The 5 Stages of Depression

Healthline reported in 2014 that roughly 1 in 10 American adults will go through clinical depression at some point, and that about 80% of those people never get medical help. The organization also noted that the count of people who become clinically depressed climbs by close to 20% each year. Something fewer people know: depression is often talked about in terms of five stages. There aren't really fixed, official stages in the way the phrase suggests. What exists is a set of signs that tend to show up at different moments inside a depressive episode, and those recurring signs are what people label as stages.

Before any of that makes sense, it helps to know what clinical depression actually is. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) uses the terms clinical depression, major depression, and major depressive disorder interchangeably. For a diagnosis, a person has to show at least five depression symptoms, including sadness and despair along with other mood-related problems, lasting two weeks in a row (Lane, 2013).

The five signs people group together are negative thought patterns, poor appetite, irregular sleep, self-blame, and suicidal ideation. Knowing them can make it easier to recognize what's happening and reach out to a professional, whether that's a counselor, psychologist, psychotherapist, clinical social worker, or psychiatrist. If you or someone close to you is dealing with depression, please contact a mental health professional.

Stage 1: Negative Thought Patterns. Early on, cynicism and pessimism tend to creep in. People around you might mention that you've gotten more negative lately. You may grow doubtful, gloomy, or suspicious of things for no clear reason. Feelings of hopelessness and helplessness can surface here too, though at this point they come and go rather than settling in permanently. When the enjoyment seems to have quietly drained out of your days, that can be one of the first clues.

Stage 2: Poor Appetite. Lost interest in eating for two weeks or longer? That tends to accompany this stage. The reason is usually that depression has taken over so much mental space. Your mind stops working the way it does on a good day, and constantly turning over heavy, unhealthy thoughts spills into behavior, including whether you want to eat at all. Foods you once looked forward to can start to turn your stomach. Eventually the missed meals add up to noticeable weight loss, and that's often when friends, family, partners, or coworkers sense that something is wrong.

Stage 3: Irregular Sleep Patterns. Maybe you're sleeping far too long, snapping awake at dawn, waking repeatedly through the night, or pushing bedtime later and later. Depression disrupts sleep in both directions, into oversleeping (hypersomnia) or not sleeping enough (insomnia), and the disruption usually grows as the depression deepens. Part of what drives it is the brain signaling that the body needs to get away from the stress and pain it's carrying. Hormone levels shift, the natural sleep rhythm gets knocked out of sync, and the irregular pattern follows.

Stage 4: Self-Blame. If you've started holding yourself responsible for everything, whether or not you had anything to do with it, you may be in this stage. The self-blame runs high. Minor things get inflated until guilt and shame feel crushing. Worthlessness sits alongside hopelessness and helplessness. In your own head, you can't get anything right and you've become a failure. You haven't. That verdict is the depression talking, not the truth.

Stage 5: Suicidal Ideation (Thoughts and Behaviors). This is the final and most dangerous stage. If you're here and genuinely thinking about suicide, get emergency help from a medical professional: a psychologist, psychiatrist, clinical social worker, therapist, or physician. This is a critical point in a depressive episode and it calls for professional care. People at this stage are often preoccupied with death and dying. Some have worked out a method, or begun handing their belongings over to friends and family. If this describes you, you are not OK, and if you can't reach a professional, call 911. What you're feeling right now is temporary. It will pass, I promise. There are people who can help you feel happy again; you only have to reach out.

- Dr. R. Y. Langham

References: Healthline. (2014). Depression statistics. Retrieved from http://www.healthline.com/health/depression/statistics-infographic. Lane, C. (2013). Major depressive disorder. PsychWeb. Retrieved from http://www.psyweb.com/mdisord/MoodDis/majordepress.jsp. Stewart, J. Y. (2013). Stages of depression. Lifescript. Retrieved from http://www.lifescript.com/health/centers/depression/articles/the_stages_of_depression.aspx