Depression is not evaluated solely by how sad a person feels. Diagnosis relies on evaluating various symptoms, their quantity, severity, and duration, as well as their overall impact on daily life.

In a severe depressive episode, symptoms are particularly intense. Under the ICD-10 classification system for diseases, a distinction is made between a severe depressive episode without psychotic symptoms (F32.2) and a severe depressive episode with psychotic symptoms (F32.3).

In everyday life, severe depression can make even the most basic tasks feel impossible to manage. Work, household responsibilities, social relationships, and crucial self-care often fall by the wayside.

It is vital to understand that severe depression is not a personal weakness. It is a medical condition that severely impairs energy, concentration, motivation, and the ability to function in daily life. Depression can affect anyone.

When affected by a severe depressive episode, psychological, physical, and social aspects of life can all be impaired. Typically, multiple symptoms occur simultaneously.

Core depressive symptoms include:

• Persistently low or severely depressed mood
• Marked loss of interest and pleasure
• Pronounced lack of motivation
• Severe exhaustion and reduced capacity to handle stress
• Difficulty concentrating and making decisions
• Low self-esteem
• Intense feelings of guilt or worthlessness
• Hopelessness and negative expectations for the future
• Social withdrawal
• Sleep disturbances
• Changes in appetite or weight
• Thoughts of no longer wanting to live

A typical experience might feel as though the demands of daily life no longer match your available energy. Walking to the mailbox feels exhausting. Taking a shower becomes a chore that requires gathering up strength beforehand. A message remains unanswered for days because the mere thought of replying feels overwhelming.

Depression is not exclusively a condition of thoughts and emotions. The body can also react significantly, especially during a severe depressive episode. Potential physical symptoms of severe depression include:

• Severe fatigue and exhaustion
• Difficulty falling or staying asleep
• Waking up very early in the morning
• Increased need for sleep
• Loss of appetite or increased appetite
• Weight loss or weight gain
• Loss of sexual desire (libido)
• Gastrointestinal issues
• Inner restlessness
• Physical pain or non-specific bodily discomforts

Physical symptoms in particular can often lead individuals to suspect an underlying medical condition at first. For this reason, professional diagnostic evaluation always includes ruling out other potential physical causes.

Severe exhaustion makes activities harder, sleep disturbances reduce recovery, concentration problems complicate decision-making, loss of interest strips activities of their former value, and profound hopelessness can foster the feeling that trying to change anything is pointless anyway. In this way, severe depression can create a vicious cycle. Harsh self-doubt and feelings of self-worthlessness are typical components of severe depression, not an objective reflection of reality.

For this very reason, taking the first step toward getting help can be especially difficult with severe depression. Family members, friends, or loved ones can provide crucial support. For example, by assisting with booking appointments or accompanying the individual to a medical consultation.

Depressive episodes can vary in duration. Without treatment, symptoms may persist for many months. At the same time, depressive phases can improve significantly with appropriate intervention. How long a depressive episode actually lasts depends on several factors, including:

• How severe the depression is
• How long the symptoms have already been present
• Whether there were previous depressive episodes
• Whether other physical or mental health conditions exist
• What treatment approach is used
• How well the treatment fits the individual's situation

If you feel that your severe depression will never end, this can be especially distressing. Depression frequently alters your perception of the future, making the idea that things could change again feel almost impossible to imagine. Thinking this way is completely understandable. It is actually another symptom of severe depression itself.

However, this does not mean that this state will be permanent. If symptoms do not improve sufficiently despite treatment, the current plan should be reviewed together with your doctors and therapists. For instance, it may be helpful to re-evaluate the diagnosis, previous therapeutic steps, medication dosage, additional life stressors, or co-occurring conditions.

A lack of improvement or only slight progress is never a reason to give up. Rather, it is an opportunity to adjust the treatment approach.

A depression test can provide an initial orientation, but it does not replace a professional diagnosis. A self-test can be particularly useful if you are unsure whether your current mood is still a normal reaction to stress or whether underlying depressive symptoms are present.

Scientifically developed questionnaires typically assess how frequently certain complaints have occurred within a defined period. These include, among others:

• Little interest or pleasure in activities
• Low or depressed mood
• Sleep disturbances
• Exhaustion and fatigue
• Changes in appetite
• Difficulty concentrating
• Negative thoughts about oneself
• Would you like to evaluate your depressive symptoms yourself?

Take the deprexis self-test. It can help you better evaluate your current mental health situation and gain an initial understanding of the severity of your depressive symptoms.

Please note: The self-test does not replace a medical or psychotherapeutic evaluation. A high or notable score is not a final diagnosis, but rather an indication to discuss your symptoms with a qualified professional promptly.

Treatment for severe depression is tailored to your individual situation. Psychotherapy and targeted medication are the primary approaches. Depending on symptom severity, course of illness, and personal circumstances, treatment can be provided on an outpatient, day-clinic (partially inpatient), or full inpatient basis.

Psychotherapy

Therapeutic approaches, such as Cognitive Behavioral Therapy (CBT), help identify and shift depressive thought and behavior patterns. Key goals include:

• Identifying negative automatic thoughts
• Gradually reducing withdrawal and avoidance behaviors
• Rebuilding meaningful daily activities
• Developing healthier coping strategies for stress
• Strengthening self-esteem and self-efficacy

In severe depression, however, the initial focus is often not on making major life changes. Instead, the first step is usually re-establishing basic daily stability and routine.

Medication

Antidepressants can be an essential component of treating severe depression. A doctor determines whether medication is appropriate and which type to select. This decision takes into account factors such as past treatment experiences, co-occurring medical conditions, potential side effects, and personal preferences.

Inpatient Treatment

For severe depression, inpatient treatment may be recommended or necessary, especially when managing daily life becomes unfeasible, intensive care is required, or there is an increased risk of suicide.

In a psychiatric or psychosomatic clinic, multiple therapeutic elements are combined into a comprehensive plan, including medication, psychotherapy, physical therapy, and other supportive interventions.

Digital health applications can also serve as low-threshold support. The current patient guidelines explicitly list online programs as a potential treatment option for depression; under certain conditions, they can be used alongside other treatments for severe depression to help you establish and maintain a daily routine.

One such online therapy program is deprexis. To help you find a sense of lightness in your daily routine again, deprexis supports you with a personalized program, targeted exercises for managing low moods, and practical guidance on self-care.

deprexis is available free of charge via prescription, the cost is fully covered by your health insurance. This means your doctor or therapist can prescribe deprexis for you, and you will receive an activation code for the program. Once you have your code, you can easily redeem it on our website and start your digital therapy right away.