. Behavioral symptoms

• • Social withdrawal (avoiding friends and family).
  • Neglecting responsibilities at work, school, or home.
  • Increased use of alcohol or drugs (often in an attempt to cope).
  • Slower movements or speech (psychomotor retardation).

Severe depression can also manifest in less commonly discussed symptoms, including:

1. Emotional and psychological signs
   
   

• • Emotional numbness. Feeling disconnected from emotions or reality.
  • Intense self-criticism, such as harsh negative self-talk beyond normal self-doubt.
  • Sudden mood swings with brief periods of apparent normalcy followed by deep despair.
  • Emotional hypersensitivity, like overreacting to small frustrations or criticism.
  • Feelings of being a burden and thinking others would be better off without you.
  • Inability to feel joy (even in happy moments). Feeling emotionally “flat” or numb.
  • Existential distress and questioning the meaning of life, or struggling with a deep sense of emptiness.

2. Cognitive signs

• • Distorted perception of reality. Feeling like life is pointless or that others would be better off without you.
  • Catastrophic thinking, such as assuming the worst possible outcomes in every situation.
  • Depersonalization or derealization due to feeling detached from oneself or the world around you.
  • Time distortion. Feeling like days drag on endlessly or pass in a blur.
  • Vast decision paralysis and struggling to make even minor choices, like what to eat.
  • Inner voice becoming crueler with thoughts like “I don’t deserve happiness” or “I’ll never get better”.

3. Physical signs
   
   

• • Unusual pain or discomfort, like chronic headaches, stomach issues, or muscle aches without a medical explanation.
  • Feeling heavy or weighed down, such as a sensation of being physically burdened or unable to move.
  • Fluctuations in body temperature. Feeling unusually cold or hot without an external cause.
  • Unusual sensory changes with light, sound, or touch, feeling too intense or too dull.
  • Frequent yawning or sighing can be a subtle sign of emotional exhaustion.
  • Changes in posture like slouching more, avoiding eye contact, or appearing physically “weighed down”.
  • Feeling physically disconnected due to experiencing a sense of detachment from your own body.

4. Behavioral signs

• • Risk-taking behavior. Engaging in reckless activities (speeding, gambling, unsafe sex).
  • Sudden bursts of energy before a decline, which is sometimes linked to suicidal planning.
  • Neglecting hygiene or self-care and going days without showering, brushing teeth, or changing clothes.
  • Avoiding enjoyable activities out of guilt because of thinking, “I don’t deserve to have fun”.
  • Sudden, impulsive decision-making and making drastic life changes (quitting a job, moving, cutting off relationships) without clear reasoning.
  • Unusual fixation on past mistakes by constantly replaying embarrassing or painful memories.
  • Sleeping in strange places and falling asleep on the couch, at work, or anywhere but a bed due to exhaustion.

When should you seek help?

Seeking assistance is critical if you or someone you know is experiencing persistent symptoms for two weeks or more.

Request immediate help from a doctor, crisis hotline, or emergency services if suicidal thoughts are present.

Conclusion

These signs can vary from person to person and might not always be obvious. Nevertheless, they can be serious.

Seeking professional help is vital if you or someone you know is struggling with severe depression.