Stages of depression

Does depression occur in stages?

Symptoms of depression are often different for everyone. Some individuals may experience a few symptoms, while others experience many. In addition, the severity of symptoms can vary from person to person.

Symptoms of depression can include ^[1]:

• Low mood
• Feelings of sadness and emptiness
• Feelings of worthlessness, helplessness, and guilt
• Feeling irritable, angry, and restless
• Feeling very low on energy and lethargic
• Little interest or motivation in hobbies and activities
• Impaired concentration and memory
• Changes in sleep patterns, such as sleeping far more than usual or disturbed sleep
• Changes in appetite, such as eating far more than usual or not feeling hungry at all
• Withdrawing from friends and family, becoming socially isolated
• Decline in self-care and hygiene
• Thoughts or attempts of self-harm or suicide

The occurrence and progression of depression is not typically referred to in stages. However, some people may view the stages of depression as ^[2][3]:

1. No symptoms of depression
2. Early or emerging signs of depression
3. Depressive episode
4. Recovery from depression

The length and severity of these stages vary depending on the person and how the condition is managed.

Additionally, some people may experience recurring episodes of depression before entering the recovery stage. Some individuals may also experience fluctuations in their symptoms’ severity and overall well-being. As such, the stages of depression may also refer to the severity of symptoms, such as mild, moderate, and severe ^[4].

Depression can, however, be a stage of other conditions or episodes of distress. For example, depression is often associated with the five stages of grief, which occur following the death of a loved one ^[5]. 

It’s important to note, however, that depressive symptoms and a clinical depression diagnosis are not the same thing. For example, someone experiencing bereavement of a loved one wouldn’t be diagnosed with depression, although they can certainly experience depression alongside bereavement. It’s also important to remember that the stages of grief are not the same as the stages of depression.

What are the five stages of grief?

Dr. Elizabeth Kübler-Ross initially discussed the five stages in 1969 to understand and outline the reaction to terminal illness and expected death ^[6]. This model was later applied to general loss, including grief and significant life changes.

The five stages of grief, dying, or loss are ^[5][6]:

1. Denial: A defense mechanism to avoid distress, preventing the individual from discussing and understanding the situation.
2. Anger: As the situation begins to be recognized as reality, individuals become angry at others, such as healthcare providers, family members, or other people or entities, for allowing the situation to occur or not preventing it.
3. Bargaining: The individual attempts to negotiate to alter the situation, potentially with healthcare providers or in a religious or spiritual context, sometimes with irrational thoughts or suggestions.
4. Depression: The first three stages may be seen as protection from or avoidance of the distress that the situation causes. In this stage, the individual begins to experience and express their pain and anguish.
5. Acceptance: Once the individual has accepted the situation, whether it is their imminent death, the loss of a loved one, or another significant change, they may start to make necessary adjustments or plans to accommodate for this experience.

These stages are widely known and utilized, although this model has other variations. For example, due to negative connotations, some have questioned the use of specific terms, such as ‘denial.’ Similarly, some consider this model too linear and believe that the experience of grief and loss can be fluid and fluctuating ^[5][7].

However, recognizing the stages of grief can help provide therapeutic support and intervention. They can also help others to understand and empathize with any changes in mood and behavior that can occur throughout the process ^[5][7].

When to seek professional help

If you are experiencing signs and symptoms of depression or are struggling to cope with the stages of grief, it is advisable to seek professional help as early as possible. Professional intervention can help you manage your emotional distress and find ways to cope with and reduce your symptoms.

Left untreated, symptoms of depression can worsen and cause increasing issues with functioning and well-being. Treatment can include therapy, medication, and self-care techniques ^[1].

Therapy

Various types of therapy can be used to help manage symptoms of depression or emotional distress. This could include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), family therapy, or group therapy ^[8].

Therapy can provide an opportunity to ^[1][8]:

• Understand the impact of the condition and its symptoms
• Explore underlying causes of depression
• Discuss emotional difficulties and experiences
• Learn helpful coping strategies
• Challenge negative thoughts and behaviors
• Improve interpersonal relationships and communication
• Receive support in moving past emotional or practical challenges

Medication

Antidepressant medication can help with managing symptoms of depression. There are several types of antidepressant medication, and the effects can vary from person to person. An individual may need to try more than one medication before finding one that works well for them.

Your doctor may prescribe you a selective serotonin reuptake inhibitor (SSRI), such as citalopram, sertraline, or fluoxetine, as these are generally effective with a low risk of side effects. However, if this medication is ineffective or inappropriate, other types of antidepressants can be prescribed ^[8].

If your doctor feels this is appropriate or necessary for you, your doctor may also prescribe other medications, such as sleeping tablets or anti-anxiety medications. This will depend on your symptoms and your response to the medications.

To prevent adverse effects, you must continue taking medications exactly as your doctor has prescribed ^[1].

Self-care

When experiencing symptoms of depression or any other emotional distress, it is important to try and look after your general well-being. There are several ways to maintain or improve self-care, such as ^[1]:

• Eating well and staying hydrated
• Getting plenty of good quality sleep
• Engaging in regular exercise
• Getting outside in fresh air and nature
• Spending time with friends and loved ones
• Engaging in hobbies and enjoyable activities
• Utilizing relaxation and mindfulness exercises
• Talking about your feelings and worries with loved ones