Moderate Depression: Symptoms, Treatment, and Coping

While everyone feels down from time to time, depression is a serious mental health condition that can make it difficult to function normally. But depression can vary in intensity. How depression is experienced can vary from one person to the next, and the condition can also be classified as either mild, moderate, or severe.

One survey found that among U.S. adults with depression, approximately 20% had mild symptoms, 50% had moderate symptoms, and 30% had severe symptoms.

When a major depressive disorder is diagnosed, it is typically classified by the degree of severity (mild, moderate, or severe) as well as whether or not there are psychotic features or a seasonal pattern. Moderately severe depression is marked by symptoms of depression that can affect a person’s ability to function normally. It may differ from mild depression in terms of severity and frequency of symptoms that a person experiences.

Someone with moderate depression may experience symptoms that are more serious in terms of severity and duration than someone with mild depression. They may also experience more symptoms than a person with mild depression does.

However, moderate depression is not listed as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). There is no official consensus on whether the number of symptoms is indicative of severity or whether the number of symptoms can be used to classify depression as mild, moderate, or severe.

Moderate Symptoms of Depression

Moderately severe depression is marked by two main symptoms: persistent low mood and decreased interest in activities. Some of the other symptoms of depression include:

• Avoiding social activities
• Changes in appetite
• Decreased productivity
• Despair and guilt
• Difficulty concentrating
• Difficulty sleeping
• Excessive worry
• Fatigue or lack of energy
• Feelings of hopelessness
• Irritability
  
• Lack of motivation
  
• Low self-esteem
  

Women are almost twice as likely to experience depression as men. While moderate depression may be less severe, it does cause impairments in work, school, home, or social difficulties.

Research also suggests that moderately severe depression increases certain health risks. One study found that people who were moderately depressed had a higher risk of cardiovascular disease compared to those who were severely depressed.

Diagnosis

In order to diagnose your condition, your doctor may perform a physical exam, ask questions about your medical history, and conduct lab tests to help rule out any underlying medical conditions that might be causing or contributing to your symptoms. Hypothyroidism, or an underactive thyroid, is one condition that can lead to symptoms of depression, for example.

Your doctor will also ask questions about the symptoms that you have been experiencing including the type of symptoms you have, how long you have had them, and the degree to which they impact your life in different areas.

The diagnosis of depression depends on the clinical judgment of a doctor, psychiatrist, or psychologist. Doctors and mental health professionals use the DSM-5 to help guide these diagnostic decisions. The DSM-5 is published by the American Psychiatric Association and outlines diagnostic criteria for mental health conditions, including depression.

In order to be diagnosed with clinical depression, a person must exhibit at least five of the nine symptoms listed in the DSM-5 during a two-week period. 

These symptoms of depression are:

• Feeling depressed or irritable most of the day, every day
• Losing interest or pleasure in activities most of the day
• Sleep difficulties, including sleeping too much or too little
• Changes in motor activity
• Low energy or fatigue
• Changes in weight
• Feelings of worthlessness
• Difficulty concentrating
• Suicidal thoughts or behaviors

Such symptoms may vary in intensity and duration in someone with moderate depression. They may experience some of these symptoms some weeks, but not others.

Where people with mild depression may be able to carry out their normal daily activities without much impairment, the symptoms of moderate depression are serious enough to create problems with work and home life. People with moderately severe depression may struggle to complete daily tasks or feel fatigued and unmotivated. At work, they may struggle to concentrate on projects. Symptoms can also lead to problems in social relationships as well.

Differential Diagnosis

Your doctor will also want to rule out other mental health conditions that can cause symptoms of depression. Such conditions include:

• Persistent depressive disorders (dysthymia): This type of depression is less severe than major depression but tends to be longer-lasting.
• Premenstrual dysphoric disorder (PMDD): This condition involves symptoms of depression that are experienced the week before and during a menstrual cycle.
• Bipolar disorders: Bipolar I and II are marked by mood swings that include periods of depression.

Distinguishing Between Moderate and Severe Depression

While there is no clear consensus on how to rate the severity of depression, one study found that DSM-5 diagnostic criteria could be used to infer the severity of the condition. 

People with moderate depression are more likely to experience primary symptoms of low mood, sleep difficulties, weight or appetite changes, and increased/slowed psychomotor activity.

Anhedonia (the loss of interest or pleasure) along with non-somatic symptoms was an indicator of severe depression. Along with losing interest in things that used to be pleasurable, people with severe depression are more likely to experience symptoms such as feelings of worthlessness and thoughts of death.

Causes

Depression is very common. According to the World Health Organization (WHO), it is the leading cause of ill health and disability globally.

There is no single thing that causes depression. In reality, there are a number of factors that are thought to contribute to the onset of depression. Sex is one factor that can play a role since women experience depression at about twice the rate of men. Other things that can contribute to depression include:

• Genetics
• Having parents or other family members with depression
• Having another mental health condition
• Poverty
• Chronic health conditions
• Certain medications

Moderate Depression Treatments

Moderately severe depression may be treated with psychotherapy, medication, or a combination of the two. 

Psychotherapy

Cognitive behavioral therapy (CBT) is a form of therapy that is often used to treat depression. CBT focuses on identifying negative thoughts that contribute to symptoms of depression. Once these thought patterns have been identified, people then work to replace those thoughts with more positive and realistic ways of thinking. 

CBT tends to be a shorter-term approach to therapy, so it may involve somewhere between 10 and 20 sessions. During this time, you will also be expected to do homework outside of your therapy sessions. This might involve practicing skills that you have learned during therapy as well as keeping a record of your symptoms, thoughts, and behaviors. 

Examples of types of thinking that can contribute to symptoms of moderate depression include:

• Overgeneralization, which involves applying one experience to all future experiences.
• Automatic negative thoughts, which are types of thoughts that are self-defeating and irrational.
• All-or-nothing thinking, which involves thinking of things in absolute terms. This type of thinking causes people to see themselves in terms of extremes, either as successes or failures with no room for anything in between.
• Ignoring or discounting positive experiences, which involves only focusing on the negative things that happen while not paying attention to the good things.
• Magnifying problems, which can involve blowing up even small problems into much more serious issues than they really are.
• Taking things personally, which can lead to feelings of blame, regret, or resentment.

Through journaling, you can begin to become more aware of these thought patterns and practice new ways of thinking about your experiences and problems. It can also help you replace negative self-talk with more positive self-talk.

Other types of therapy that can be used to treat moderately severe depression include:

• Dialectical behavior therapy (DBT): This approach is a form of CBT that focuses on helping people with depression learn to tolerate distress, regulate their emotions, and improve their relationships with others. 
• Interpersonal therapy (IPT): This approach focuses on understanding how relationships with others can impact depression. People then work to improve these social relationships and resolve existing conflicts.
• Psychodynamic therapy: This form of talk therapy, sometimes known as psychoanalytic therapy, focuses on helping people identify unconscious and unresolved conflicts that lead to troubling feelings.

Medications

There are a number of different types of antidepressants that can be used to treat moderately severe depression. The most commonly prescribed are known as selective serotonin reuptake inhibitors (SSRIs). These include medications like Zoloft (sertraline), Prozac (fluoxetine), and Paxil (paroxetine). 

While SSRIs are usually the preferred choice because they tend to have fewer side effects, other medications are sometimes prescribed. Other types of antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), atypical antidepressants, and tricyclic antidepressants.

Complementary and Alternative Treatments

There are some alternative remedies that may be helpful for some people who have mild to moderate depression. St. John's wort, for example, is one herbal supplement that is sometimes used to help alleviate symptoms of mild to moderate depression. While the supplement is not FDA-approved for the treatment of depression, some research suggests that it may help reduce symptoms.

Because St. John's wort affects serotonin levels in the brain, it can lead to a serious condition known as serotonin syndrome. It can also interact with other medications, including antidepressants. You should always talk to your doctor before trying any complementary treatment such as St. John's wort.

Coping

While antidepressants are the most effective choice for people who have severe depression, lifestyle modifications may be a helpful choice for people who have more mild or moderate symptoms.

Get Regular Exercise

Regular physical activity has been shown to help prevent and treat depression. Studies have even shown that exercise can be an effective first-line treatment in cases of mild to moderate depression.

The good news is that you don't have to become a gym devotee to reap these depression-fighting rewards. Moderate physical activity, such as walking for a total of three hours a week, can help.

Manage Stress Levels

Stress can contribute to and worsen symptoms of moderately severe depression, so finding ways to relax and manage your stress levels can be helpful. One way to do this is to focus on relaxation techniques designed to improve your ability to tolerate and manage distressing emotions.

When faced with distress, people often rely on unhelpful coping mechanisms that can worsen symptoms of depression. Some more helpful strategies include yoga, deep breathing, meditation, and mindfulness. 

Take Care of Yourself

Practicing good self-care can be helpful when coping with symptoms of depression. It is important to remember, however, that depressive symptoms can often make taking care of yourself more difficult. Feeling fatigued, unmotivated, disinterested, and distracted can interfere with normal daily tasks. 

While it may require extra effort, doing some of the following can help you feel better:

• Eat a healthy diet
• Seek out social support
• Engage in activities you enjoy

Try to avoid isolating yourself when you are feeling down. Depression often causes people to withdraw from friends and loved ones, but reaching out to the people who care about you can actually help reduce feelings of depression.