Understanding the 3 Stages of Depression

Depression is a complex mental health condition with many different types & stages - from thoughts of suicide & self-harm to death & postpartum depression.

Understanding the 3 Stages of Depression

Depression is a complex mental health condition that can have countless origins, depending on the individual situation. It can range from thoughts of suicide and self-harm to death, and there are many different types of depression. Events in life can cause some, while chemical changes in the brain can cause others. Your doctor may diagnose major depression if you have five or more symptoms most days for two weeks or more.

At least one of these symptoms should be a depressed mood or loss of interest in activities. If you have depression that lasts two years or more, it's called persistent depressive disorder. This term is used to describe two conditions formerly known as dysthymia (persistent low-grade depression) and chronic major depression. A person with bipolar disorder, also sometimes called manic depression, has mood episodes that range from high-energy extremes with a high mood to low depressive periods.

When you're in the low phase, you'll have symptoms of major depression. Traditional antidepressants are not always recommended as first-line treatments for bipolar depression because there is no evidence that these drugs are more useful than a placebo (a sugar pill) for treating depression in people with bipolar disorder. In addition, for a small percentage of people with bipolar disorder, some traditional antidepressants may increase the risk of causing a high phase of the disease or speed up the frequency of having more episodes over time. Seasonal affective disorder is a period of major depression that occurs most often during the winter months, when days get shorter and you get less and less sunlight.

It usually disappears in spring and summer. A combination of antidepressant and antipsychotic drugs can treat psychotic depression, while electroconvulsive therapy (ECT) can also be an option. Women who have major depression in the weeks and months after childbirth may have peripartum depression. About one in ten men also experience depression in the peripartum period.

Antidepressant medications may help in a similar way to treating major depression that is not related to childbirth. However, there are some key elements that most people will experience, and these form the basis of the five stages of depression. Before discussing these stages, it may be helpful to understand the five stages of grief. Medically reviewed studies on depression show that people suffering from this condition often go through a variation of the five stages of grief, from initial denial to acceptance. The goal of treatment in the acute phase is to induce remission. For patients with severe major depression, evidence supports drug therapy alone or a combination of pharmacotherapy and psychotherapy.

There is not enough evidence that psychotherapy alone is effective for major depression. For patients with mild to moderate major depression, initial treatment modalities may include drug therapy alone, psychotherapy alone, or the combination of medical treatment and psychotherapy. Patients with mild or moderate depression may use antidepressant medications as an initial treatment modality. Clinical features that may suggest that antidepressant medication is preferred over other modalities are a positive response to previous antidepressant treatment, significant disturbances in sleep and appetite, severity of symptoms, or anticipation by the physician that maintenance therapy will be necessary. The patient's preference for antidepressant medication alone should be taken into account. Most primary care physicians can medically treat these patients in their office, as long as they continue to monitor the patient's symptoms closely.

The frequency of monitoring in the acute phase of drug therapy is from once a week to several times a week. Psychotherapy alone can be considered as an initial treatment modality for patients with mild to moderate depressive disorder. Clinical features suggesting the use of psychotherapy are the presence of psychosocial stressors, interpersonal difficulties, intrapsychic conflicts and personality disorders. In addition, the patient's preference for psychotherapy alone should be taken into account, as well as any desire to become pregnant, be pregnant or breastfeed. Most primary care physicians will refer these patients to a professional psychotherapist for management. The frequency of monitoring in the acute phase of psychotherapy is from once a week to several times a week. Persistent depressive disorder is a depressive disorder that affects people for at least two years.

The severity of depressive symptoms may vary from person to person but this type of depression is typically “persistent” in nature for anyone suffering from it. Postpartum depression affects women during pregnancy or after giving birth and the severity of depression can often be quite severe. Cyclothymic disorder is often described as a milder form of bipolar disorder; the person experiences chronic fluctuating moods for at least two years including periods of hypomania (a mild to moderate level of mania) and periods of depressive symptoms with very short periods (no more than two months) of normal between. The duration of symptoms is shorter, less severe and not as regular and therefore does not fit the criteria for bipolar disorder or major depression. The symptoms of dysthymia are similar to those of major depression but are less severe; however, in the case of dysthymia, they last longer. A person has to have this milder form of depression for more than two years to be diagnosed with dysthymia. Some people describe depression as a set of symptoms while others describe it as a set of stages much like how people articulate the periods they experience when grieving.

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