The World Health Organization (WHO) recently ranked major depressive disorder as the third cause of the burden of disease globally. Depression is a highly prevalent mood disorder affecting people all over the world. It is characterized by a persistent low mood and loss of interest, impacting how you think, feel, and act.¹
When depression becomes so severe, it can affect your ability to complete basic tasks such as waking up, eating, and showering. This is often referred to as crippling depression — a form of severe depression that can affect every aspect of your life.
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It’s important to note that crippling depression is not an official medical term. The word “cripple” has previously been used as a derogatory term for people with disabilities, so it has become outdated in recent years. It is more appropriate to utilize terms like major depressive disorder (MDD) or severe or debilitating depression.
Normally, depression is associated with a persistent low mood. For many individuals with depression, it is still possible to participate in day-to-day life. In more severe cases, it can drastically impact your life and make it seem almost impossible to carry out basic tasks. Different types of depression can lead to periods of severe depression.
Seasonal affective disorder (SAD): In this form of depression, symptoms are associated with the changes of the seasons, and it begins and ends around the same time every year.²
Bipolar disorder: Also known as manic depression, in which people shift between periods of mania (feeling agitated and overactive) and depression (feeling lethargic and low energy).³
There is no single cause of severe depression. Instead, it is often a combination of genetic, biological, environmental, and psychosocial factors, including:
Personality (for example, if you tend to be highly self-critical and have low self-esteem)
Symptoms of depression include:
Lacking motivation or interest in things
Difficulty making decisions
Low sex drive
Avoiding social activities
In some individuals, mild to moderate depression means that their symptoms impact their day-to-day life, but they can still go about their normal activities. In severe depression, the symptoms become debilitating and can make getting through daily life seem impossible.
It can be hard to watch when the people we love are suffering from depression.
Encouraging them to seek treatment and helping them through this process can be highly beneficial. While you may be able to provide them with some level of emotional support, finding a professional to provide structured therapy may be the best option.
This may help them come to terms with how they are feeling and empower them to look after themselves rather than feeling shame about seeking out help.
Supporting them through their treatment process can be very helpful. Throughout the process, however, remember to also look after yourself. You can simply lead by example, which can help your loved one to model those same behaviors.
Setting boundaries is important, as while you may want to do everything you can to help, you can only do so much. As you’re not a therapist, you want to avoid burnout by taking care of yourself at the same time.
To carry out a diagnosis, your doctor will ask you a series of questions, which may include your family history of depression, your own past and life events, and your current feelings and behavior. Depression symptoms are unique to every individual, so it’s important that you provide honest information regarding your emotions and thought processes.
Individuals are diagnosed with major depressive disorder (MDD) if they have at least five persistent symptoms nearly every day for two weeks.
It has been estimated that up to 40–80% of individuals do not seek help for their depression. There are often barriers to seeking help. Sometimes this can be the most challenging part of the process as it requires confronting your depression head-on. In addition, some services do have financial barriers.⁴
Medication: Generally, selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment. Serotonin-norepinephrine reuptake inhibitors, serotonin modulators, and tricyclic antidepressants are also alternative options if SSRIs are ineffective.
Therapy: Cognitive behavioral therapy (CBT) and interpersonal therapy are common options. In CBT, patients are encouraged to challenge and replace negative thought patterns and develop positive, reality-based thoughts.
Electroconvulsive therapy (ECT): Often, ECT is offered when first-line treatment with medication and therapy has failed. In recent years, ECT has been found to be highly effective at reducing symptoms in some individuals, with fewer unwanted side effects.
When you’re experiencing severe depression, it is unlikely that a change in your routine and self-care will resolve your symptoms entirely. However, small changes do help:
Spending time with family and close friends: When you’re depressed, it is easy to become quite isolated from those around you. Spending time around people who you feel you can be completely honest with is important to help you maintain a sense of connection and progress toward recovery.
Schedule: Sticking to a regular sleep schedule is important — around 80% of individuals with depression suffer from sleep disturbances. Food can significantly impact your mental health, so opting for healthy foods and eating regularly can also be highly beneficial. As well as this, having a structured routine can reduce stress and make your environment more calming.
Small changes: Addressing the symptoms of your depression won’t result in overnight change. Your best option is to focus on making incremental changes and be patient. This will help you take the time to explore various treatment options and find what works best for you.
Severe depression can be hugely challenging and isolating to cope with. Remember that you are not your depression and what you’re experiencing is not permanent. Seeking out help and support both professionally and through your loved ones and making other changes in your lifestyle are all potential ways to alleviate or relieve symptoms of depression altogether.
Depression is hugely common, so participating in support groups in your local area can be a great way to seek help and support others on their journey at the same time.
Depression occurs on a sliding scale, as it presents differently in everyone — so there is no clear cut-off that indicates where depression becomes severe. Generally, the difference that defines severe depression is when symptoms become very intense and interfere with everyday life.
Anxiety that is debilitating can involve fear or dread of relatively routine, everyday tasks. Anxiety is quite a common comorbidity seen in people with severe depression. In some cases, anxiety can get to a point where it becomes impossible to go to work, see friends, or sleep restfully.
Major depressive disorder (2022)
Seasonal affective disorder | National Institute on Mental Health
Bipolar disorder (2012)