What is mild, moderate and severe depression?

Depression, or Major Depressive Disorder (MDD), is characterised by a consistently low mood and a loss of interest in activities, other people or even in life. Depression affects bodily functions such as sleep and appetite, and it changes our thought patterns to favour negative or critical stimuli.

It’s safe to say that depression can have a detrimental effect on our wellbeing, health, work and social relationships. Still, not every depressed person is deeply disabled by their condition.

Depression comes in different forms – or levels of severity. The mildest form of depression may not even be recognisable by other people, whereas the most severe form hardly goes unnoticed.

So, how do you recognise the different levels of severity in depression?

To get an indication of depression severity, you can use a self-report scale. The MADRS-s takes you through the symptoms of depression and automatically places your score into one of four categories:

1. No depression
2. Mild depression
3. Moderate depression
4. Severe depression

To take the test – click HERE.

Below, you’ll find descriptions of the 4 different levels of severity.

1. No Depression

What does ‘no depression’ mean?

Scores 0-12 on the MADRS-s indicate that your symptoms may not be a sign of clinical depression. It’s common to experience a few symptoms without having a full diagnosis.

What’s next?

If you want to know more about the depression criteria, read What are the signs of depression?

Also, these 5 medication-free lifestyle changes can prevent depression.

2. Mild depression

What is mild depression?

Scores 13-19 on the MADRS-s indicate mild depression.

In the case of mild depression, all criteria for depression are met, but you can still keep up with everyday chores, work, self-care and important social relationships.

The symptoms of mild depression may not be noted by the people around you.

You may experience a low mood and less energy than usual, which makes daily tasks more challenging. Life doesn’t seem as fun or as meaningful as it used to and you have less interest in activities that you usually enjoy. It’s common to think negative and critical thoughts about yourself and/or others.

Even though this is the mildest form of depression, it’s more than just feeling blue temporarily. The symptoms of mild depression don’t disappear after a period of rest as in the case of ordinary fatigue or sadness.

What’s next?

It’s important to treat your symptoms as soon as possible. Mild depression can progress into more severe forms.

Even though you may not feel like it, depression is a highly treatable condition. And mild symptoms are the easiest to recover from.

Do you recognise a critical voice in your head saying “this is hopeless” or “this will never get better”? That’s not true. That’s depression talking.

Depression is a temporary disorder with many effective cures.

Treatment options

• Psychotherapy, such as CBT, is recommended for this type of depression.
• tDCS – a very gentle form of brain stimulation that you can administer at home – is another recommended treatment.

These 12 lifestyle changes and natural treatments can have a significant impact on your depressive symptoms or help you recover completely.

3. Moderate depression

What is moderate depression?

Scores 20-34 on the MADRS-s indicate moderate depression.

In the case of moderate depression, you experience a significantly lower mood than usual. You have lost interest or pleasure in activities that used to be enjoyable and it’s a challenge to complete work assignments and daily chores. It’s common to experience unusual fatigue which doesn’t disappear even when resting.

Moderate depression usually involves physical symptoms, such as sleep disturbance (sleeping too much, having problems falling asleep or early morning awakenings), changes in appetite or weight and concentration difficulties.

The symptoms of moderate depression are severe enough to cause problems in your social life. It’s common to avoid spending time with friends and family and to experience more conflicts at home than usual.

Another indication of moderate depression is to feel excessively guilty and/or worthless and to be tormented by critical thoughts about yourself and/or other people. You may experience intrusive thoughts about death or suicide.

What’s next?

If you recognise this level of depression, seek treatment as soon as possible.

Even though you may not feel like it, depression is a highly treatable condition.

Note that moderate depression can be accompanied by a critical voice in your head saying “it’s hopeless”, “I will never get better”, “treatment can help others, but not me”, “nobody needs me”, “the world is a better place without me”. That is not true. That’s depression talking.

Depression is a temporary disorder with many effective cures.

Treatment options

• Psychotherapy, such as CBT, is a recommended treatment option.
• Antidepressant medication, for example SSRIs, are commonly used to treat moderate depression.
• tDCS – a very gentle form of brain stimulation that you can administer at home – is another recommended treatment.

Note that psychotherapy, antidepressants and tDCS can be combined to treat moderate depression. Combining two or more options can increase the effectiveness of each treatment.

• In addition, regular physical exercise, good quality nutrition, meditation practice and good quality sleep can significantly reduce symptoms of moderate depression or help you recover completely.

4. Severe depression

What is severe depression?

Scores above 34 on the MADRS-s indicate severe depression.

Severe depression is characterised by extremely low levels of energy, disinterest in most activities throughout the day and a consistently low mood.

This is a level of depression which makes it a challenge to get out of bed in the morning and to perform daily chores. It’s usually impossible or extremely difficult to manage work and it may even be challenging to leave the house. Severe depression probably affects all social relationships. You may withdraw from all or almost all social situations.

Severe depression is often accompanied by noticeable physical symptoms, such as major changes in sleep and eating patterns. Some people sleep through most of the day and struggle to get out of bed. Others sleep very little and are tormented by early morning awakenings or difficulties falling asleep even when exhausted. You may experience significant weight loss or weight gain.

Severe depression is often associated with a deep experience of worthlessness and/or hopelessness and excessive guilt. It’s common for severely depressed people to have intrusive thoughts of death, suicide and to make suicidal plans.

It’s difficult to maintain self-care when severely depressed. You may stop showering, brushing your teeth or changing your clothes due to the extreme effort. Some people with severe depression can seem physically ill – their posture may change to look slumped and their facial expressions can become dull. Severe depression is usually noticed by other people, especially people who live with you.

What’s next?

If you recognise this level of depression, contact a healthcare professional or a helpline as soon as possible to receive the proper treatment.

Even though you may not feel like it, depression is a highly treatable condition.

Perhaps you recognise a critical voice in your head saying “it’s hopeless”, “I will never get better”, “treatment can help others, but not me”, “nobody needs me”, “the world is a better place without me”. Know that it is not true. It’s depression talking.

Depression is a temporary disorder with many effective cures. And the sooner you get help, the better.

Treatment options

Two or more treatment options can be combined to treat severe depression. Combined treatments are associated with better results.

• First of all, consult a physician. Make sure to contact a medical doctor to find out whether your symptoms originate from a physical illness (e.g a metabolic disease or a stroke) or if your condition is indeed depression.
• During initial treatment, severe depression is most often treated with antidepressant medication.
• Psychotherapy, such as CBT, can be combined with medication to treat severe depression.
• tDCS – a gentle form of brain stimulation – is another evidence-based option that can be combined with antidepressant medication and/or psychotherapy.

In case several types of antidepressant medications have proven ineffective (a so-called “treatment resistant depression”), ECT can be an effective treatment for severe depression. ECT is not used as a first option due to its side effect profile.