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The rules on "Instant Death" state:

Massive damage can kill you instantly. When damage reduces you to 0 hit points and there is damage remaining, you die if the remaining damage equals or exceeds your hit point maximum [...]

Does this only apply if you aren't already at 0 HP? Or rather, what happens if you are currently at 0 HP and take massive damage?

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Yes, Massive Damage can kill you at 0 HP

Damage at 0 Hit Points. If you take any damage while you have 0 hit points, you suffer a death saving throw failure. If the damage is from a critical hit, you suffer two failures instead. If the damage equals or exceeds your hit point maximum, you suffer instant death.

Death Saving Throws, Player's Handbook, pg. 197

Mathematically, this is equivalent to the normal rule that occurs when a character is above 0 hit points, so it makes perfect sense that they would reimplement the rule here in precisely this manner.

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