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Depression is a common but serious disease that ranges widely in severity. If you have a milder case, you may struggle with symptoms that include sadness, irritability, anger, and fatigue that last for weeks or longer. Such depression interferes with your daily life and relationships.

But some cases of depression are more severe, with intense symptoms that may include significant appetitie and weight loss, sleep problems, and frequent thoughts of death or suicide. Such depression can be paralyzing. You may isolate yourself and have trouble getting out of bed or leaving the house.

Symptoms of Severe Depression

What are the symptoms of severe depression?

  • Alcohol or drug abuse   
  • Insomnia or excessive sleeping
  • Irritability
  • Loss of interest in activities that used to be enjoyable  
  • Hopelessness
  • Persistent thoughts of something bad happening  
  • Thoughts of death or suicide or suicide attempts  
  • In very severe cases, psychotic symptoms (such as hallucinations or delusions)

Although you might feel that there's no hope, talk to your doctor about treatment options. Even severe depression symptoms can be treated.

Risk Factors for Suicide

Not all people with risk factors will be suicidal. In addition to depression or other mental illness, risk factors for suicide include:

  • Past history of substance abuse
  • Past history of suicide attempt
  • Family history of suicide
  • Family history of mental illness or substance abuse
  • Firearms in the home
  • Incarceration
  • Feelings of hopelessness

Suicidal Thoughts: An Emergency

For people who are severely depressed, suicide is a real threat. Each year, about 30,000 people in the U.S. take their own lives, although the true number may be higher. Some suicides go unrecognized because they're classified as accidents, drug overdoses, or shootings. Among people whose depression remains untreated, up to 15% will kill themselves.   

What are the warning signs of suicide? According to the National Suicide Prevention Lifeline, they include:  

  • Talking about wanting to die or wanting to kill yourself
  • Looking for a way to kill yourself, such as searching online for methods or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

Getting Help

Be aware that often, suicidal behavior is impulsive. Remove any weapons, medications, or other means that you might use to harm yourself. Ask a trusted person to keep your gun away from you and to lock up your knives. Flush stockpiled pills down the toilet. By getting such items out of your surroundings, you may buy time -- enough valuable time for you overcome a suicidal impulse and to consider other ways to cope with your pain.

Avoid using alcohol or illegal drugs, or seek treatment to break dependence on these substances. They can worsen your depression and lead to thoughts of suicide. Some studies have found that among people who have completed suicide, 33%-69% have had alcohol detected in their blood.

If you are severely depressed or have suicidal thoughts, tell your primary care doctor, psychiatrist, or therapist. Or call the National Suicide Prevention Lifeline anytime at (800) 273-TALK.

If you feel that you can't control the urge to harm yourself, or if you've already taken steps to harm yourself, call 911 or go to the emergency room without delay. You may need to be hospitalized for supervised treatment to reduce the risk of suicide.