My Four Stages of Depression

Below is a description of, to my best ability, the four stages my depression seems to go through. I am reprinting this blog post as it originally appeared in my blog, which can be viewed here: http://thegallowspole.wordpress.com/ 1) Pre-depression: This may actually appear to be a fairly good period for me to outsiders, but it actually is the catalyst for everything that follows. I usually feel and appear to be relatively happy, but lose awareness. In other words, I begin to assume my happiness is being provided by the world around me and I begin to pay more attention to what I can do to hold on to that happiness than to maintaining an awareness of my own mind. During this stage, I start to worry more about material things. I want to buy things, changes things in my life — even do things that sound like a good idea, like exercise more or eat better. But the motivation all stems from a belief that happiness happens externally. If I lose weight, or buy a new toy, or whatever, I'll be happy. In future blogs, I'll explain how this thinking can be disastrous for nearly everyone in its own way, but for now, suffice it to say that as my attention turns outward, my brain begins to worry more. That leads to the second stage. 2) Sustained anxiety: Once I start believing that things external to me can make me happy, it follows fairly quickly and obviously that what the world giveth, the world can taketh away. If I lose weight, that may be great, but if I am happier because of it, that may not be so great. Simply put, anything that can be acquired can be lost. If a new toy makes me happy, losing that toy makes me sad. If losing weight and looking better makes me happy, what happens if I gain the weight back? Should that mean I lose all confidence in myself? So my brain begins a pattern of worry. What if I lose these things that make me happy? How can I work to keep them? It is, of course, a fool's errand. No one has such control over their environment that they can prevent loss. And everyone's brain is inherently aware of this. So worry is very much like Sisyphus and the rock. You simply can't push the rock of worry over the hill. As I said above, everything gained can be lost. So my brain begins a brutal period of feckless concern — a constant and debilitating process of fretting over every potential bad outcome. I use the word debilitating here in almost a clinical way. When the brain begins this period of intense worry, it is much like an engine running too hot. Eventually, it will fail. That is why many clinicians now think of depression as a "safe mode" for the brain. The brain may simply shut down much of its activity to save it from burning itself out. Once that finally happens, the real depression sets in. 3) The fall and the denial: Now the brain shuts down and the conscious mind tries to make sense of the pain that now consumes it. "I was happy!" it thinks. "What the hell just happened?" Of course, there must be a culprit (one other than depression, of course). This is usually when I start to blame other things or people for my unhappiness. If you believe as I did in Stage 2 that happiness could be acquired through earthly means, now that the happiness has gone away, it must have been taken away through earthly means. Then comes the anger. Anger is very much a part of depression, probably far more than most people realize. I become angry at everything I perceive to have taken my happiness from me, unaware (again, a key word) that I never was genuinely happy. 4) The final plunge: Now, if I had never learned about how to manage my depression and never taken any substantial steps toward treating it, eventually stage 3 would morph into Stage 4. This pattern happened for me for many years. Eventually, the loathing and pain of Stage 3 accumulates to a point where it is unbearable and the brain truly does shut down. I become reclusive, unresponsive, and acquire a flat affect. It may seem to people who know me that my personality has disappeared. Things begin to fall apart on multiple levels. This is where work suffers the most. Physical activity becomes very limited, deepening the metabolic collapse that attends the lowest depths of depression. This is where thoughts of suicide start, or other ideas of self-destructive behavior. If unchecked, suicide can happen fairly easily now. I do not have an addictive personality or the genetic coding for alcoholism, so I do often drink more heavily during this phase, but nothing like the way someone afflicted with alcoholism does. If a person has an addiction, here is probably where it will hit rock bottom. Toward the end of this stage, physical pain sets it with a vengeance. And despite the low activity levels and the seemingly never-ending feeling of lethargy, sleep is never satisfying. No matter how long I sleep, I never feel rested. Fortunately, for most depression sufferers, myself included, this stage eventually abates. Unfortunately, without a clear understanding of what actually is happening in the mind during this process, this cycle simply resets and goes back slowly to Stage 1. This pattern may not describe how most depression sufferers experience their illness, but it does describe my cycle fairly accurately. The brain being so complex, any such description must necessarily be an oversimplification, and this one is no exception. But at least making in-roads into describing the process helps me better recognize how I am doing at any given time. Crisis can be averted at any stage if I just regain my awareness. And one important point, my description should also help make it clear the role anxiety plays in my depression. There is research to suggest that anxiety and depression are very much linked for many patients. The above description is my explanation of where that link exists, at least for me. Everything I've learned over the years about severe chronic depression suggest to me that these four stages are probably not uncommon in other depression sufferers, but I discuss them here only by way of explaining my own personal experiences. Of course, I am no clinician and my assessments here are entirely subjective. However, given that awareness is the key to beating back depression and anxiety, I hope that reading this provokes greater consideration of the actual processes at work not only for sufferers, but those who care deeply about them. Dealing with depression is a delicate process, but it is a process. Sitting back and hoping it all corrects itself will never work.