What Level of Depression Involves Self-Harm?

Self-harm is often associated with significant mental health concerns, particularly depression. When a person has been diagnosed with depression and engages in self-harming behaviors, it typically indicates moderate to severe depression based on the Self-Rating Depression Scale (SDS) and clinical evaluation. However, a definitive classification requires a comprehensive assessment of other symptoms and clinical indicators.

Key Symptoms of Depression

Understanding the broader symptom profile is essential in determining the severity of depression. The three core symptoms include persistent low mood, diminished interest in activities, and loss of pleasure (anhedonia). These are central to a depression diagnosis and must be evaluated alongside additional symptoms.

Additional Symptoms That Influence Severity

Depression may also present with various secondary symptoms such as slowed thinking, impaired cognitive function, negative thought patterns, suicidal ideation or behaviors, psychomotor retardation or agitation, and psychotic features. The number and intensity of these symptoms help determine whether the depression is moderate or severe.

A diagnosis of moderate depression typically involves two core symptoms plus at least three or four secondary symptoms. In contrast, severe depression is characterized by all three core symptoms and at least four or more additional symptoms, significantly impairing daily functioning and emotional well-being.

Treatment Options for Moderate to Severe Depression

For individuals experiencing moderate to severe depression, prompt and effective treatment is crucial. Antidepressant medications are often a cornerstone of therapy and include several major classes:

Tricyclic antidepressants (TCAs): such as amitriptyline, doxepin, imipramine, and clomipramine.
Selective serotonin reuptake inhibitors (SSRIs): including fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine.
Serotonin-norepinephrine reuptake inhibitors (SNRIs): like venlafaxine and duloxetine.
Reversible monoamine oxidase A inhibitors: such as moclobemide.
Norepinephrine and specific serotoninergic antidepressants (NaSSAs): for example, mirtazapine.
Selective norepinephrine reuptake inhibitors: like reboxetine.

These medications can help regulate brain chemistry and reduce symptoms of depression over time.

Complementary Psychological Therapies

In addition to medication, psychological interventions play a critical role in recovery. Evidence-based therapies such as supportive therapy, cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and family or couples therapy can provide valuable tools for coping and emotional regulation. This is especially important for patients who experience slowed thinking, difficulty concentrating, or trouble communicating effectively.

Alternative and Adjunctive Treatments

When traditional treatments are not sufficient, physical therapies can be considered. These include:

Electroconvulsive therapy (ECT)
Transcranial direct current stimulation (tDCS)
Vagus nerve stimulation (VNS)
Deep brain stimulation (DBS)
Repetitive transcranial magnetic stimulation (rTMS)
Light therapy

These modalities can be particularly helpful for individuals who do not respond well to medication or who experience a delayed response and are at risk for relapse.

Important Considerations About Self-Harm

It's important to note that self-harm is not exclusive to depression. It can also be a symptom of other conditions such as bipolar disorder, borderline personality disorder, substance abuse, alcoholism, or impulsive and aggressive personality traits. If you or someone you know is engaging in self-harming behavior, it is crucial to seek professional support as soon as possible.

References

[1] Hao Wei, Lu Lin. Psychiatry [M], 8th Edition. Beijing: People's Medical Publishing House, 2018: 110.

[2] Tian Bo (Ed.). Modern Psychiatric Disorders and Mental Health [M]. Beijing: Science and Technology Literature Press, 2019: 219-222.