What Are The Stages Of Depression?
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While many people experience moments of sadness, depression goes beyond occasional sadness, involving persistent feelings of sadness or hopelessness that can significantly interfere with functioning. However, if you experience symptoms of depression, you're not alone. According to the Anxiety and Depression Association of America, over 260 million people worldwide live with this mental illness.
Depression is often included in the "five stages of grief" framework as the fourth stage. For this reason, some may wonder if depression also has stages that can be tracked and understood. However, it may be valuable to note that depression can affect different people differently, and it may look different from one person to the next. Depression is not widely defined in stages and is often experienced through various symptoms, so understanding those symptoms may help you understand the condition.
What is depression?
Depression is a mood disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition involving a low mood for an extended period, a loss of interest in previously enjoyed activities, and a loss of motivation. The word is an umbrella term to describe any of the several depressive disorders listed in the DSM-5. The term depression is often used to refer to major depressive disorder (MDD), also known as major depression. Other depressive disorders include the following:
- Persistent depressive disorder: Persistent depressive disorder is a less severe but more persistent type of depression than MDD. It involves classic depressive symptoms lasting most days for two years or more.
- Seasonal affective disorder (SAD): Seasonal affective disorder is brought on by the changing seasons, with low mood often beginning in late fall or winter. It can also occur in areas with a lack of sun.
- Post-partum depression: Post-partum depression occurs when a person experiences depression after giving birth or adopting a child. It can impact gestational and non-gestational parents.
- Major depressive disorder with psychotic features: This form of depression involves symptoms of major depressive disorder with the addition of psychosis.
The exact causes of depression are unknown, but various factors may have an impact, including brain chemistry, hormones, inherited traits, and biological differences. In addition, various environmental risk factors may increase the likelihood of depression, including traumatic life events, a history of other mental illnesses, and serious chronic illness.
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The five stages of grief vs. depression
Dr. Elisabeth Kübler-Ross developed the five stages of grief based on her work with people diagnosed with a terminal illness. Though initially developed to describe the experiences of people facing their death, the theory has been adapted to offer a model for the various stages of grief that a person might experience when coping with any loss.
Note that this is a theory, not a psychological fact. For this reason, the stages of grief model might not make sense for everyone who has experienced loss. In addition, people might go through the stages differently or skip one or two. If the model makes sense to you, you can use it. If not, there are other theories on grief you might explore.
The five stages of grief include the following:
- Denial: When faced with loss, resisting the loss and pretending it is not happening can be common.
- Anger: Anger can also be a common reaction to loss; there might be anger or frustration about the unfair situation, and anger might feel easier to express than other emotions.
- Bargaining: In the face of loss, some people may try to make a deal to change the situation or find relief. It might involve "what if" statements or trying to appeal to a higher power.
- Depression: Experiencing profound sadness and other depressive symptoms might be a reaction to loss. These symptoms might meet the criteria for a depressive disorder or dissolve after processing the grief.
- Acceptance: Many people can accept the loss and readjust after a certain period. Acceptance might come in waves and may not be an "end state" to grief.
Although depression is a stage of grief in this model, depression and the five stages of grief are not necessarily directly related.
Does depression have stages?
Depression does not manifest the same for everyone. The amount of time it can take to develop, the symptoms, and the severity can all vary. As there are multiple depressive disorders and multiple ways to experience depression, it can be challenging to put it into neat "stages." Instead of thinking about stages of depression, you might find it helpful to consider symptoms that individuals with depression often experience.
These symptoms include but are not limited to the following:
- Pessimism
- Feelings of hopelessness or worthlessness
- Feelings of guilt
- Anxiety
- Irritability or anger
- Self-blame
- Restlessness
- Loss of interest in previously enjoyed activities
- Body aches
- Sleep disorders like insomnia
- Appetite changes
- Reduced energy and fatigue
- Difficulty remembering, concentrating, or making decisions
- Suicidal thoughts or actions
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Five possible symptoms of depression
If you prefer looking at symptoms in a linear fashion, it can be helpful to consider a few of the most common symptoms of depression. While experiences can vary considerably from person to person, the following list provides a summary of five symptoms those with depression may experience.
Maladaptive thought patterns
Depression often includes a pattern of maladaptive thoughts that are disruptive, intrusive, and difficult to dismiss. These negative thoughts may be about your appearance, work, relationships, or life in general. In addition, thoughts may be focused on the world around you or your beliefs about who you are. You may feel that situations are hopeless or that change isn't possible.
Appetite changes
Many people living with depression experience changes in appetite. Some may lose their appetite entirely, while others may begin to eat more as a coping mechanism. Some people have no changes in appetite at all. These changes are common symptoms of depression that may eventually result in weight changes.
Changes in sleep patterns
Many people with depression experience changes in sleep patterns. Some people may experience symptoms like insomnia due to racing thoughts at night or co-occurring anxiety. Others might feel so drained from symptoms that they have difficulty waking up or feel fatigued during the day, leading to extra sleep.
Self-blame
Another common symptom of depression is guilt or self-blame, including blaming yourself for your situation or past mistakes or failures. You might blame yourself for what you cannot control, including having a depressive disorder. Feeling you can't keep up with your usual activities and responsibilities could also prompt these feelings, which might turn into a cycle of feeling unworthy, helpless, and hopeless.
Difficulty caring for your needs
Some people with depression may struggle to bathe, brush their teeth, get out of bed, clean their homes, pay bills, work, or complete other essential tasks. When this occurs, they might experience more guilt or feelings of hopelessness. In severe cases, neglecting oneself might lead to health problems, loss of income, hoarding behaviors, or hygiene challenges. If you're struggling to care for yourself and don't have support, consider contacting a therapist or case manager for guidance.
Treatment options for depression
Depression is a treatable condition, and many clients find they can manage their symptoms effectively with therapy. Treatment options for depression may include cognitive-behavioral therapy, other therapeutic modalities, support groups, and medications. For some people, a combination of therapy and medication is most effective. It’s recommended that you ask a health care professional for medical advice before starting, changing, or stopping any medication.
For others living with depression, leaving the house and going to a therapist's office can feel exhausting. In these cases, you might try online therapy through a platform like BetterHelp, which offers connections to over 30,000 licensed therapists with experience in depression and other mental illnesses. With an online platform, you can choose between phone, video, and chat sessions with your therapist and reach this support from home or anywhere you have an internet connection.
Numerous medically reviewed studies have shown that online therapy can be an effective tool in reducing symptoms of several mental disorders, including anxiety, bipolar disorder, and depression. One study examined the effectiveness of an online cognitive-behavioral therapy program in improving symptoms of depression and anxiety. The researchers observed that the program significantly reduced depression and anxiety symptoms, allowing researchers to conclude that "digital interventions can support sustained and clinically meaningful improvements in depression and anxiety."
Takeaway
What helps people cope with depression?
Coping with depression can sometimes be challenging, but some strategies are likely to be helpful. One of the best approaches to addressing depressive mental health conditions may be to seek professional help from a licensed therapist. Depression can be complex and nuanced, and a therapist or other professional can help identify underlying causes, recommend coping strategies, and use evidence-based therapies to help their client recover from depression.
Other common strategies to cope with depression include engaging in physical activity, keeping a gratitude journal, and reaching out to others for support. Regular exercise is one of the most effective treatments for depression available. In some cases, exercise can be more effective than antidepressant medication.
Regularly noticing and accepting positive things in life is also associated with lowered severity of depression symptoms. Many people simplify this process by keeping a gratitude journal where they write positive things that have occurred and then review them later to choose gratitude intentionally. Finally, interacting with others is known to lower depression symptoms. Engaging with support groups and spending time with others, even if not discussing the cause of the depression directly, may help improve depressive thoughts and feelings.
What are the two best coping mechanisms to mitigate depression?
Every person’s journey through depression will look different, and everybody has their own conception of what the best coping mechanism is. Almost any coping mechanism can be helpful if it reduces depressive symptoms without inducing other medical or mental health conditions. Substance use, for example, is an unhelpful coping mechanism because it offers only short-term reduction in negative feelings but can impart serious harm to the user.
Despite individual differences, evidence suggests two especially helpful strategies: socialization and exposure to nature. Evidence suggests that positive social interactions can help reduce the severity of depression symptoms. Depression can severely limit the amount of energy a person has, but using what little energy is available to engage in socialization is likely worthwhile. Socializing also reduces loneliness, and loneliness is a strong promoter of depression.
Evidence also strongly indicates support for time spent in nature as a way to cope with depression. Nature walks have been shown to reduce the symptoms of depression significantly, including physical symptoms like trouble sleeping. If a walk isn’t feasible, simply spending time in nature is also likely to provide some benefit, but a walk combines the power of nature with the depression-reducing effects of exercise.
Does everyone go through a stage of depression?
Everyone feels sad, helpless, or hopeless at some point in their lives, but not everyone experiences depression. When a person experiences major life changes, they may feel symptoms akin to depression, such as hopelessness, a lack of pleasure, and excessive sleeping. However, these symptoms usually spontaneously resolve as life circumstances improve and the person adjusts.
According to the Diagnostic and Statistical Manual of Mental Disorders, major depression must be persistent and cause a marked impairment in social or occupational function. While depression is a common diagnosis, the vast majority of people do not reach a level of depression that requires clinical treatment.
How can you help lessen the impact of depression?
Arguably, one of the best ways to lessen the impact of depression is to seek the guidance of a mental health specialist. The path to depression remission can be complex, and a professional is likely able to help identify underlying causes of depression, recommend treatment options, and identify possible alternate causes of the depression, such as another medical condition.
While it is possible to recover from depression without the help of a therapist or other mental health professional, it will likely be significantly easier if professional help is sought. Not only does seeing a therapist make recovery more likely, but they may help lessen the severity of the impact felt during the recovery and treatment process.
How effectively do they treat depression?
There are many effective treatments for depression, but challenges remain when deciding which treatment will work best for each person. Both psychotherapy and antidepressant medication have been shown to be effective, and they often work best when combined. For advanced, treatment-resistant cases of depression, evidence suggests that brain stimulation therapies may provide relief if other treatment methods have failed. Overall, a person with depression is likely to see their symptoms improve over time, either with or without treatment. However, seeking treatment can make the process quicker and easier while avoiding potential pitfalls that may lead to serious consequences.
What should be avoided if you are being treated for major depressive disorder?
Those being treated for major depressive disorder should avoid anything that contradicts their treatment plan and goals or puts them at risk of a depressed mood. For example, substance use may provide short-term relief from depression symptoms but comes at the risk of worsening the symptoms when they return. A person may also want to avoid people or situations that may trigger a major depressive episode, as well as any person or situation that prevents them from engaging in healthy coping strategies.
Is depression curable or just treatable?
Depression is highly treatable; as many as 90% of those with depression who seek professional help see a significant improvement in their symptoms. For many of those people, their depression never returns, and they likely consider themselves cured. In that sense, depression is both treatable and curable, but it is challenging to accurately predict if depression will return in the distant future.
It may be helpful to think of depression as an illness caused by a germ or other pathogen; a person may recover completely and be “cured” of the illness, but it is still possible that a similar pathogen could cause the same illness in the future. Even for situations where depression does become a chronic condition, treatment is likely to reduce symptom severity and make them more manageable.
What is the strongest stage of depression?
According to the Diagnostic and Statistical Manual of Mental Disorders, clinical depression must persist all day, for nearly every day, for at least two weeks. It is likely that this stage, when depression symptoms are worsening and life circumstances may be unpredictable, represents the strongest stage of depression. The person experiencing the symptoms may struggle to understand their feelings, feel powerless to address them, or feel as though addressing their feelings isn’t possible. Different stages of depression can appear differently depending on individual characteristics, and it is important to remember that a well-defined staged model of depression is still being developed.
How can you reduce depression severity?
It may not be possible to immediately remove the symptoms of depression altogether, but it is likely possible to make them less severe. Below are a few basic techniques you can use to reduce depression severity:
- Go for a walk in nature.
- Join a friend for regular exercise.
- Socialize with others, even if you experience a loss of interest in activities or if you aren’t directly seeking support for your depression.
- Keep a gratitude journal to keep track of positive events.
What is the most common approach to treating depression?
One of the most common and effective approaches to treating depression is the combination of psychotherapy and antidepressant medication. Evidence suggests that combining pharmacological and psychological treatments is likely to be more effective than using either strategy alone. Many psychotherapeutic approaches are available, and a mental health professional can leverage their expertise to choose the best therapy. Two of the most common and effective include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).
For more information on depression, depression treatments, and risk factors for depression, visit the following website of the National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/depression.
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