More and more often online, you will find five “stages of depression”: pre-depressive, progressive, acute, remission and recovery.

This representation is not completely absurd. It describes fairly intuitively one possible trajectory of a depressive episode: something begins to change, symptoms settle in, become significant, then may gradually decrease until recovery.

But these are not five universal, officially recognised clinical stages that every person with depression must necessarily go through.

And that distinction matters.

Because depression is not an organised tour with five compulsory stops and “recovery” waiting at the terminus.

Depression is unfortunately highly variable. It may develop gradually or appear to arrive abruptly. It may be mild, moderate or severe. There may be one episode or several over a lifetime. Improvement may be complete or leave residual symptoms. Relapse or recurrence may also occur.

So what do these famous five stages of depression actually describe? And how far can the model help us understand what is happening without misleading us?

Before the five stages: what do we mean by “depression”?

The word is used so often in everyday language that it can end up describing very different realities.

“I’m depressed.” “I’ve got the blues.” “I’m going through a rough patch.” “I have depression.”

Those sentences do not necessarily describe the same thing.

Clinical depression is not simply sadness. The World Health Organization explicitly distinguishes it from ordinary mood fluctuations and temporary emotional reactions to difficulties. It notably involves depressed mood or a persistent loss of interest or pleasure, potentially accompanied by fatigue, sleep or appetite disturbances, concentration difficulties, guilt, low self-worth or hopelessness.

In France, the Haute Autorité de Santé notes that a characterised depressive episode involves symptoms present almost every day for at least two weeks, representing a change from previous functioning and causing significant distress or impairment.

In other words: sadness is a human emotion; depression is considerably more complex.

There is no single depression that looks the same for everyone

This is the first problem with trying to fit depression into five neat boxes.

A depressive episode may be mild, moderate or severe. Two people meeting criteria for a depressive disorder may have noticeably different experiences.

For one person, fatigue and loss of motivation may dominate. For another, sleep problems, anxiety, irritability or inability to feel pleasure. Another may experience rage, frustration or anger linked to helplessness.

One person may continue working at enormous cost while another can no longer manage their usual activities.

Talking about depression therefore means talking about a range of possible manifestations and trajectories, not a single script.

Stage 1: the pre-depressive stage or early signs

In the popular five-stage model, the first stage is a period in which something begins to change.

Unusual fatigue, disturbed sleep, irritability, gradual loss of motivation, concentration difficulties, isolation or the feeling that previously enjoyable activities now require disproportionate effort may appear.

The problem is that these early signs of depression are not specific.

Fatigue has many possible causes. Professional stress is not automatically the beginning of depression. A week in which you want the entire human race to bugger off is not, by itself, a psychiatric diagnosis.

The idea can nevertheless be useful as an invitation to notice a lasting change from your usual functioning, rather than as a compulsory medical stage.

Stage 2: depressive symptoms settle in

The second stage describes symptoms becoming more established.

What looked like a bad period begins to last. Lack of energy affects work. Social interaction becomes costly. Previously pleasurable activities bring less pleasure. Sleep or concentration problems persist.

An important concept here is anhedonia: a marked reduction in interest or pleasure.

Depression does not always look like someone constantly crying. It may also feel like:

“I don’t feel much anymore.”

or:

“Everything takes effort and nothing really appeals to me.”

When several symptoms persist, intensify and significantly affect daily life, assessment by a health professional becomes particularly relevant.

Stage 3: the acute phase of depression

This is what the model presents as the peak of the episode.

Symptoms of depression are numerous or intense enough to seriously disrupt daily functioning: depressed mood, loss of interest or pleasure, exhaustion, sleep disturbance, appetite changes, cognitive difficulties, guilt, loss of curiosity, bitterness, anger, self-devaluation or a very pessimistic view of the future may occur.

In severe forms, normal professional, family or social activities can become extremely difficult. Suicide risk also needs to be assessed where relevant.

But even here, calling this the “third stage” can mislead.

A person does not have to consciously experience stages 1 and 2 before reaching this point. Some depressions develop slowly; others appear much more abruptly, particularly in the context of major traumatic or cumulative events.

The acute phase therefore describes intensity, not the third level of a video game that everyone must unlock.

Stage 4: partial remission

When symptoms begin to decrease, some articles describe a fourth stage: remission.

This term does have clinical meaning.

But remission and recovery are not the same thing.

A person can feel considerably better without having returned to previous functioning. Fatigue, sleep problems, cognitive difficulties or residual anhedonia may remain.

And importantly: remission is not “acceptance”.

Acceptance may describe how a person psychologically understands and lives with their illness. Remission concerns the evolution of symptoms.

You can fully recognise and accept that you are depressed while still being in the middle of a depressive episode.

Stage 5: recovery and relapse prevention

The fifth stage is described as recovery: symptoms have greatly decreased or disappeared, functioning gradually returns and activities resume.

But feeling better does not necessarily mean everything is over overnight.

Clinical recommendations commonly distinguish an acute treatment phase from maintenance treatment, which aims to consolidate remission, restore functioning and quality of life, and reduce recurrence risk.

This helps explain why follow-up may continue after symptoms improve.

After depression, learning to recognise your own early warning signs, vulnerability factors and what helps maintain improvement can be useful.

Where the five-stage model becomes misleading

This is where I begin to have a problem with the five neat boxes.

Because they easily suggest:

1 → 2 → 3 → 4 → 5 → finished.

Reality is considerably less disciplined.

Someone may improve and then worsen. Some symptoms may disappear while others remain. There are single episodes, recurrent depressions and persistent or chronic forms.

A real trajectory might look more like:

early symptoms → worsening → improvement → residual symptoms → further improvement

or:

depressive episode → remission → another episode months or years later

or something far less easy to draw as a tidy arrow.

The five-stage model can serve as a simplified map. The problem begins when we confuse the map with the territory.

What if my symptoms do not fit these five stages?

That absolutely does not mean your suffering is illegitimate or that you are somehow “doing depression wrong”. There is no great depression examiner waiting to give you a mark, and depression is not a performance.

This is precisely the danger of overly linear psychological models: they can create a norm where they were only meant to help understanding.

Conversely, recognising a few symptoms in an article does not allow you to diagnose yourself with depression.

If a persistent low mood, loss of interest or pleasure, significant fatigue or other symptoms continue and affect daily life, speaking with a doctor or mental-health professional can help assess what is happening and what forms of support are appropriate.

So, are the five stages of depression bullshit?

Not exactly.

But they are not a psychological law either.

Pre-depression, establishment of symptoms, acute phase, remission and recovery are a fairly intuitive way of describing one possible trajectory of depression.

They can help explain that a depressive episode evolves, that symptoms may develop gradually and that recovery itself may take time.

What becomes problematic is treating them as five official, universal and successive stages.

Clinical classifications and guidelines focus instead on symptoms, duration, severity, functional impact, evolution, remission and risks of relapse or recurrence.

Ultimately, the most useful question may not be:

“Which stage am I in?”

but:

“What has been changing for me, for how long, what effect is it having on my life, and what help do I need today?”

You know that kind of day: you know perfectly well what you need to do. The file is open. So is the task list. You had even planned to start at 9 a.m. It is now 11:42 and you have learned an astonishing amount about the best way to clean bathroom grout…

Yes, yes, you are procrastinating.

Or, in its much more scientifically precise formulation:

you just can’t be arsed.

Well… maybe.

Because behind this apparent loss of motivation, very different mechanisms may be hiding.

And before trying to become more disciplined, it might be worth understanding why you can no longer get yourself moving.

The answer may be subtler than it looks.

Procrastination is not necessarily laziness

That is probably the first idea to get out of the way.

Procrastination means voluntarily delaying an action even though we know that postponing it may work against us.

Psychologist Fuschia Sirois’s work notably invites us to understand it as an issue of emotion regulation: we are not merely trying to avoid a task, but the unpleasant emotion associated with that task. APA

In other words:

maybe I am not putting off this report because I am lazy.

I am putting it off because it bores me.

Because it makes me anxious.

Because I do not know where to start.

Because I am afraid it will be bad.

Because I do not understand what is expected of me.

Because the task is so enormous that my brain would rather alphabetise my spice rack.

And in the short term, the mechanism works remarkably well.

I postpone the task. And voilà: Relief.

The problem?

The task still exists.

And now… it has invited stress over for dinner, the annoying bastard.

So no, procrastination is not necessarily self-sabotage

Immediately describing all procrastination as self-sabotage implies that we are consciously involved in some sort of conspiracy against ourselves.

It is rarely that simple.

Procrastination can temporarily help us avoid an uncomfortable emotion. The problem begins when this strategy becomes repetitive and ends up increasing the stress, guilt or difficulties it was supposed to help us avoid. APA

So the right question is not necessarily:

“How can I force myself to work?”

but:

“What am I avoiding when I avoid this task?”

And that is where the answers become much more interesting.

“I can’t be bothered”: yes, but which kind?

Because there are probably fifty different things hiding behind that sentence.

The tired kind: I am genuinely exhausted and need to recover.

The bored kind: this task stimulates absolutely nothing in me.

The scared kind: starting means risking failure.

The perfectionist kind: if I cannot do it perfectly, I would rather not start.

The confused kind: I do not even know what the first action is.

The rebellious kind: I could do it, but I hate being told how, when and why.

The absurdity kind: I can no longer see the point of what I am doing.

And finally, a particularly interesting category:

the demotivated kind.

I know how to do it. I could do it. But something in me replies:

“What’s the point?”

And now we are no longer talking only about procrastination.

We are talking about motivation.

How do you get your motivation back?

We often imagine motivation as some mysterious quantity in our body made from heaps of dopamine and pleasure.

Some people supposedly have lots of it. Others very little.

And some have probably lost it down the back of the sofa along with their car keys and the remote.

But motivation depends enormously on the context in which we act.

In Drive, Daniel Pink popularised research on intrinsic motivation around three major factors:

autonomy, mastery and purpose.

Autonomy: having some latitude over what we do and how we do it.

Mastery: feeling that we are progressing and developing our skills.

Purpose: understanding why what we do matters and what it contributes to. Daniel Pink

And suddenly the question:

“Why do I procrastinate so much at work?”

can become:

Do I still have room to make decisions?

Am I learning anything?

Do I feel that I am progressing?

Do I still understand why I am doing this job?

Because trying to solve structural demotivation with nothing but more discipline is a bit like pressing harder on the accelerator when the car has clearly run out of fuel.

Motivation and recognition: “What’s the point if nobody sees what I do?”

Recognition also matters.

Not necessarily in the form of applause, medals and a brass band every time we answer an email.

But human beings generally need to feel that their contribution exists, is useful or is at least noticed.

When effort seems invisible for a long time, motivation can erode.

And once again, the solution is not necessarily to become “more disciplined”.

Sometimes the real issue is the environment.

Being busy is not the same as moving forward

Procrastination has a particularly elegant disguise:

productive procrastination.

Answering emails.

Reorganising your folders.

Redoing your Notion setup. (No, no, I am absolutely not targeting anyone.)

Watching fifteen videos about productivity.

Choosing a new time-management app.

You are extraordinarily busy.

You still have not started the thing.

That is where it can help to ask:

“If I could accomplish only one thing today, which one would actually change something?”

Then start that one.

Even imperfectly.

What if procrastination were sometimes information?

Let us be reasonable: I do not think we should glorify it.

Regular procrastination can be costly in stress, guilt, opportunities and sometimes health. APA

But I do not think it is particularly intelligent to respond automatically to procrastination with:

“Get off your arse.”

Well… sometimes, yes.

But when the phenomenon keeps repeating, it may deserve something better than a moral judgement.

Because behind “I’m procrastinating”, there may be:

“I’m scared.”

“I’m exhausted.”

“I don’t know how to start.”

“I want to do it so well that I no longer dare to do it at all.”

“I have no autonomy.”

“I’m no longer progressing.”

“Nobody recognises what I contribute.”

“I no longer understand why I’m doing this.”

Or even:

“I don’t want this anymore.”

(A sentence we often hear from our Manifesting Generator friends in Human Design.)

No time-management app will properly answer that kind of sentence.

Coaching, motivation and procrastination: getting moving again

That is precisely where coaching can become useful.

Not to have someone standing behind you shouting:

“COME ON! MOTIVATION! DISCIPLINE! MOVE!”

But to understand what is actually happening.

Is the task unclear?

Is there fear?

Perfectionism?

Exhaustion?

A lack of meaning?

A lack of autonomy?

A problem with recognition?

Or is this goal simply no longer yours?

Motivation is not always something you need to recover. Sometimes its disappearance is information you need to listen to.

And once we know what the problem actually is, we can stop trying to repair everything with yet another productivity hack.

Catégorie : depression

The 5 stages of depression: useful for understanding… but beware of the shortcut