Severe or Major depression causes considerable distress or agitation, loss of self-esteem or feelings of uselessness and guilt. We are unlikely to be able to continue with work, social and domestic activities. Severe (or Major) depression usually causes severe enough symptoms for a change to be noticeable by those around us even if we try to mask how we are feeling.

Suicide is a distinct and major danger. While we may be managing one moment, we can plummet very quickly into feelings of hopelessness and despair. It is common for people to feel that they are somehow responsible and 'to blame' for the way they are feeling and believe that others are better off without them. 

It is vital that professional help and treatment is sought as soon as possible and that treatment is adhered to. As with all major illnesses, during major depression we need additional support on a daily basis both in managing the symptoms and to provide help with treatment.

People with severe depressive episodes may also suffer from delusions, hallucinations or depressive stupor although these are less common.