The Stages of Depression

If you’ve been recently diagnosed with depression, you know you have tough challenges ahead. Learn more about the stages of your condition from depression experts, including diagnosis, treatments, medication and self-care suggestions. Plus, one woman shares her experiences with battling depression and coming out on top. Also, test your depression IQ with our quiz…

Living with depression is like lugging around unwanted baggage: hopelessness, despair, fear, anxiety and thoughts of suicide can all seem to be jockeying for space in your overloaded psyche.

If you’ve been diagnosed with depression, the stigma associated with mental illness may be hard to shake. You might also feel guilt or shame.

But an accurate diagnosis is the first step to getting better.

“The good news is there are many treatments for depression and people generally get well,” says Michelle Riba, M.D., a professor of psychiatry at the University of Michigan. “What’s important is getting the right diagnosis and appropriate treatment.”

This disease is too complex to rely on self-diagnosis. The right diagnosis needs a mental health professional and may take more than one session, or even weeks, to determine appropriate medication and dosage, Riba says. But that process yields early rewards. You may begin to understand why you feel the way you do.

“The symptoms of depression, such as headaches, irritability and sensations of feeling full are sometimes very vague,” Riba says. A mental health professional understands these subtleties and others, such as tiredness or the struggle just to get out of bed, as well as the way depression interacts with diabetes, heart disease and other illnesses.

“Women who self-diagnose may miss all the issues and conditions that trigger depression,” Riba says. “That’s why it’s important to work with a clinician or a physician to determine the causes.”

Finding the right help for you can be tough, but it’s crucial, says Therese Borchard, who writes about her battle with depression in Beyond Blue: Surviving Depression & Anxietyand Making the Most of Bad Genes (Center Street).

As a child, Borchard says she experienced symptoms of depression that included anxiety, sadness, guilt, obsessions and compulsions, to name a few.

It wasn’t until she was in college that Borchard’s depression was diagnosed. Fifteen years later, she learned she also had bipolar disorder.

When she couldn’t get the professional help she wanted, she decided to go it alone: no doctors or medicine. The day her husband found her in a closet, curled in the fetal position and shaking, he pushed her to seek expert help.

“I was depressed for so long, I really didn’t think it was ever going to get better,” she recalls.

Education, Exercise and Self-Management
There are many types of depression. Based on the diagnosis, treatment will likely depend on the patient’s day-to-day activities and physical health. It may also include psychotherapy, also known as “talk therapy,” and/or medication.

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRI's) such as Prozac, Celexa and Zoloft, among others. They normalize naturally occurring brain chemicals called neurotransmitters that may become imbalanced and affect everyday functions, such as sleep, eating and mood.

Many of these drugs contain a “black box warning label,” indicating that they may increase suicidal thoughts or attempts, usually in children, using the medication.

SSRI's can trigger potential side effects, such as a lowered libido, headache, nausea, insomnia and bladder problems, so they're usually prescribed in conjunction with talk therapy and frequent physician visits.

“It’s important not to say, ‘Here’s a pill and go take it,’” Riba says.

Treating depression is complicated, takes a lot of time and requires close monitoring. In fact, it may take weeks to determine the most helpful medication and many more before it becomes fully effective.

“We don’t have a test to determine that any one drug is going to work 100% of the time,” Riba says.

All this makes the early days of treatment some of the toughest.

The overall goal is to “improve the patient’s functionality and quality of life,” Riba says.

A range of health-care professionals work with depressed women. Social workers provide most of the mental health outpatient care in the U.S., says Kathleen M. O’Leary, acting chief of the Women’s Program at the National Institute of Mental Health. They offer therapy, counseling and help locating resources from affordable legal assistance to special living residences.

Others include psychologists, nurses and nurse practitioners, physicians and psychiatrists.

Borchard found her mental health team at John Hopkins Hospital. They spent lots of time getting to know her and were less reliant on medication – “perfect for me,” says Borchard, who lives in Annapolis, Md., with her husband and their children.

Borchard’s Treatment Tips

1. Get enough sunlight. (In winter, she uses a light therapy lamp.)

2. Practice meditation or yoga.

3. Laugh.

4. Eat a healthy diet, including omega-3 fatty acids, which can improve depression symptoms, according to a 2010 study from the University of Montreal.

5. Foster healthy relationships.

6. Practice your faith. “It gave me hope when I was hopeless,” Borchard says.

A Vital Part of Caregiving
Being a caregiver for someone with depression also isn’t easy. It requires patience, alertness and sometimes a willingness to speak frankly.

“People with depression often have trouble detecting [the condition] in themselves because depression impairs judgment and thinking,” O’Leary says.

That’s why it’s important for family and friends to encourage them to get help, even when they resist the idea, O’Leary adds.

A caregiver may even be asked to participate in therapy, Riba says. Their presence may offer insight.

Borchard advises family and friends to tread lightly – do more and say less.

“A depressed woman feels so horrible about herself, anything you say will probably backfire,” Borchard says.

“The hardest part is being a mom and struggling with depression when you’re supposed to be the strong matriarch, nurturer and caregiver of the family,” Borchard says. “When you’re under a lot of anxiety and depression, it’s hard to do that.”

Her husband’s approach was to just be “very compassionate without saying a lot.” Friends showed their support with actions that Borchard says she treasured: making lunch, doing laundry, cleaning the house.

They avoided saying things like: “You’d feel better if you ate organically.” Or, “It’s all in your head.” Or, “Everyone has problems.” A major shift in her outlook took place the day Borchard caught an impromptu performance of her young daughter singing and dancing around the house naked.

“I was laughing so hard,” she says. “I thought, This is joy. I haven’t felt this in so long.”

Jocelyn Y. Stewart is a 2011 fellow at the Alicia Patterson Foundation.

How Much Do You Know About Depression?
Depression is an extremely disabling disorder. Despite all the progress in diagnosing and treating this disease, many people still are in the dark when it comes to understanding depression.