Helping Adults With Severe Depression
August 1, 2025
Severe depression is not just feeling sad or going through a rough patch. It’s a serious medical condition that strips away your energy, motivation, and the ability to handle basic daily tasks. And it requires prompt support.
The better you understand what depression is, how it can change your thoughts and behavior, and the ways it can be treated, the better prepared you’ll be to support yourself or someone you care about.
This page will talk you through the signs of severe depression in adults and practical ways to help them.
Recognizing the Signs of Severe Depression
A major depressive episode requires at least five of the following nine symptoms present nearly every day for at least two weeks:1
Depressed mood (sadness, emptiness, hopelessness, irritability)- Markedly reduced interest and pleasure
- Appetite/weight change (gain or loss)
- Sleep disturbances (lack of sleep or too much sleep)
- Psychomotor agitation (restlessness that shows through constant movements like pacing, fidgeting, or not being able to sit still)
- Loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating
- Recurrent thoughts of death or suicidal ideation
It’s important to note that a person’s symptoms may differ depending on the severity of their depression. For example, anhedonia, which is the inability to feel pleasure, and suicidal thoughts are particularly associated with severe depression.2 In contrast, somatic symptoms like sleep disruption, appetite change, fatigue, and psychomotor slowing are more common in moderate depression.
Active suicidal ideation, suicide plans, or suicide attempts, severe agitation or psychotic symptoms (e.g., hallucinations), and extreme self-neglect (neglecting hygiene, food, or safety) can also occur in some cases of depression. If any of these signs are present, it’s important to make an urgent referral to a mental health provider.
How to Help Someone With Severe Depression
Once you recognize the signs of severe depression in a loved one, you naturally want to step in. Below are some compassionate ways you can offer meaningful support.
Listen Actively
When someone opens up about how they’re feeling, your first instinct may be to fix the problem or offer advice. But what they need most is for you to simply listen.
Active listening means giving someone your full, undivided attention. It is not simply hearing their words but showing through your responses and body language that you understand their feelings.
When someone listens without interrupting, judging, or trying to fix things, it reduces feelings of loneliness and shame. In some cases, structured listening interventions have reduced depressive symptoms in people.3
To practice active listening effectively, you want to create an environment where the person feels safe opening up. That means:
- Putting away distractions
- Maintaining gentle eye contact if appropriate
- Nodding occasionally to show you are following along
- Asking open-ended questions
- Avoiding jumping in with solutions unless they ask for advice
Encourage Treatment
According to the latest research, people with moderate to severe depression respond best to a combination of talk therapy (like cognitive behavioral therapy) and medication.4
A study also highlighted that the earlier someone begins treatment, the more effective it tends to be. In contrast, people who delayed treatment were significantly more likely to continue struggling into later stages of life.5
This means if someone you care about is struggling, gently encouraging them to seek treatment could be life-saving. However, you must approach this conversation with compassion, not pressure.
Here are some ways you can encourage treatment:
Explain that mental health care is just as important as seeing a doctor for physical illness.- Research therapists, support groups, online counseling, or low-cost clinics together.
- Offer to make calls, schedule appointments, or drive them to sessions.
- Check in regularly and offer to attend the first appointment if they want company.
- Encourage trying one or two sessions instead of committing to long-term therapy.
- Share the experiences of people who found relief through treatment
- Promote family or group therapy, since family involvement improves adherence to therapy.
Offer Positive Reinforcement
In simple terms, positive reinforcement means responding to someone’s effort, however small, with encouragement and recognition. Such a response increases the chances they will repeat the behavior.
Evidence shows that social support, when it’s positive and not overbearing, predicts lower depression symptoms over time. In one study, increases in perceived positive social support among adults in supportive housing correlated with meaningful reductions in depressive symptoms over 18 months.6
However, overly enthusiastic or forced praise may backfire. What works is consistent, authentic acknowledgment that meets the person where they are. Instead of pushing them to do more or be cheerful, you notice what they’ve already managed and let them know it matters.
Please be aware that positive reinforcement doesn’t cure depression on its own, but it helps rebuild the emotional link between effort and reward.
Supporting Someone in Case of a Life-Threatening Emergency
If someone is experiencing a life‑threatening emergency, such as active suicidal behavior or self-harm, you need to act fast and decisively.
First, don’t leave them alone, and if possible, have someone else stay with them while you act. If you believe there’s an imminent risk or they’ve acted on a plan to harm themselves, call 911 immediately, and make sure you provide:
The exact address where emergency responders should go- A clear statement that mentions a person may be attempting suicide
- Any known details about the plan, methods, timing, recent behavior, or substances involved
After you call 911, dial the 988 Suicide & Crisis Lifeline for additional expert support. You can call, text, or chat in English, and they offer trained crisis counselors who can de-escalate the situation.7 Veterans can call 988, then press “1,” or text 838255 to connect with the Veterans Crisis Line if appropriate.8
Severe Depression Treatment Options
Severe depression is treated using both medication and psychotherapy, often in hospital settings.
1. Medication
The treatment of severe depression begins with antidepressants, most commonly SSRIs (like Prozac, Zoloft, and Lexapro) and SNRIs (like Effexor and Cymbalta).
These medicines help the brain use serotonin and norepinephrine better, chemicals that play a role in how we feel emotionally. Although they are safe and effective in severe depression, they take a few weeks to work.9
If the first medication doesn’t work well enough, doctors may try a different antidepressant or add a second medicine to “boost” the effect. Sometimes, small doses of antipsychotic medications (like Abilify or Rexulti) or a mood stabilizer like lithium may be used.
For cases where someone has tried at least two antidepressants without relief, there are newer, faster-acting options.
Esketamine (brand name Spravato) is a nasal spray given in a clinic under medical supervision. It works differently from regular antidepressants and can ease symptoms within hours or days.10 Auvelity is also a new pill that may help people feel better within the first week. However, these options are reserved for people who haven’t improved with standard medications.
2. Psychotherapy
Evidence-based psychotherapy is a structured medical treatment delivered by trained professionals to help those struggling with severe depression.
Cognitive behavioral therapy (CBT) is the most well-studied psychotherapy. It teaches people to notice negative thoughts and gently challenge them. Therapists guide patients to test those thoughts, report changes, and practice new habits. Multiple studies show that CBT reduces symptoms reliably, often as effectively as medication.11
Behavioral activation (BA) is another therapy type that focuses on what people do every day: sleeping, moving, and connecting. It encourages planning small, positive actions and celebrating when any of them happen.
Interpersonal therapy (IPT) helps people explore how relationships, grief, role changes (like job loss), or isolation may have triggered or worsened depression.
It works by strengthening social support and communication skills. In clinical studies, IPT has reliably eased severe depression when combined with medication. One large review found that IPT plus antidepressants cuts relapse better than medication alone, with tangible benefit for long-term stability.12
CBT, IPT, and BA are all first-line therapies for severe depression, but in all of them, the bond with the therapist matters a lot. A strong, trusting relationship between therapist and patient can predict improvement almost as much as the therapy method itself.
3. Hospitalization or Intensive Outpatient Programs
Hospitalization is a short-term stay in a psychiatric or specialized unit of a hospital. It’s used when someone is at immediate risk of suicide or self-harm, or is unable to care for themselves (for example, not eating, drinking, or taking medications).
In the hospital, doctors monitor the person 24/7 and start or adjust medications safely. Patients receive structured daily treatment that includes both medication management and therapy. Research shows that hospitalization reduces immediate suicide risk and can prevent a crisis from becoming fatal.
Hospital stays last a few days to a couple of weeks. Once stabilized, many people step down to a partial hospitalization or intensive outpatient program (IOP).
These programs allow people to live at home but spend several hours a day, multiple days a week, receiving treatment. Such structured, high-frequency treatment reduces severe symptoms and lowers rehospitalization rates.13
While it is hard to imagine sending a loved one to the hospital, the alternative, i.e., staying in crisis without enough support, is far more dangerous.
What Should You Do if They Don’t Want Help?
When someone you love is drowning in depression but refuses help, it’s one of the hardest places to be. Depression often makes people believe nothing can improve their situation or that asking for help is a burden to others. That mindset closes the door to treatment even when it’s desperately needed.
In moments like this, the best thing you can do is keep the connection alive without pushing too hard. Let them know you’re there and that you love them without judgment. Forcing treatment or constantly arguing with them rarely works.
Instead, small, steady acts of support create trust between you two. You can offer to do simple things like cooking a meal, watching a movie together, or handling small errands for them.
Also, make time to protect your own mental health. It’s natural to feel guilty when you step back to care for yourself. But research on caregiver stress shows that burnout can lead to resentment and worsening outcomes for the person you’re trying to help.14
Getting Help for Severe Depression at Mission Connection
If you’re watching someone you care about struggle with severe depression and you’re unsure how to help, you’re not alone. Speaking with a qualified mental health professional can make the next steps clearer.
Mission Connection provides compassionate, personalized care for adults facing serious depression. Our team of experienced clinicians works closely with each person to create a treatment plan tailored to their needs and level of support required.
We offer several levels of care, including:
- 24/7 residential mental health treatment for ongoing, structured support
- Short-term inpatient programs for crisis stabilization
- Intensive outpatient and partial hospitalization programs for those who need daily treatment while living at home
- Outpatient therapy is available both in-person and online for continued care
If you’d like to talk through treatment options for a loved one, give us a call or get started online.
References
- UpToDate. (2023). DSM-5-TR diagnostic criteria for a major depressive episode. Uptodate.com. https://www.uptodate.com/contents/image?imageKey=PSYCH%2F89994
- Bains, N., & Abdijadid, S. (2023). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/
- Hirota, M., Chiba, R., Aoyama, S., Hirano, Y., Ichikawa, K., Greiner, C., Fujimoto, H., Kayano Yotsumoto, & Hashimoto, T. (2023). Individual Nurse-Led Active Listening Intervention for Spouses of Individuals With Depression: A Pre-/Posttest Pilot Study. Journal of Psychosocial Nursing and Mental Health Services, 61(12), 1–7. https://doi.org/10.3928/02793695-20230524-01
- Dunlop, B. W. (2016). Evidence-Based Applications of Combination Psychotherapy and Pharmacotherapy for Depression. Focus, 14(2), 156–173. https://doi.org/10.1176/appi.focus.20150042
- Guidi, J., & Fava, G. A. (2020). Sequential Combination of Pharmacotherapy and Psychotherapy in Major Depressive Disorder. JAMA Psychiatry, 78(3). https://doi.org/10.1001/jamapsychiatry.2020.3650
- Tan, Z., Mun, E.-Y., Nguyen, U.-S. D. T., & Walters, S. T. (2021). Increases in social support co-occur with decreases in depressive symptoms and substance use problems among adults in permanent supportive housing: an 18-month longitudinal study. BMC Psychology, 9(1). https://doi.org/10.1186/s40359-020-00507-0
- 988 Lifeline. (2025). 988 Suicide & Crisis Lifeline. 988lifeline.org. https://988lifeline.org/
- U.S. Department of Veterans Affairs. (2020). Veterans Crisis Line: Suicide prevention hotline, text & chat. Veteranscrisisline.net; U.S. Department of Veterans Affairs. https://www.veteranscrisisline.net/
- Kovich, H., Kim, W., & Quaste, A. M. (2023). Pharmacologic Treatment of Depression. American Family Physician, 107(2), 173–181. https://pubmed.ncbi.nlm.nih.gov/36791444/
- Bahr, R., Lopez, A., & Rey, J. A. (2019). Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant. Pharmacy and Therapeutics, 44(6), 340. https://pmc.ncbi.nlm.nih.gov/articles/PMC6534172/
- Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major Depressive disorder: Validated Treatments and Future Challenges. World Journal of Clinical Cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350
- Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A. (2011). Interpersonal Psychotherapy for Depression: A Meta-Analysis. American Journal of Psychiatry, 168(6), 581–592. https://doi.org/10.1176/appi.ajp.2010.10101411
- Siciliano, R. E., McGonigle, T. W., Benningfield, M. M., Vandekar, S., Owens, M. V., Felts, B., Anderson, A. S., Cole, D. A., & Bettis, A. H. (2024). Anxiety and Depression Symptoms Improve in Partial Hospitalization Treatment for Adolescents with and without Suicidal Thoughts and Behaviors: Leveraging Measurement-Based Care and Electronic Health Record Data. Evidence-Based Practice in Child and Adolescent Mental Health, 1–16. https://doi.org/10.1080/23794925.2024.2358494
- Broxson, J., & Feliciano, L. (2020). Understanding the impacts of caregiver stress. Professional Case Management, 25(4), 213–219. https://doi.org/10.1097/ncm.0000000000000414
