Depression, also known as major depressive disorder or clinical depression, is one of the most widespread mental health conditions in America. In fact, in 2020, approximately 21 million adults (8.4% of the population) experienced at least one depressive episode. These episodes can have a severe impact on people’s lives, making it difficult for them to work, study, and engage in other activities the way they used to.
It can be overwhelming and even frightening when the symptoms of depression first start manifesting themselves. Therefore, the idea that there are stages of depression that one goes through that eventually lead to healing and recovery can be a comforting idea.
Are Depression Stages Legitimate?
It has been proposed that people with depression go through stages that roughly follow the same trajectory as the five stages of grief. But, because people experience depression in so many ways, the stages may not be completely valid.
This article will take a look at the stages of grief and how they might relate to depression. Then it’ll evaluate whether there really are stages of depression based on the input of mental health practitioners.
What Is Depression?
Everyone feels down once in a while but people with clinical depression experience a variety of symptoms in addition to feeling sad or low for an extended period of time. The symptoms of depression include:
- Persistently feeling sad or empty
- Feeling hopeless, worthless, or guilty
- Feeling irritable or restless
- Lack of interest in activities that used to be enjoyable
- Lack of energy and feelings of fatigue
- Trouble sleeping
- Difficulty concentrating and remembering
- Difficulty making decisions
- Changes in appetite that may lead to weight gain or loss
- Pain, cramps, or digestive issues that don’t seem to have a specific physical cause
- Thought of death or suicide or suicide attempts
Not everyone with depression will experience all of these symptoms, symptoms may vary over time, and some symptoms may be more severe than others. However, if an individual experiences several of these symptoms for a period of two weeks or more, it may be valuable to see a doctor or mental health professional.
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They will be able to determine if you are grappling with depression or another issue and can help formulate a plan for treatment. Even the most severe cases of depression can be treated, however the sooner one starts treatment after the onset of symptoms, the more likely it is to help.
The Stages of Grief
The five stages of grief, proposed by psychiatrist Elisabeth Kübler-Ross, is among the most well-known frameworks in all of psychology. Kübler-Ross developed her stage theory to describe how dying patients grappled with a terminal diagnosis.4 Later, her five stages of grief model was expanded to include the experience of anyone going through grief due to the loss of a loved one.
The five stages are: denial, anger, bargaining, depression, and acceptance. Kübler-Ross’ presentation of the stages in her book On Death and Dying suggested that people went through these stages in a linear sequence.2 Since then it has been acknowledged that not everyone will go through each one of these stages in order and some may not experience each one of them, but the perception that these stages prescribe how people will experience grief remains.
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Stages of Grief Controversy
Due to this issue, and the damage it may do to bereaved people who do not experience the five stages of grief, as well as problems like minimal solid empirical evidence and lack of practical use for designing treatment, the model has become controversial, with some suggesting it should be discarded.
Nonetheless, given the continued prominence of the five stages of grief in both clinical and lay settings and the fact that depression is the fourth stage, it’s easy to understand why this framework might also be adapted to the experience of clinical depression.
How the Stages of Grief Relate to Depression
The so-called stages of depression follow the same five-stage sequence as Kübler-Ross’ stages of grief, however the description of the stages has been adjusted to describe the experience of realizing one has depression and accepting treatment for the disorder. The stages of depression are:
- Denial: Some people may want to ignore the onset of depressive symptoms and try to go on as normal. They may reject the idea that their symptoms mean they have depression and believe that the feeling will pass on its own.
- Anger: Once the person stops denying their depression, they may feel angry or wonder why they must deal with the condition. If they are concerned about the stigma attached to mental illness or the effort it might take to overcome depression, they may feel victimized and be upset that depression is happening to them.
- Bargaining: At this stage, an individual may try to bargain away their depression. They may try to negotiate, pray, or engage in activities that they hope will keep their symptoms at bay.
- Depression: Once the person has realized they can’t bargain the condition away, they may sink into a deep depression. This stage can involve feelings of helplessness and extreme sadness. People may withdraw from others, feel empty or numb, stay in bed all the time, or fail to take care of themselves or others who rely on them. They may also have suicidal thoughts or attempts.
- Acceptance: Finally, the person comes to accept that they suffer from depression. At this stage, they will finally seek treatment, or if they are already in treatment, they will start to adhere to that treatment, including seeing a therapist and taking prescribed medications.
Much like the stages of grief, the stages of depression are meant to suggest some common experiences that people with depression go through. However, not everyone will go through each stage, they may not follow the exact order of the stages or go back and forth between them, and different stages may last for different lengths of time, depending on the individual.
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Are There Really Stages of Depression?
Psychologists have never proposed any official stages of depression. In fact, because depression and other mental illnesses tend to be varied and specific to the individual, stage theories aren’t often used to describe mental health experiences.
More often, stage theories, which outline the steps of a particular process, describe things like development, such as Piaget’s four stages of cognitive development and Freud’s five stages of psychosexual development.
It’s Possible That There Are Depression Stages
That said, Erica Golofski, MA, LPCC, ATR-P, a therapist at Ellie Mental Health in Minnesota notes that clinical depressive episodes and struggles with grief sometimes align and overlap, especially if a bereaved person has experienced depression in the past.
In addition, Rachel Cavallaro, PsyD, a psychologist at Thriveworks in Boston has noticed that when people are diagnosed for the first time, some of them react in ways that line up with the stages of grief to some degree.
Dr. Cavallaro thinks there’s a reason for that. With a terminal diagnosis or the loss of a loved one “you’re losing the life that you once knew, and I think it’s very similar with [a diagnosis of] depression,” Dr. Cavallaro observes, “because in some ways, you recognize that you have depression and you’re grieving the loss of a previous reality.”
Denial of a Depression Diagnosis
Dr. Cavallaro has seen many people express denial over a diagnosis of depression, especially when they came in expecting a different diagnosis based on information they read online or through social media. In particular, this response seems to be related to the stigma that continues to come with depression.
Even though depression can be treated and can go into remission, Dr. Cavallaro notes that people gave negative feelings about a depression diagnosis because they may think they’re at fault for their depression.
The Bargaining Stage Following a Depression Diagnosis
If someone feels they’re responsible for their depression, they may become angry or engage in bargaining behavior, Dr. Cavallaro said. Some individuals may be mad that they have to deal with their depression to get better and express that frustration in therapy, especially when the low motivation that may arise due to their depression leaves them struggling to do simple tasks.
People May Bargain With Symptoms
Furthermore, Dr. Cavallaro has witnessed some people trying to bargain with their symptoms, suggesting that if they fix one thing about their current situation, they’ll no longer have depression.
According to Dr. Cavallaro, when people are feeling denial or anger about a diagnosis of depression, their treatment outcomes aren’t as good. “When somebody accepts the diagnosis, they engage in treatment more readily,” Dr. Cavallaro points out, an observation that falls in line with the acceptance stage of the stages of depression and grief.
A Depression Stage Model May Oversimplify Depression
Yet, both Dr. Cavallaro and Golofski believe that the idea of stages of depression might not be useful to clients in therapy. Golofski reveals that she hasn’t seen the stages of grief line up with people’s experiences of depression and believes that’s because depression is “unique to the individual.” Dr. Cavallaro concurs, noting “there is so much variability in how [depression’s] showing up for people.”
Because of that variability, both Dr. Cavallaro and Gofolski feel that the idea of stages of depression could oversimplify the experience each individual can expect to go through during treatment.
According to Dr. Cavallaro, people with depression often have numerous negative thoughts and perspectives. So, if they learn of the depression stages and find that they have not experienced a stage or skipped one, they might feel defeated. Gofolski cites this as the reason she finds the stages of grief model to be unhelpful because everyone experiences grief and depression in very different ways.
People should feel safe enough to explore all of their feelings, no matter the order in which they feel them in. In fact, some psychologists want to discard the stages of grief2 because of this.
And when it comes to depression stages, compartmentalizing depression into stages can also be a hindrance in therapy if people feel restricted to stages.
A Word From Verywell
If you’re dealing with depression, please understand that depression can bring about a range of complex emotions. You deserve to explore all of the feelings that may come up for you and not feel boxed in by stages. If you are having a hard time navigating your depression symptoms, it’s best to enlist the help of mental health professional.