The model of the 5 stages of depression is not a rigid medical classification, but rather a simplified framework to make the course of a depression easier to understand. It describes typical patterns that many individuals experience, with symptoms ranging from initial emotional lows and physical changes to severe crises. Not everyone experiences all stages to the same extent, let alone in the same order. The course of depression can therefore vary greatly from person to person.

However, the 5-stage model helps to make the illness more tangible, to take warning signs seriously, and to seek help early. If you notice such symptoms in yourself over an extended period, it is vital that you seek professional help early on before your symptoms worsen.

In the initial stage, subtle changes begin to creep in. Those affected by depression notice that they experience less joy in things they used to enjoy. Their mood is more frequently low, and both motivation and energy levels decline. Negative thought patterns are also typical, such as the feeling of doing nothing right or not being good enough. Some notice that they become more easily irritated or find themselves worrying more. Particularly regarding the future, a more pessimistic outlook tends to develop, which can lead to prolonged feelings of dejection.

How can you deal with negative thoughts during this stage of depression?

• Self-observation: Keep a mood diary or use digital support to track changes. Writing a journal often defuses negative thoughts and helps you develop helpful, realistic thought patterns.
• Plan mini-steps: Small, achievable activities (e.g., a short walk, a phone call with a friend) can provide stability and create small moments of success. This boosts your self-confidence. Be careful not to overwhelm yourself.
• Speak up early: Talk to trusted individuals, a doctor, or a therapist about how you are feeling. Even though it can be difficult to open up about your thoughts and emotions, doing so is vital to getting help in good time.

During this stage, physical symptoms often begin to appear. Changes in appetite, in particular, are highly typical of depression. Some people lose their sense of hunger because other emotions, such as sadness, are felt so intensely that they overshadow the desire to eat. Others, however, turn to snacks and high-fat foods more frequently out of frustration or for comfort—often as a way to compensate for these overwhelming feelings. You might also recognize the urge to reach for high-calorie foods just to feel better for a short moment. This happens because our brain associates sugary snacks or sodas with rewards, triggering a temporary feeling of happiness.

What can help you if you notice changes in your appetite?

• Mindful eating: Schedule fixed, preferably smaller, meals throughout the day and focus consciously on the taste and your body's signals of fullness.
• Light exercise: This stage is often about finding healthy ways to cope with and manage intense emotions. Regular walks or stretching exercises can clear your mind and also help regulate your appetite.
• Seek medical advice: Discuss physical symptoms with a healthcare professional to rule out other causes and detect depression early on.

Sleep problems are a common warning sign of depression. Difficulty falling asleep, restless sleep, frequent waking, or waking up very early in the morning are typical during this stage. Throughout the day, those affected feel drained and exhausted, which in turn can reinforce negative thoughts. During this stage of depression, concentration and memory performance often decline noticeably.

What can you do to improve your sleep quality?

• Optimize sleep hygiene: Set fixed times for going to bed and waking up, reduce your screen time before sleep, and instead use relaxation rituals such as breathing exercises or reading a calming book.
• Daytime movement: Daylight and moderate exercise improve your sleep-wake cycle and help build up sleep pressure by the evening.
• Seek support: If sleep problems persist, consult a doctor or a therapist.

During this stage, self-criticism and feelings of guilt become dominant. Those affected blame themselves for problems, even when these are completely outside of their responsibility. Feelings of worthlessness and failure can become so overwhelming that social interactions are avoided. However, withdrawal and isolation only reinforce the depressive mood, often resulting in a vicious cycle.

How can you manage to treat yourself with more compassion?

• Practice self-compassion: Remind yourself that depression is an illness, not a sign of weakness. Focus on the things that are within your control, and treat yourself the way you would treat a close friend.
• Maintain connections: Stay in touch, even if it feels difficult. Even brief messages or short get-togethers can break the vicious cycle of loneliness. Social connections are vital for our well-being.
• Express your feelings: Writing, painting, or making music can help organize your thoughts and relieve pressure. This is not about perfection, but simply about finding a form of self-expression.

In severe cases, depression and the accompanying sense of hopelessness can progress to the point where suicidal thoughts occur. This stage is life-threatening and must never be ignored. Feelings of deep despair or thoughts of being a burden to others are serious warning signs that require immediate action.

Emergency numbers and support for suicidal thoughts:

• Get help immediately: Reach out to people you trust or specialized support services. In Germany, the TelefonSeelsorge (Crisis Helpline) can be reached 24/7 anonymously and free of charge at 0800 111 0 111 and 0800 111 0 222, or online at TelefonSeelsorge® Deutschland | Sorgen kann man teilen. 0800/1110111 · 0800/1110222 · 116123. Ihr Anruf ist kostenfrei. .
• Call emergency services: In case of immediate danger, call the emergency services at 112.
• Involve professional help: Crisis intervention or an inpatient hospital stay can be life-saving during this stage.

You can access early help with deprexis, a digital therapy program designed for the treatment of depression. To help you find your way back to a lighter state of mind step by step, deprexis supports you with a personalized program, exercises for dealing with emotional lows, and practical tips for self-care.

deprexis is available to you free of charge on prescription – the costs are fully covered by your health insurance. This means your doctor can prescribe deprexis for you, and you will receive an activation code for the program. Alternatively, you can request a prescription online in just a few minutes through our partner, Wellster. As soon as you have your code, you can easily redeem it on our website and start using deprexis right away.