Managing Uncontrolled Emotional Outbursts: A Comprehensive Guide

Severe depression can feel like emotional numbness, crushing exhaustion, and hopelessness - and it can look like withdrawal, flat affect, and a person slowly losing the ability to function the way they used to.

For many people, the hardest part is the confusion. You may still show up, reply to messages, or get through the day on autopilot, while inside everything feels heavy, empty, or unreal. Others might only notice that you seem “off,” quieter, more irritable, or less present - even if you’re trying your best to hide it. In this article, we’ll break down what severe depression feels like and look like - including the emotional and physical feelings it creates and what evidence-based treatment options can actually help.

What is Severe Depression

Severe depression, clinically known as major depressive disorder (MDD), is a serious medical and emotional condition that goes far beyond feeling sad or having a bad day. It changes how a person thinks, feels, and functions in everyday life - often affecting sleep, appetite, energy, motivation, and relationships.

According to the National Institute of Mental Health, major depressive disorder is defined by a persistently depressed mood or loss of interest, combined with other symptoms that last most of the day, nearly every day, for at least two weeks and cause significant impairment in daily functioning.

What Does Severe Depression Look Like

Changes in Behavior

People with severe depression often start pulling away from normal life. Activities that once felt simple, like texting a friend, showering, and leaving the house, can begin to feel exhausting or pointless. This is not avoidance; it is the nervous system under strain.

Social withdrawal can deepen depression, which is why understanding the negative effects of social isolation matters.

Changes in Mood and Personality

Depression does not only affect how someone feels - it changes how they relate to themselves and others. Loved ones often say the person feels emotionally distant, flat, or “not like themselves anymore.”

Common emotional changes include:

• Persistent hopelessness or pessimism
• Emotional numbness or emptiness
• Increased irritability or anger
• Loss of emotional warmth or connection

Someone with severe depression may still laugh or smile occasionally, but underneath, their emotional world feels muted, heavy, or hollow. 

Changes in Daily Functioning

Severe depression doesn’t just affect mood - it begins to interfere with basic daily tasks and responsibilities. Even when someone wants to function normally, severe depression can disrupt the brain systems responsible for motivation, focus, and decision-making. As a result, basic tasks stop feeling automatic and begin to require intense mental and physical effort.

Common changes include:

• Inability to initiate tasks, even when they matter
• Extreme mental effort to complete simple actions
• Difficulty concentrating or making decisions
• Feeling “frozen” when trying to start or finish something

What Does Severe Depression Feel Like Physically

Fatigue and Low Energy

Individuals with severe depression often feel exhausted even after sleeping for many hours. The body feels heavy, slow, and drained, as if it is running on empty. Simple actions like standing up, showering, or walking outside can feel physically demanding.

This happens because depression disrupts the brain systems that regulate energy, motivation, and stress. As a result, the nervous system stays in a depleted state, making rest feel unrefreshing and movement feel difficult.

Sleep and Appetite Changes

Severe depression often throws off the body’s natural rhythms. Some people struggle with insomnia and lie awake feeling restless or wired, while others sleep excessively but still wake up exhausted. Appetite may also change - food can lose its appeal, or eating may become a way to cope with emotional emptiness.

These shifts create a cycle:

• Poor sleep increases fatigue
• Fatigue reduces motivation
• Low motivation worsens mood
• Worsening mood further disrupts sleep and eating

Pain, Aches, and Brain Fog

Many people with severe depression experience real physical discomfort. Headaches, muscle tension, back pain, and unexplained aches are common. At the same time, thinking can feel slow and foggy - like trying to focus through a thick mental haze.

This happens because depression affects how the brain processes pain, attention, and memory. The result is not just emotional suffering, but a full-body experience that makes even thinking clearly feel difficult.

When Severe Depression Becomes a Clinical Condition

Severe depression becomes a clinical condition when it is persistent, intense, and begins to interfere with daily life. Instead of coming and going with circumstances, the low mood, numbness, or hopelessness stay present for weeks or months. People may find it hard to work, connect with others, or take care of themselves, even when they want to.

At this point, depression is no longer just a reaction to stress or loss - it is a disorder of the brain and nervous system. That is what clinicians call major depressive disorder, and it requires professional treatment, not willpower.

Treatment Options for Severe Depression

Therapy and Psychological Support

Therapy helps people with severe depression understand what is happening in their mind and learn how to change the patterns that keep them stuck. Evidence-based approaches like cognitive behavioral therapy (CBT) and trauma-informed therapy focus on how thoughts, emotions, and behaviors interact.

In therapy, people learn how to:

• Recognize distorted or self-critical thinking
• Regulate overwhelming emotions
• Rebuild motivation and connection
• Develop healthier coping strategies

Medication for Severe Depression

When depression is severe, medication can play a critical role in stabilizing mood and restoring basic functioning. Antidepressants work by helping balance the brain chemicals involved in mood, sleep, and energy. When those systems are disrupted, people may feel constantly drained, emotionally numb, or overwhelmed.

Medication does not change who someone is - it helps reduce the intensity of symptoms so the person can think more clearly, engage in therapy, and begin rebuilding daily life. For many people with severe depression, medication creates the foundation that makes other forms of treatment possible. If you want a clearer explanation of how these meds work in the brain, see our article: How do mood stabilizers work?

Structured and Intensive Care

Some people need more support than weekly therapy can provide. Structured care offers a higher level of monitoring, treatment, and stability.

This stepped approach allows treatment to match the intensity of the illness.

How Amae Health Helps People With Severe Depression

Amae Health is a specialized mental health clinic designed for people struggling with serious and persistent mental health conditions, including severe depression. Our treatment offerings go beyond surface-level symptom management - we focus on understanding the whole person and building a treatment plan that fits their unique needs.

We provide psychiatric evaluation, therapy, medication management, and structured services for people who need more than occasional support. Whether someone is newly experiencing severe symptoms or has been struggling for a long time, our team works to create stability, safety, and a path forward.

You can reach Amae Health directly or refer a loved one by contacting our clinic to begin a confidential assessment and explore the right level of care.

Comparing Spravato vs ketamine infusion treatment means comparing two versions of the same idea: using ketamine's fast action on the brain's glutamate system to treat depression that standard antidepressants haven't relieved. The best comparison so far, a 2025 meta-analysis by Mayo Clinic researchers, found no statistically significant difference in how often the two lead to response or remission. What separates them is everything around the drug: FDA status, how it's given, how quickly it tends to work, what it costs, and who pays.

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So far, neither has been shown to be the better drug.

What Is Spravato (Esketamine)?

Esketamine vs ketamine comes down to chemistry. Standard ketamine is an equal mix of two mirror-image forms of the same molecule. Esketamine is one of those forms on its own, and Spravato is esketamine delivered as a nasal spray.

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The FDA first approved Spravato in 2019 for treatment-resistant depression, taken together with an oral antidepressant, as the Mayo Clinic review notes. A second approval, again paired with an oral antidepressant, covers depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. And the most recent change came in January 2025, when the FDA added standalone use for treatment-resistant depression, as the current prescribing information shows.

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Every dose happens in a certified healthcare setting under the Spravato REMS, an FDA-required safety program. Each device delivers 28 mg, and a session uses two or three devices (56 or 84 mg), with a five-minute wait after each one. You're then monitored for at least two hours, and you can't drive again until the next day, once you've had a restful night's sleep. The label sets the early schedule: twice a week for weeks one through four, once a week for weeks five through eight, then weekly or every two weeks, adjusted to the least frequent dosing that maintains the response.

What Is Ketamine Infusion Therapy?

A ketamine infusion uses standard ketamine, both mirror-image forms together, delivered through an IV line. Ketamine has been FDA-approved as an anesthetic since 1970, but for depression, IV ketamine "remains an off-label treatment," in the Mayo Clinic review's words. Off-label prescribing is legal and common in medicine. It also means there is no FDA-approved depression regimen, so dosing schedules and safety protocols are set by each clinic.

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The most studied dose is 0.5 mg per kilogram of body weight, infused over about 40 minutes with continuous heart and blood pressure monitoring. A first course typically runs two to three infusions a week for about three to six treatments, followed by maintenance sessions on a schedule that varies from clinic to clinic.

Spravato vs Ketamine Infusion: Side-by-Side Comparison

Efficacy: What the Research Shows

The most complete head-to-head evidence is the 2025 Mayo Clinic meta-analysis in Therapeutic Advances in Psychopharmacology. The authors identified eight studies with 978 patients in total. Only one was a randomized trial, and it compared IV ketamine with an IV form of esketamine rather than the nasal spray, so the pooled comparison rests on observational studies of IV ketamine versus nasal esketamine.

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In those studies, the odds of response were 1.26 times higher with IV ketamine and the odds of remission 1.31 times higher, but neither difference was statistically significant. The authors concluded that the evidence suggests no significant difference in short-term efficacy, with a slight numerical trend favoring IV ketamine.

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Speed may be where the two differ. In one Mayo Clinic observational study included in the review, people reached remission after a median of two IV ketamine treatments, compared with seven nasal esketamine treatments. That's a real gap in lived experience. But it comes from observational data, where the people who choose or can access each treatment may differ in ways a study can't fully account for.

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So is Spravato better than ketamine infusions? On current evidence, neither has been shown to be. A randomized trial built to settle the question, called EQUIVALENCE, plans to assign 400 people to one treatment or the other for eight sessions over four weeks. Its protocol was published in 2026, and results are not yet available.

FDA Approval and Insurance Coverage

FDA approval changes who pays. Because Spravato has approved indications, insurers can write coverage criteria around it, and they typically require prior authorization and documentation of earlier antidepressant trials. Ketamine infusions for depression are off-label, so coverage is inconsistent, and many people pay out of pocket.

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The Spravato vs ketamine cost comparison has a twist. Economic modeling cited in the Mayo Clinic review found nasal esketamine unlikely to be cost-effective compared with IV ketamine from a health-system perspective. Yet an individual patient's out-of-pocket cost for Spravato may be lower, thanks to insurance coverage or manufacturer assistance. Published price estimates vary too widely by dose, frequency, and coverage to quote a single figure, so ask each provider and your insurer for the numbers that apply to you.

Side Effects and Safety Considerations

Because both drugs act on the same receptor, their side effects overlap. In Spravato's clinical trials, 48% to 61% of people developed sedation, and 61% to 84% experienced dissociative or perceptual changes, such as distortions of time or space, according to the prescribing information. Dizziness, nausea, vertigo, anxiety, and a temporary rise in blood pressure are also common, which is why blood pressure is rechecked about 40 minutes after dosing. IV ketamine produces the same family of effects, concentrated during and shortly after the infusion.

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Direct safety comparisons are limited. In one retrospective analysis included in the Mayo Clinic review, a rise in blood pressure during treatment occurred in 45% of IV ketamine patients versus 9.2% of nasal esketamine patients, and dissociative effects were also more frequent with IV ketamine, though they were described as transient. That is one retrospective study. It doesn't establish either drug as safer overall.

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Both drugs carry a potential for misuse, which shapes who is a candidate, and each has its own exclusions. Spravato, for example, isn't used in people with aneurysmal blood vessel disease, an arteriovenous malformation, or a history of bleeding in the brain.

What Influences the Choice Between Them

There isn't a universal right answer. A psychiatrist weighing the two usually considers:

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• Coverage and cost. Whether insurance will cover Spravato in your situation, and whether infusions are affordable out of pocket.
• How quickly relief is needed. Early data suggest infusions may reach remission in fewer sessions, which matters more when symptoms are severe.
• Medical history. Blood pressure, vascular conditions, and any history of substance misuse.
• Route. Some people would rather avoid an IV line. Others prefer an infusion that can be slowed or stopped.
• Logistics. Spravato means at least two hours in the clinic and no driving until the next day, twice a week at first. Infusions take about 40 minutes, plus recovery time that varies by clinic.
• Continuity. Whether you're already established with a psychiatrist or clinic that offers one of them.

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The choice belongs in a conversation with a psychiatrist who knows your treatment history, not in a ranking of favorites.

Making the Decision With a Psychiatrist

Spravato and ketamine infusions are tools for treatment-resistant depression, not a complete plan. They work alongside medication, therapy, and ongoing psychiatric care, and they sit among other options, including TMS therapy for depression that hasn't responded to medication. When depression brings thoughts of suicide, care for suicidal thoughts comes first.

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We don't offer Spravato at Amae. Our psychiatrists treat depression that hasn't responded to medication through our integrated care model, with therapy, medication management, and TMS, which we provide in Los Altos, San Mateo, and Los Angeles. Whether the question is Spravato vs ketamine infusion or something else entirely, talk through your options with an Amae psychiatrist, including ones we don't provide ourselves. For anyone in crisis right now, 988 is a call or text away.

Frequently Asked Questions

Is Spravato more effective than ketamine infusions?

Not on current evidence. A 2025 meta-analysis found no statistically significant difference in response or remission between IV ketamine and nasal esketamine, only a slight numerical trend favoring IV ketamine. Most of that evidence is observational, and a large randomized head-to-head trial is still underway.

Which works faster, Spravato or ketamine infusions?

IV ketamine may reach remission in fewer sessions. In one observational study, the median was two IV infusions versus seven nasal esketamine treatments. Because that finding comes from observational data rather than a randomized trial, treat it as preliminary.

Is Spravato safer than ketamine infusions?

Neither has been established as safer overall. The two share a similar side-effect profile because they act on the same receptor. One retrospective comparison found more blood pressure spikes and dissociation with IV ketamine, but a single study can't settle the question, and individual risk depends on your medical history.

Why is Spravato covered by insurance but ketamine infusions often aren't?

Spravato has FDA approval for treatment-resistant depression, which gives insurers defined criteria for covering it, usually with prior authorization. IV ketamine for depression is off-label, so coverage is inconsistent and infusions are often self-pay.

Can I switch between Spravato and ketamine infusions?

That's a clinical decision to make with a psychiatrist, based on how you've responded, the side effects you've had, your goals, and your coverage. It isn't something to change on your own.

How many sessions does each treatment typically require?

Spravato starts at twice a week for four weeks, then weekly, then weekly or every two weeks based on response. Ketamine infusions often begin with three to six sessions given two to three times a week, followed by maintenance on a schedule that varies by clinic.

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Citations

1. Elmosalamy A, Tarikogullari I, Patarroyo-Rodriguez L, et al. Intravenous ketamine versus esketamine for depression: a systematic review and meta-analysis. Therapeutic Advances in Psychopharmacology. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12615959/ (Tier 1)
2. U.S. Food and Drug Administration. SPRAVATO (esketamine) nasal spray prescribing information, revised January 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf (Tier 2)
3. Wilkinson ST, Prashad S, Dalthorp R, et al. Non-inferiority, comparative effectiveness study of intravenous ketamine v. intranasal esketamine for treatment-resistant depression: the EQUIVALENCE trial protocol. Contemporary Clinical Trials. 2026;164:108273. https://pubmed.ncbi.nlm.nih.gov/41780747/ (Tier 1, trial protocol)
4. 988 Suicide and Crisis Lifeline. https://988lifeline.org (Tier 2)

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If you or someone you know is in immediate danger or having thoughts of self-harm, call 911 or go to the nearest emergency room. You can also call or text the Suicide & Crisis Lifeline at 988 for free, confidential support 24/7.

You're lying awake at 3 AM with your mind racing through tomorrow's worries, yet feeling too drained to care about things you once loved. Your heart pounds during everyday situations, but you're also pulling away from friends and family.

If this sounds familiar, you're not alone — anxiety and depression often appear together, creating a complex web of symptoms that can feel overwhelming. Understanding what's happening in your mind and body, recognizing the signs, and being aware of effective treatments can help you regain control.

If you’re wondering how to ask for help when depressed, start by choosing one trusted person, describing what you’re experiencing in simple terms, and asking for specific support. Professional help from therapists or mental health clinics can provide guidance when symptoms feel overwhelming.

How Are Anxiety and Depression Connected?

The relationship between anxiety and depression is more common than many people realize. Mental health professionals refer to this as "comorbidity" — when two conditions occur together in the same person. Research shows that about half of people diagnosed with major depression also experience significant anxiety symptoms, and vice versa.

These conditions often feed off each other in a cycle that can be difficult to break. Anxiety frequently comes first, with constant worry and fear gradually wearing down your emotional reserves. This mental exhaustion can lead to hopelessness and low energy characteristic of depression. Conversely, when you're depressed and withdrawing from activities, you might develop anxiety about your changing relationships, work performance, or ability to function normally.

The cycle looks like this: persistent worry leads to emotional and physical exhaustion, which triggers a low mood and avoidance behaviors, creating more situations to worry about. Understanding this connection helps explain why treating both conditions together often produces better outcomes than addressing them separately.

What Is Anxiety?

Anxiety is your body's natural alarm system gone into overdrive. While everyone experiences worry and fear sometimes, anxiety disorders involve excessive, persistent worry that interferes with daily life. The core features include hyperarousal (your nervous system staying "revved up") and worry that feels impossible to control.

Common anxiety symptoms include:

• Restlessness or feeling keyed up
• Racing heart or rapid breathing
• Difficulty sleeping or staying asleep
• Stomach upset or digestive issues
• Muscle tension, especially in the shoulders and jaw
• Difficulty concentrating due to racing thoughts

Anxiety disorders come in several forms. Generalized Anxiety Disorder (GAD) involves worry about many different areas of life. Panic disorder features sudden, intense episodes of fear. Social anxiety centers on fear of judgment in social situations, while specific phobias involve intense fear of particular objects or situations.

What Is Depression?

Depression goes far beyond temporary sadness or "having a bad day." It's a persistent condition that affects how you think, feel, and function. The hallmark features include prolonged low mood, loss of interest or pleasure in activities you once enjoyed, and significant fatigue that is not relieved by rest.

Depression also commonly involves feelings of guilt or worthlessness, difficulty concentrating or making decisions, changes in appetite and sleep patterns, and physical symptoms like headaches or unexplained aches. In severe cases, people may have thoughts of death or suicide.

Signs You May Have Both Disorders

When anxiety and depression occur together, symptoms can overlap and intensify each other. You might notice both the hyperarousal of anxiety and the low energy of depression, creating an exhausting internal conflict between feeling wired and tired simultaneously.

Watch for these combined symptoms:

• Racing thoughts mixed with feelings of hopelessness
• Fatigue coupled with restlessness or inability to sit still
• Difficulty sleeping due to both worry and low mood
• Loss of appetite from anxiety alongside changes in eating changes
• Avoiding social situations due to both fear and lack of interest
• Physical symptoms like headaches, rapid heartbeat, and muscle tension
• Irritability that stems from both anxiety and depression
• Trouble concentrating, whether from racing thoughts or mental fog
• Withdrawing from activities you once enjoyed
• Feeling overwhelmed by everyday tasks and decisions

If these symptoms are affecting your work, relationships, or daily functioning for two weeks or more, it's time to seek professional help.

How Clinicians Diagnose

Mental health professionals use several approaches to diagnose anxiety and depression. The process typically begins with a comprehensive clinical interview where you'll discuss your symptoms, their duration and severity, family history, and how they're impacting your life.

Your clinician will also rule out medical causes, as conditions like thyroid disorders, heart problems, or certain medications can mimic anxiety and depression symptoms. Blood tests or other medical evaluations might be recommended.

Many professionals use brief, standardized screening tools like the GAD-7 for anxiety and the PHQ-9 for depression. These questionnaires help quantify symptom severity and track improvement over time. At Amae Health, our clinicians combine thorough interviews with these validated assessments to ensure accurate diagnosis.

Getting a clear diagnosis is crucial because it guides treatment decisions. When both conditions are present, integrated treatment approaches that address the relationship between anxiety and depression tend to be most effective.

Evidence-Based Treatment for Anxiety and Depression

Psychotherapy

Several types of therapy have strong research support for treating anxiety and depression together. Cognitive Behavioral Therapy (CBT) is often considered the gold standard, helping you identify and change negative thought patterns that fuel both conditions. You'll learn to recognize cognitive distortions — like catastrophic thinking that worsens anxiety or all-or-nothing thinking that deepens depression.

For anxiety specifically, exposure therapy gradually helps you face feared situations in a safe, controlled way. This reduces avoidance behaviors that often contribute to depression as well. For depression, behavioral activation focuses on gradually re-engaging with meaningful activities, which can also reduce anxiety by providing structure and accomplishment.

Medications

Several medications effectively treat both anxiety and depression simultaneously. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are typically first-line treatments because they address the underlying brain chemistry involved in both conditions.

These medications typically take 4-6 weeks to show full benefits, although some people may notice improvements earlier. Common side effects may include initial nausea, headaches, or changes in sleep patterns, but these often improve as your body adjusts. Your prescriber at Amae Health will closely monitor your progress, adjusting dosages as needed and watching for any concerning side effects.

It's essential to work closely with your healthcare provider throughout the medication process, as finding the right medication and dosage can be a time-consuming and patient process.

Lifestyle & Skills

Lifestyle changes play a crucial role in managing both conditions. Maintaining a consistent sleep schedule helps regulate mood and reduce anxiety. Regular exercise — even just 20-30 minutes of walking daily — can be as effective as medication for mild to moderate depression and significantly reduces anxiety symptoms.

Limiting alcohol and caffeine helps stabilize mood and reduce physical anxiety symptoms. Simple coping skills can also make a significant difference:

• Deep breathing exercises to calm your nervous system
• Grounding techniques using your five senses during anxiety spikes
• Setting aside "worry time" to contain anxious thoughts
• Progressive muscle relaxation to reduce physical tension

For individuals who don't respond adequately to standard treatments, options like Transcranial Magnetic Stimulation (TMS) may be considered as additional treatment approaches.

When to Seek Urgent Help

While anxiety and depression are treatable conditions, certain warning signs require immediate attention. Please seek emergency help if you or someone you know experiences suicidal thoughts, plans, or intentions, self-harm behaviors, inability to care for basic needs like eating or hygiene, signs of psychosis such as hallucinations or delusions, or dangerous substance use that puts safety at risk.

How Our Amae Health Clinic Can Help

At Amae Health, we understand the complex relationship between anxiety and depression and offer comprehensive, integrated care. Our approach begins with a same-week evaluation where our experienced clinicians conduct thorough assessments to understand your unique situation.

We then develop personalized treatment plans that may include therapy (or group therapy), medication management, or both, depending on your needs and preferences. Our team coordinates care to ensure all aspects of your treatment work together effectively, addressing both conditions simultaneously rather than in isolation.

We accept most major insurance plans and offer telehealth options for convenient access to care. Our goal is to help you not just manage symptoms, but rediscover joy and confidence in your daily life.

Ready to take the first step toward feeling better? Contact Amae Health today to schedule your comprehensive assessment and begin your journey toward improved mental health.

Medical Disclaimer

This blog post is provided by Amae Health for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition, treatment options, or before making any changes to your medication regimen.

Reliance on any information provided in this article is solely at your own risk. If you believe you are experiencing a medical emergency, call 911 (or your local emergency services) immediately.

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