Depression is a recognised illness and can affect the way that we think, feel and work in our day-to-day lives. It occurs on a continuum from mild to moderate to severe and knowledge of how our symptoms stand on this scale may be of benefit to us in accessing treatment within the NHS. I suspect that there are a lot of people who question how it is that one can be ‘severely’ depressed and on what scale our symptoms need to reach to gain higher intensity help.
Although everybody’s experience of depression is unique, the level to which one is seen as “severe” by the NHS is less defined by symptoms on a checklist and more by how greatly those symptoms affect the day to day life, the individual’s immediate safety and their sense of wellbeing.
Within the NHS, patients’ lives are generally investigated in terms of depression using a variety of clinical assessments such as structured interviews and questionnaires. For example, the PHQ-9 questionnaire, can be completed by clinicians in order to identify the extent of each mood disturbance; such as an inability to get out of bed in the morning to trouble concentrating or having suicidal thoughts.
These can be broadly classified into three levels: mild, moderate and severe. Mild depression can occur if people are generally low and unmotivated but are able to still continue their daily tasks. Moderate depression can impact people’s work, relationships and ability to care for themselves noticeably. The patient suffers symptoms of severe depression if they can no longer cope with the symptoms or feel safe.
What the NHS Considers Severe Depression
Generally speaking severe depression will involve a combination of high symptom levels and high functional disability. It’s the extent to which the person can no longer fulfill everyday tasks like work, schoolwork, family or social roles, or self-care, that constitutes important indicators of the severity of depression.
Someone experiencing severe depression may be completely unable to get out of bed, have significant problems with personal hygiene or can no longer fulfill necessary tasks like cooking. The mood symptoms associated with the person’s depression may be profound and enduring and could involve deep feelings of hopelessness and/or emptiness or feeling that “life is meaningless” or having feeling “empty”.
The presence of suicidal thoughts or self-harm risk are critical indicators of the severity of depression in the context of NHS assessments and are always considered carefully when assessing severity. Although not everybody with severe depression will have suicidal thoughts, suicidal ideation can be of critical importance in these assessments, and may signify that a higher level of urgent or specialist care is required.
The physical symptoms of severe depression may include considerable amounts of energy and also include major changes in appetite/weight and considerable disturbances of sleep (which may be manifested by insomnial) or hypersomnia, slowness of thought, speech or movement.
How the NHS Assesses Severity
If you have presented to the NHS you are likely to be offered an initial assessment, where a GP or mental health practitioner will talk about the symptoms that you are experiencing and how they are affecting your day to day life and when they developed. Questions that could be asked in the assessment would be regarding your mood, sleep and energy levels, concentrations and whether you are feeling suicidal. This assessment is not to give you a diagnosis; but instead it is to work out which treatment will be best for you.
For moderate to mild depression patients may be offered treatment via NHS Talking Therapies; and be offered something such as Cognitive Behavioural Therapy, counselling or guided self-help. Severe cases will typically be managed with treatment involving therapy, antidepressants (if appropriate), or with enhanced levels of monitoring and support from mental health practitioners. A referral to an expert mental health team or a crisis team might be necessary depending on the severity of illness, especially if the patient’s life is at risk.
When to Seek Urgent Help
Seek help immediately if depression symptoms are severe or if you’re having suicidal or harmful thoughts. Emergency services available for mental health crisis at the NHS include emergency psychiatric interventions and the services of A&E departments or crisis helplines.
In spite of the severity of depression and potential side-effects it can be successfully treated; early intervention is essential for successful recovery. The NHS is committed to safety of patients and provision of right care at right time. There is not one symptom that defines severe depression; it is about the severity of the symptoms.
It also takes into account how well daily tasks and your own safety can be maintained. If you are finding it hard to carry out everyday tasks because of depression, then you need to find help. There are various forms of treatment available through the NHS, ranging from talking therapies to specialist mental health care, dependent on how severe the depression is. Working out where symptoms sit on the scale is a way to achieve help in a timely manner
