Defining the 'degree' or 'severity' of depression ie if it is mild, moderate or severe, requires an extensive medical judgement that involves the number, type, and severity of the symptoms present.

Mild depression usually causes symptoms that are detectable and impact upon our daily activities. We are less interested in doing things we previously enjoyed, unusual irritability, reduced motivation in work, home or social activities are common however we continue to function - just perhaps not as well as we normally would do when healthy.

Mild depression often goes undiagnosed because the symptoms are not considered to be 'bad enough' for people to think they may have depression and discuss it with their doctors or other people. However accurately diagnosing depression when it is mild, and treating it effectively at this stage can prevent the condition from worsening to become moderate or severe.

There are also more treatment options available for mild depression. Lifestyle changes such as regular exercise, relaxation, ensuring sufficient and regular sleep, etc are often sufficient. Natural therapies such as St John's Wart may also be effective treatments for depression if it is diagnosed early - when 'mild'.

Moderate depression can cause real difficulties with social, work and domestic activities. The characteristics described for mild depression are worse here - by definition. A reduced interest in normally pleasurable activities becomes no interest - a real lack of interest and motivation. Simple things start to require real effort or just get neglected.

With moderate depression there is usually a detectable reduction in self confidence and/or self esteem which can have a 'snowball' effect as we become less motivated and hence less productive. Often we start to worry about things unnecessarily such as performance at work, even if we are managing to maintain our previous standards, or more sensitive and susceptible to feeling hurt or offended within personal relationships.

Again, there are more treatment options available and the time it will take to recover from moderate depression will be less than if it is left untreated and develops into major depression. Cognitive Behavioural Therapy (CBT) can be very effective and some natural therapies may still be helpful, although it is essential that you discuss this with your doctor to ensure you use the most effective treatment option and don't waste time, money and energy on treatments that aren't doing anything. This only gives the illness an opportunity to worsen as it is not being effectively treated.

If medication is required, you are likely to be need a lower dose for moderate depression than for major depression. Lifestyle improvements always have a positive impact, however can take more effort to actually do as the depression becomes more severe.

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. A person with major depression will usually experience most, if not all of the symptoms listed on 'Symptoms of depression'.

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 thery 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.

General Comments
One of the most insidious aspects of depression is that there is a tendency to attribute the symptoms to other factors in our lives. A lack of enjoyment, motivation or increased irritability at home may be considered to be due to a (possibly non-existent) problem with personal relationships. Similarly we may start to consider changing jobs believing that it is the external environment that is responsible when in fact it is a treatable illness affecting our interpretation of the external environment.

What often happens is that in looking to our environment to find the reasons for what are symptoms of an illness, we try to 'fix' things that are not broken which can have a very real destructive impact on our lives. Obtaining an accurate diagnosis and getting the most effective treatment for you, will make an enormous difference.

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