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We know that breakups can be devastating, no matter how they play out. One minute you’re strolling through the park hand in hand, picturing your future together. Next thing you know, you’re left alone with visions of your future plans crumbling around you.

Going through a breakup can be as painful as grieving the death of a loved one because we’re essentially losing one of the most important relationships in our lives, says Claudia de Llano, LMFT, a licensed marriage and family therapist and author of “The Seven Destinies of Love.”

The grieving process can feel like an emotional roller coaster, where you’re riding waves of anger, sadness, confusion, loneliness, anxiety, guilt, and regret, interwoven with moments of relief, hope, and acceptance. Sometimes you go through these stages one by one, other times you repeat them or bounce back and forth between different emotional states so fast that it gives you whiplash.

When it comes to breakups, you can experience anger, resentment, and loss all in the same breath, says Clarissa Silva, a behavioral scientist, relationship coach, and developer of “Your Happiness Hypothesis.”

But at the end of this road, there is acceptance and growth, so hang in there!

Stage 1: Ambivalence

A million thoughts and feelings run through your head immediately after a breakup. At this stage, your heart and head play tug of war with your emotions, pulling you in different directions.

These are some of the thoughts and behaviors you may experience in this stage:

• Wondering if you did the right thing: Sometimes, you’re convinced that breaking up was the best thing to do. Other times, you find yourself wondering if maybe, just maybe, you could’ve made it work.
• Playing out all the scenarios: Your mind keeps playing out all the different “what-if” scenarios: “What if I had said this? What if they had done that? Would we still be together then?”
• Getting emotional whiplash: One moment you’re feeling empowered, imagining your future without them, and the next, you’re drowning in a sea of nostalgia, going through old photos and texts, desperately trying to hold onto something that’s slipping away.
• Experiencing mixed emotions: Your emotions are all over the place. You’re relieved that the fights are over, but you don’t want to be single again. You’re angry at your ex about the way they treated you, but you also miss them.

Coping Strategies

These are some strategies that can help you cope with mixed feelings:

• Acknowledge your feelings: Remember that it’s OK to have conflicting feelings. Acknowledge your emotions and allow yourself to feel your feelings fully as they arise so they can be felt, expressed, and moved through you.
• Be honest with yourself: Take the time to understand your needs, desires, and priorities. Reflect on what you want in a relationship and whether the ambivalence you’re feeling is because you genuinely want to be with the person or because you’re afraid of change. “Don’t lie to yourself. You have to be honest with yourself and define your truth,” says Silva.
• Make a pro and con list: It may be helpful to make a list of the pros and cons of the relationship. This can help you objectively figure out whether or not breaking up was the right thing to do.
• Consider a grief ritual. Rituals can help you regain a sense of stability and work through your emotions. They can be powerful and symbolic ways to help you in the process of healing and letting go. It may help to write a letter to your ex of all the things you want to express and then burn it, intentionally dispose or give away physical reminders of the relationship, or clean and update your environment in a way that brings you feelings of peace and hope.

Stage 2: Denial and Shock

Shock tends to set in soon after a breakup. At this stage, we’re in denial about the breakup and our emotions. “Denial is a protective mechanism that absorbs the pain as we slowly deal with a shifting reality,” says de Llano. 

These are some of the thoughts and behaviors you may experience in this stage:

• Refusing to accept reality: You’re probably thinking that this can’t be happening. You’re hoping that things get better and go back to the way they were. According to de Llano, common thoughts at this stage are: “We’ve been through this before, we can fix it,” or “They’ll come around and we’ll get back together.” 
• Avoiding painful emotions: Denial serves as a protective shield against the intense emotions that come with a breakup. Instead of facing the pain head-on, you bury your emotions and distract yourself with work or other responsibilities, to avoid thinking about it.
• Forgetting it happened: You keep forgetting that you’re not together anymore. You may find yourself reaching for them in your sleep or expecting to see them when you walk through the door.
• Staying in touch with your ex: You may continue to text and call your ex as though you’re still together, consulting them about your life as though nothing has changed, says de Llano.
• Not sharing the news: You may not have told your friends and family members about the breakup yet, because you’re not ready to face it and a small part of you is still hoping that maybe you’ll get back together.

Coping Strategies

These are some strategies that can help you cope with shock and denial:

• Allow yourself to feel: Stop hiding from your emotions and busying yourself with other tasks to distract yourself. Allow yourself to feel all the feels, no matter how painful they are in the moment.
• Share the news with loved ones: De Llano recommends sharing the news with your loved ones and telling them how you feel, so you can begin to process the situation.
• Adjust to your new reality: Forgetting that you’ve broken up, only to be reminded of it again and again can be painful. Allow yourself to grieve when you find yourself forgetting that things in your life are not the same anymore, says de Llano. Slowly, you will start to adjust to your new reality.
• Avoid contact with your ex: Follow the no contact rule and avoid calling and texting your ex. Stalking them on social media is off limits too, says Silva. “This habit only slows your progress because it occupies your brain with thoughts of their activities and whereabouts.” Research shows that staying in touch with your ex makes it harder to move on.

Stage 3: Anger and Resentment

In the wake of a breakup, you may feel intense anger and resentment toward your ex.

These are some of the thoughts and behaviors you may experience in this stage:

• Feeling hurt: You may feel hurt at your ex’s actions. This hurt can manifest in the form of anger, says de Llano. She explains that you may find yourself thinking: “How dare they ignore me/hurt me/leave me?”
• Picking fights: Your anger may prompt you to act out in reactive ways, such as sending hurtful messages, saying things you don’t mean, and picking fights with your ex even after the breakup, says de Llano.
• Playing the blame game: You may look for a target to direct your anger toward. You may blame your ex, yourself, or other factors for the breakup.
• Replaying past offenses: A reel of your ex partner’s offenses may play in your head on a loop. Every little thing they did to offend you over the course of your relationship can pile up and intensify your anger.
• Sending them bad vibes: You may hope and pray that misery befalls your ex, so that they can’t be happy without you.
• Destroying memories: Your anger may manifest in physical ways, prompting you to discard or destroy items that remind you of them.
• Becoming bitter: Your anger can color your view of life, making you feel bitter, cynical, and resentful toward others.

Coping Strategies

These are some strategies that can help you cope with anger and resentment:

• Sit with it: De Llano explains that it’s natural to feel angry in these circumstances. She recommends sitting with your anger, even though it’s uncomfortable, so that it can rise and fade away on its own.
• Channel your anger: It’s important to channel your anger toward healthy outlets such as exercise, art, or music, says de Llano. 
• Set healthy boundaries: Establish clear boundaries with your ex-partner to avoid any situations that may trigger your anger or resentment.
• Avoid badmouthing your ex: Avoid badmouthing your ex’s negative traits and character flaws to others as it reflects poorly on you, says Silva. She recommends using your conversations with others to focus on rebuilding yourself and not diminishing your ex.
• Seek professional help: If your anger and resentment are overwhelming, consider seeking therapy. A mental health professional can provide guidance and support as you deal with your anger.
• Forgive: Forgiveness doesn’t mean forgetting or condoning everything that happened. Rather, it’s about releasing the hold that the resentment has on you. This process can take time and it may involve forgiving yourself as well.

Stage 4: Bargaining and Negotiation

The bargaining stage is where we negotiate with ourselves and our partners ways in which we can change ourselves or our situation in order to regain the relationship, de Llano explains. “It’s a grief response that helps us cope with the pain of a breakup.”

These are some of the thoughts and behaviors you may experience in this stage:

• Wishing for another chance: You might find yourself wishing for a second chance, thinking: “If only I had one more chance, things could be different.”
• Promising change: You may promise your ex that you’ll change, in the hopes of getting them back. For instance, de Llano says some common promises are: “I’ll change,” “I promise things will be different this time,” or “I’ll do what you asked me to do.”
• Seeking compromises: You may try to compromise with your ex, by agreeing to attend couples therapy for example.
• Negotiating relationship terms: You may try to renegotiate relationship terms with your ex to keep them in your life, proposing friendship, friends with benefits, an open relationship, or other alternatives instead of a complete separation.
• Compromising personal values: You may compromise on your personal values, boundaries, or lifestyle choices to try and make things work with your ex-partner.

Coping Strategies

These are some strategies that can help you cope:

• Avoid reminiscing about the relationship: Although it may be difficult, try not to reminisce about the relationship because when you do that, you’re only extracting the moments of the relationship you want to remember, says Silva. “When you start to think that they should be back in your life, avoid reminiscing and weigh out the reasons that you’re no longer together.”
• Don’t idealize the person: Once you’ve broken up with someone, it’s easy to over-idealize the person, says Silva. It’s important to remember both the good and the bad.
• Don’t compromise your values: Don’t compromise the values that are important to you. Remember that you can have a fulfilling relationship on your own terms with someone who shares your values.

Stage 5: Depression and Sadness

Breakups can be painful and even lead to depression.

These are some of the thoughts and behaviors you may experience in this stage:

• Overwhelming sadness: You may feel sad and low all the time, which can make it difficult to function. Even things you once enjoyed may not seem exciting anymore.
• Crying spells: You may find yourself crying frequently, triggered by memories or reminders of your relationship.
• Hopelessness: You may experience a sense of hopelessness about the future. According to de Llano, some common thoughts at this stage include: “I’ll never love again,” “I’ll be single forever,” “I’ll never be loved in the same way,” “I feel lonely,” “I can’t handle this all alone,” “I don’t know if I can go on,” or “This feels hopeless.”
• Social withdrawal: You may find yourself isolating yourself from friends and family, as socializing can feel emotionally exhausting.
• Physiological changes: You may also experience changes in appetite and sleep patterns.

Coping Strategies

These are some strategies that can help you cope with depression and sadness:

• Let yourself grieve: Understand that it’s normal to grieve after a breakup. Allow yourself to mourn the loss of the relationship. “Be patient with yourself and the process,” says de Llano. Avoid putting pressure on yourself to “just get over it.”
• Redirect negative thoughts: Challenge negative thoughts and replace them with more positive and balanced perspectives. For example, if you tend to think “I’ll be single and alone forever,” reframe the thought to “I’m single and this is a great opportunity for self-discovery and personal growth. I have the chance to build a fulfilling life on my terms.”
• Create a self-care routine: Take care of your mental and physical health, making sure you get enough sleep, exercise, and nutrition. Do things that make you feel happy and relaxed.
• Reach out to loved ones: Lean on your closest friends and family members for comfort. “​Keep yourself surrounded by those that help you feel most supported,” says de Llano.
• Focus on the present moment: Practice mindfulness to stay present and avoid being overwhelmed by thoughts of the past or future. Meditation and journaling can help with this, says de Llano.
• Seek professional support: “In this state, it is particularly recommended that you seek the help of a professional mental health clinician who can help you navigate the loss and process the feelings of sadness,” says de Llano.

Stage 6: Acceptance and Healing

You will heal over time and eventually be able to accept the loss. 

These are some of the thoughts and behaviors you may experience in this stage:

• Embracing the new normal: You’re able to recognize that the relationship has ended and accept the new normal.
• Feeling more stable: Your emotions are more stable and you’re less likely to experience sadness, anger, or regret.
• Getting closure: You’re finally able to understand and accept the reasons for the breakup. This understanding gives you closure and helps you grow as a person.
• Letting go: You’re able to forgive yourself and your ex, letting go of your anger and resentment.
• Being open to moving on: The idea of moving on may have been unimaginable when you first broke up, but now you feel more ready for it. According to de Llano, common thoughts at this stage include: “That was a time in my life that has run its course. It’s over now,” or “I’m moving on. They are moving on and I’m fine with it.”

Healing Strategies

These are some strategies that can help promote healing:

• Reframe the narrative: Shift the narrative of the breakup from loss to an opportunity to learn and grow. 
• Recognize your strength: Recognize the strength and resilience within you that has helped you overcome this difficult time.
• Be grateful for the relationship: Be grateful for the positive parts of the relationship—all the memories, experiences, and lessons you took away from it.

Stage 7: Growth and Moving On

Eventually, you will reach a frame of mind where you’re ready to move on and grow as a person.

These are some of the thoughts and behaviors you may experience in this stage:

• Regaining self-esteem: You may start to regain your self-esteem, feeling more confident and sure of yourself.
• Reconnecting with your social life: You may start to reconnect with your friends and start engaging in more social activities.
• Being open to new relationships: You may feel ready to start dating again and be open to the idea of a new relationship.

Growth Strategies

These are some strategies that can help promote growth:

• Read: De Llano recommends reading about relationships and personal growth, to help you process your emotions, broaden your horizons, and grow.
• Connect with others: Cultivate a network of support that has diverse perspectives, says Silva.
• Explore new interests: Start exploring new interests. You will undoubtedly learn new things about yourself in the process.
• Travel: Visiting new places can help reset your frame of mind.

Keep in Mind

A breakup can be quite an emotional journey. Although the process can be painful, each stage is a stepping stone toward a stronger, wiser version of ourselves.

If you’ve recently been through a bad breakup, hang in there and remember that things will get better. It will take time, but one day you’ll wake up and it won’t hurt so much. Focus on practicing self-compassion and taking care of yourself in the meantime. You’ve got this!

Emotional numbness is a state of being in which you are not feeling or expressing emotions.

“Emotional numbing is the mental and emotional process of shutting out feelings and may be experienced as deficits of emotional responses or reactivity,” explains Mayra Mendez, PhD, LMFT, a licensed psychotherapist and program coordinator at Providence Saint John’s Child and Family Development Center.

Quite often, feeling numb is temporary. However, for some, emotional numbness becomes a strategy to protect themselves from further emotional or physical pain. While it may provide temporary relief, learning to cope with difficult feelings this way can have long-lasting consequences. 

Symptoms of Emotional Numbness

The symptoms of emotional numbness include:

• Experiencing an inability to fully participate in life
• Failing to access your feelings
• Feeling distant or detached from others
• Feeling flat, both physically and emotionally
• Having difficulty with experiencing positive feelings such as happiness
• Losing interest in activities you used to enjoy
• Preferring isolation rather than being with others

People with emotional numbness might use strategies to resist confronting their emotions. Even if they’re doing it unconsciously, they might use avoidant behaviors and steer clear of certain people or situations. They might be in denial, which is a common defense mechanism people use to avoid emotional triggers and negative feelings.

Causes of Emotional Numbness

Feeling emotionally numb can happen as a result of physical or emotional pain. In an attempt to protect yourself from being hurt again, it’s not uncommon to disconnect, detach, or numb out feelings related to the situation.

When this happens, you may feel temporary relief that allows you to move on. Over time, though, this protective shield can begin to get in the way of connecting with others and getting in touch with feelings that are both positive and negative.

There are a variety of reasons you might feel numb.

Anxiety

People diagnosed with anxiety disorders may experience emotional numbness as a response to extremely high stress levels, fear, or excessive worry. High levels of anxiety are linked with the avoidance of both positive and negative emotions.

Borderline Personality Disorder (BPD)

People with BPD may experience periods of emotional detachment or numbness. It may feel as though their feelings are not their own.

Grief

When coping with death, a person may go through a period where they feel completely disconnected from their emotions.

Depression

Dr. Mendez points out that people going through depressive episodes may be less attuned to their feelings, or experience a dulling of emotions. “Higher levels of depression and mood dysregulation result in a greater propensity for emotional numbing,” she adds.

Emotional Dysregulation

Numbness can be a part of emotional dysregulation and is often referred to as a form of dissociation, depersonalization, or derealization, which can occur with stress, PTSD, borderline personality disorder, and other conditions.

Medications

Feeling emotionally numb can be a side effect of some medications that treat depression and anxiety. If you’re taking an antidepressant and feeling emotionally numb, it’s essential to work closely with your doctor. They may choose to adjust your dosage or change the medication altogether.

Mental or Emotional Abuse

Studies show that people who were emotionally abused as children are more likely to experience emotional dysregulation, including emotional numbing, as adults.

Overwhelming Stress

Emotional numbness can result from high levels of stress. If you’re feeling burnt out, emotionally or physically exhausted, or overwhelmed, you might feel detached from your feelings.

Physical Abuse

People who are physically abused may feel emotionally numb. Feeling numb can be a coping mechanism to avoid dealing with a dangerous and frightening situation.

Post-Traumatic Stress Disorder (PTSD)

Some people will turn to emotional numbing as a way to manage emotional and physical pain. For people with PTSD, this can manifest as avoiding thoughts, feelings, or conversations relating to a traumatic event.

Schizophrenia

People with schizophrenia may go through periods of time where they feel complete apathy or disinterest as well as emotional numbness or blunting.

Substance Misuse

People who misuse substances like marijuana or cocaine can alter the brain’s reward system, making it harder to feel pleasure without the drug. Substance use can produce a detachment from one’s emotions and an overall lack of motivation and interest.

“While emotional numbing blocks or shuts down negative feelings and experiences,” Dr. Mendez says, “it also shuts down the ability to experience pleasure, positive interactions and social activities, and intimacy.”

Treatment for Emotional Numbness

There are a variety of treatment options available that can help you reduce the extent to which you try to escape, disengage from, or avoid your emotions.

Once you find a therapist or psychologist to work with, the first step in the treatment process is unpacking the cause of your emotional numbing. A therapist can help you determine the underlying cause of the trauma, and come up with better ways to cope with overtaxing experiences and emotions. 

The primary goal of psychotherapy, says Dr. Mendez, is to stimulate an understanding of the problem and expose viable and effective problem-solving alternatives.

Psychotherapy may support the learning and the use of emotion-focused problem-solving tools. You may learn to allow feelings to emerge and to process them in the safe environment of therapy.

Whichever therapy you choose, getting help can provide you with a safe place to express and approach your emotions so that you’re no longer feeling numb.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) gives you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. It addresses how certain thoughts may be contributing to your emotions.

Rather than avoiding or using maladaptive coping tools (such as numbing), CBT strategies aim to empower you to shift from thoughts of powerlessness to beliefs of strength and emotional competence.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is another form of behavior therapy that is often used with PTSD and other mental health issues that have emotional numbness and avoidance as symptoms.

ACT uses a mindfulness-based approach to help you recognize ways in which you attempt to suppress or control emotional experiences. The goal of ACT is to help you experience your inner feelings while focusing attention on living a meaningful life.

Coping With Emotional Numbness

In addition to psychotherapy, your doctor or therapist may recommend several lifestyle modifications to help relieve some of the symptoms of emotional numbness, and hopefully, prevent more episodes from happening in the future.

While it may take a bit of trial and error, the key to the success of lifestyle modifications is to find what works best for you. Here are a few ideas you can try on your own. 

Develop a Support System

While reaching out to others may seem difficult at first, seeking social support from friends and family that you trust may help provide a safe way to express your emotions. 

Engage in Physical Activity

Staying physically active and engaging in exercises that you enjoy not only benefits your health, but it can also reduce the symptoms of depression and anxiety. Try to include some form of exercise or physical activity most days of the week. 

Get Adequate Rest

Both the quality of sleep and the amount of rest are critical to managing the symptoms of any physical, emotional, or mental health issue. Insufficient sleep can make coping with the stressors of life more challenging.

While waking up during the night is common when dealing with PTSD, depression, anxiety, or any other trauma, try to get seven or more hours of sleep each night, which is the recommended amount for adults.

Minimize Stress

Both daily stressors and overwhelming stress are major contributors to emotional numbness. Finding ways to better manage stress is key to addressing the avoidance of emotions and feelings.

Try managing your schedule, being sure to make time for activities that you enjoy. Practice deep breathing, which can help provide almost immediate relaxation. Eat a nutritious diet.

It’s also important to note that while some use drugs and alcohol to cope with stress, substances can contribute to greater stress levels. If you are struggling with substance use, talk to a doctor. They may recommend you attend counseling or a support group for additional support.

Use Mindfulness Strategies

“Mindfulness strategies may be particularly helpful in reducing emotional numbing and increasing emotional strength and competence to manage stressful experiences,” says Dr. Mendez.

Engaging in relaxation exercises, particularly body awareness exercises, says Dr. Mendez, can be very helpful for awakening sensations, feelings, and regulation of emotions.

Severe depression is often characterized by symptoms of hopelessness, increased irritability, loss of pleasure, trouble concentrating or sleeping, or thoughts of death or suicide. Technically, severe depression isn’t a formal mental health diagnosis. Instead, it refers to more debilitating depression.

The severity of depression is determined by how your symptoms interfere with your day-to-day life, such as causing you to miss school or work. While you may be able to gauge the severity of your depression by looking at your symptoms, only a doctor or mental health professional can diagnose your condition.

This article discusses the spectrum of depression severity, the signs of severe depression, and how severity is assessed. It also explores some of the treatments that may be used to help relieve severe depression.

The Depression Spectrum

It should be noted that there are several types of depression and while they may share some common symptoms, each person’s experience can be different.

Symptoms of depression can occur along a spectrum both in duration and severity:

Mild Depression

Mild depression can occur during periods of stress but resolve with time and may not require any specific treatment. Around 20% of people with the condition experience mild depression. 

Moderate Depression

Moderate depression causes chronic symptoms and usually requires at least one form of treatment, if not multiple treatments. Moderate depression often involves having more symptoms that are more significant in terms of severity and duration.

Severe Depression

Generally speaking, severe depression requires some type of treatment to find some relief.

If someone has severe depression, they may self-harm, have suicidal thoughts, or be at risk for attempting suicide. If you are severely depressed, help is available to help you manage your symptoms and ensure your safety and well-being.

Symptoms of Severe Depression

There is no set definition of severe depression. If you are diagnosed with a form of depression, the severity of the condition will be assessed by your doctor or a mental health professional based on their training and experience. When determining if depression is severe, there are some key signs and symptoms clinicians consider.

Psychosis

Psychosis symptoms such as delusions and hallucinations indicate a person has experienced a break from reality. Psychotic depression symptoms may include:

• Agitation
• Believing that one is ill despite evidence to the contrary
• Delusions or hallucinations
• Extreme anxiety
• Intellectual impairment
• Physical immobility
• Trouble falling asleep

Suicidal Thoughts and Behaviors

Strong signs of suicidality include talking about wanting to die, making plans, or attempting to take one’s own life. Warning signs of suicidal intention include:

• Acquiring the means to commit suicide (purchasing a gun, accumulating a large number of pills, etc.)
• Changes in eating or sleeping habits
• Engaging in risky or self-destructive behavior
• Extreme agitation or anxiety
• Getting one’s affairs in order (drawing up a will, giving away possessions) 
• Increased use of substances such as drugs and alcohol
• Intense changes in mood/mood swings
• Saying goodbye to friends and family as though for the last time
• Feeling trapped or hopeless in one’s situation
• Talking a lot about death, dying, and violence
• Talking about suicide or wishing that one hadn’t been born
• Withdrawal from friends or family

Melancholia

Feelings of profound sadness are common with depression and may be persistent and intense. Melancholia is depression that rises to the level of losing interest in most everything in your life. Research reveals that melancholia is often worse in the morning hours and is typically accompanied by slow movement, trouble concentrating, and loss of appetite.

Physical Effects of Depression

Depression can appear physically via symptoms felt in the body. Examples of physical effects of depression include sleep disturbance, appetite changes, poor concentration or memory, and a loss of interest in sex. Some people with depression may also feel chronic pain, experience gastrointestinal issues, or have a higher level of fatigue.

Psychomotor Changes

Noticeable slowing down of mental and physical activity can sometimes occur in mental illnesses such as depression. Clinically, this is often referred to as psychomotor retardation and can include impairment in fine motor behavior (such as having trouble when trying to pick a coin up from the floor), speech, and facial expressions.

Diagnosis of Severe Depression

Guidelines such as those found in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) and the International Classification of Diseases (ICD) help doctors and mental health professionals systematically assess a person’s symptoms. These criteria can be changed and are periodically updated when new research findings become available.

A Lack of Standardization

Quantitative scales help researchers measure and organize symptoms, as well as designate a “cutoff point” for what’s considered “severe depression” for the purpose of a specific study. However, methodologies vary between studies and researchers, meaning there isn’t a single definition of severe depression across the board. 

A lack of standardization means that if a person’s depression symptoms are assessed with different scales by different providers, the diagnosis may not be consistent. Some providers don’t use them in clinical practice unless a patient is taking medications, whereas others use them regularly. 

Types of Diagnostic Tools

Researchers have been using such scales since the 1960s. One of the first, the Hamilton Depression Rating Scale, is still sometimes used today. However, there are many more scales available that are better suited for doctors to use with patients. There are even scales patients can use on their own to track or self-report depression symptoms. 

The inconsistencies of the tools, their use, and interpretation can make it challenging to determine the severity of someone’s depression, as different scales may provide different (even conflicting) results. That said, when used along with other diagnostic measures and the judgment of an experienced clinician, the scales can be useful tools. 

Most Common Depression Diagnosis Scales

Some of the most popular scales used to help clinicians diagnose depression include:

• Beck Depression Inventory (BDI-II)
• Carroll Rating Scale (CRS)
• Center for Epidemiological Studies Depression (CES-D)
• Children’s Depression Inventory (CDI)
• Clinically Useful Depression Outcome Scale (CUDOS)
• Depression Anxiety Stress Scale (DASS-21)
• Geriatric Depression Scale (GDS)
• Major Depression Inventory (MDI)
• Patient Health Questionnaire-9 (PHQ-9) and adolescent PHQ-9 
• Plutchik-Van Praag Self-Report Depression Scale (PVP)
• Quick Inventory of Depressive Symptomatology (QIDS)
• Rome Depression Inventory (RDI)
• Zung Self-Rating Depression Scales (SDS)

Some scales, such as the Beck Depression Inventory, are copyright protected and not available outside of a doctor’s office or mental health clinic (as they must be paid for). There are inventories, scales, and questionnaires that are in the public domain and, therefore, more accessible. 

The PHQ, for example, is available for free online and in over 30 languages. It can be downloaded as a PDF or accessed as an interactive quiz on several reputable mental health websites. 

Treatment for Severe Depression

Fortunately, there are a number of treatment options for severe depression. Your doctor can help decide the best one for you based on your symptoms. Other factors also considered when suggesting a treatment plan include your level of function and if you pose a risk to yourself or others.

Psychotherapy

Also referred to as talk therapy, psychotherapy can often help ease depressive disorder symptoms. Different types of psychotherapy include:

• Cognitive behavioral therapy (CBT): This approach to treatment involves helping people identify and change the underlying negative thoughts that contribute to feelings of depression.
• Interpersonal therapy (IPT): This treatment focuses on helping people change the interpersonal relationships and social interactions that impact their mental health.
• Psychodynamic therapy: This treatment involves helping people become more aware of the feelings and emotions to gain insight than can help people feel less depressed.

Many clinicians offer several types of therapies. You can ask your healthcare provider for a referral or search the American Psychological Association’s site to find out which ones are available in your area. It may also be helpful to ask local therapists if they specialize in severe depression.

Medication

Medication is frequently prescribed to treat severe depression. The most common type of medication used is selective serotonin reuptake inhibitors (SSRIs).  This includes antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine).

Other medications used to treat depression include:

Brain Stimulation Therapy

If someone has severe depression that has not responded well to first-line treatments like antidepressant medication or psychotherapy, brain stimulation treatments may be tried. Examples of these therapies used for depression include:

Inpatient Depression Treatment

In some cases, inpatient treatment may be recommended for severe depression. Being hospitalized for depression doesn’t mean that you’re weak. It simply means that your treatment may be more effective in a more controlled environment.

Getting depression treatment as an inpatient also allows doctors to keep you safe as they closely monitor how well you are responding to the treatment protocol. It allows them to make any necessary changes should your depression not initially respond or become worse.

Complementary Treatments

There are a few additional things you can do, along with the other treatment options, to help ease your depression. Your doctor may recommend one or more to aid in your recovery.

The Cleveland Clinic shares that some of the remedies that have been found to help are:

Your doctor and mental health care team can help you evaluate all the different depression treatment options and find the one best suited for you, your type of depression, and its severity. 

Coping With Severe Depression

You can also take some steps on your own as you are navigating depression treatment and learning to cope with and manage your symptoms. These include: 

Such lifestyle changes can improve your mood and overall health and well-being.

Sometimes when life gets hard, you might think, ‘I want to disappear.’ Maybe your life feels too heavy with the injustices in the world, you feel too overwhelmed with everything you need to do, or you wish a relationship you were in looked different. If you’re feeling depressed and in a downward cycle of rumination, you may be feeling like you can’t do anything right and wish you could only disappear before you mess even more up.

Disappearing can feel tempting because it may feel like a potential opportunity to hit a pause in your life. You wouldn’t have to tell anyone what was wrong, you wouldn’t have to deal with your jerk of a boss, and the dishes in the sink would no longer be taunting you.

Shame involves an uncomfortable sense of exposure that naturally leads to wanting to disappear. It is also accompanied by a physiological response contributing to behavioral disengagement and withdrawal.

This article offers some tips for navigating this feeling of wanting to disappear.

Take Stock

Gersten recommends noting the next time you find yourself thinking I want to disappear. What are you doing? Who are you with? How are you feeling? Where are you? These are all cues to pay attention to, no matter how big or small they seem.

Maybe you want to disappear every time you’re standing in line at the grocery store after a long day at work. OK, sure, grocery shopping can be tedious, but if you take a step back, you know it’s not worth disappearing over. Because it’s not really about the shopping.

Do you feel social anxiety at a crowded grocery store? Do you resent that your partner expects you to do the grocery shopping? Maybe you sat in a ton of traffic to get there, or that particular grocery store reminds you of a breakup, and you’re afraid of running into that ex. Or maybe you feel that there’s no room for fun in your life between the monotony of work and chores.

In this example, just noting that you are feeling this way in a particular place at a specific time can bring up any number of feelings that could point to something small to change. This could mean ordering groceries instead of standing in line after a long day of work or having a bigger conversation, such as division of labor in your relationship.

Reach Out

If you are feeling like you want to disappear, feelings of shame may be leading to your desire to isolate. However, the health consequences of isolation, including depression, can be serious. But a dialectical behavioral therapy principle, opposite action can be helpful here.

The idea behind opposite action is that, often, when we are feeling a form of emotional distress, our go-to is to believe what our emotion is trying to tell us. If you’re feeling shame, this means your emotions may be telling you to isolate yourself. Acting opposite—in this case, reaching out, rather than pulling back—can decrease these feelings of shame.

Tell Yourself a Different Story

If you find yourself thinking, “I want to disappear,” it can feel overwhelming and only intensify those feelings of shame or self-loathing as your brain attacks itself. Instead, a concept from narrative therapy called externalization can help you change the story you’re telling yourself.

Rather than thinking, “I want to disappear,” try to name what wants you to disappear. Is it shame? Fear of embarrassment? Telling yourself, “shame wants me to disappear,” can put some distance between you and these thoughts. This may help you take a step back and realize that it is these unhelpful thoughts that want you to disappear.

Take a Break

Gersten suggests taking a break from what makes you want to disappear for as long as you can help. If it’s work that’s making you think of disappearing, maybe a long vacation isn’t feasible right now, but taking a day off or an actual break time are smaller ways to remove yourself from the cause. 

Research shows that even microbreaks are helpful at work. Sometimes, wanting to disappear could mean getting off the grid, disconnecting for a day or an afternoon, and spending time in nature. 

Once you have removed yourself from whatever that’s making you want to disappear, “check in with yourself to get to the root of what’s going on to cause the feeling,” says Gersten. If this is at work, it could be that you feel you are not being respected, that you have more work than is manageable—or maybe you hate your boss.

From there, take a look at what you can change. If you’re feeling like you’re not being respected or have more work on your plate than you can handle, there may be conversations you can have with coworkers on these points. If not, you can decide to change how you deal with the situation or leave the job—not disappear—altogether. 

If I Want to Disappear, Am I Depressed or Suicidal?

You might be worried that wanting to disappear means that you are depressed or suicidal. Gersten says that wanting to disappear doesn’t necessarily equate to a diagnosis of depression or feelings of suicide. Sometimes it may just be as simple as you don’t want to deal with whatever’s going on that day, and checking out sounds like a better option.

But it also can be a warning sign that there’s more going on with your mental health than you realize, especially depending on how often you’re thinking this way. If you think I want to disappear multiple times during the day or most days, you might want to find a therapist.

They can help you untangle what the feelings of fantasizing about disappearing are covering up. They can also help you think through which problems you think disappearing might solve and what that would look like. A therapist may finally help you find tools to deal with these feelings or guide you to discover changes you want or need to make in your life. 

A therapist may ask you if you feel other things that might point to depression. Other symptoms of depression can include:

• Low mood
• Loss of interest
• Lack of motivation
• Changes in sleep and appetite
• Fatigue and changes in activity levels
• Feelings of guilt or worthlessness
• Problems concentrating

An appointment might include a suicide risk assessment to determine what wanting to disappear means to you. Does it mean you are experiencing thoughts of suicide or that you simply want to get away? 

Even if you tell a therapist that you have had thoughts of suicide, this does not automatically mean that you will be hospitalized. Sharing these thoughts with your therapist can help them develop proper treatment and minimize risk by creating a safety plan if they believe you may be a danger to yourself.

Cannabigerol (CBG) is a type of cannabinoid found in the cannabis plant. It’s often referred to as the “mother of all cannabinoids.” This is because other cannabinoids are derived from cannabigerolic acid (CBGA), an acidic form of CBG.

CBG is found in smaller quantities than other cannabinoids in cannabis plants, such as cannabidiol (CBD) and tetrahydrocannabinol (THC). This makes consumer products derived from cannabigerol rare and often expensive. However, CBG is growing in popularity because of the many potential benefits the cannabinoid offers. 

CBG Concentration in Plants

CBG is derived from young cannabis plants, which contain higher amounts of this cannabinoid than plants that are fully developed. Both CBD and THC start as CBGA, an acidic form of CBG. This is why younger cannabis plants contain higher concentrations.

Conversely, in fully developed plants with high concentrations of THC and CBD, you’ll find very low concentrations of CBG. In most plant strains, only 1% of CBG can be found. This happens because most of the CBG has already been converted as the plant developed.

Some strains of cannabis have higher CBG content due to their genetic and biochemical makeup. Because of the difficulty in getting CBG, cannabis growers have been experimenting with cross-breeding and genetic manipulation to help cannabis plants produce more of this cannabinoid. 

How CBG Works

CBG is processed by the body’s endocannabinoid system. The endocannabinoid system is made up of molecules and receptors that are responsible for keeping our bodies in an optimal state, regardless of what’s going on in our external environment.

In our bodies, CBG imitates endocannabinoids, the natural compounds our body makes. But it does not have THC’s psychotropic effects, so it will not give you a high. 

Cannabinoid Receptors in the Body

Our body contains two types of cannabinoid receptors—CB1 and CB2. CB1 receptors are found in the nervous system and brain, while CB2 receptors are located in the immune system and other areas of the body.

CBG works by binding to both receptors, where it’s thought to strengthen the function of anandamide. Anandamide is one of many neurotransmitters in the brain. It plays a role in enhancing pleasure and motivation, regulating appetite and sleep, and alleviating pain.

Potential Benefits of CBG

Research shows that CBG may have therapeutic effects. While more research is needed to learn the exact effects of this cannabinoid and its potential benefits, here are a few of their findings.

Anxiety and Depression

One small-scale study found that the number one reason people used cannabis preparations high in CBG was to reduce anxiety, with one in three using it to ease depression. Most of the users reported that they felt that CBG was more effective for these purposes than conventional medicines.

Chronic Pain

In the study mentioned above, the second-most common reason people used CBG was for chronic pain, with 73.9% reporting that it worked better than traditional medicines. Chronic pain is pain that lasts three months or more. This type of condition impacts roughly one in five U.S. adults or around 51.6 million Americans.

Inflammatory Bowel Disease (IBD)

According to one review, between 15% and 40% of people with inflammatory bowel disease (IBD) use cannabis and cannabinoids to increase their appetite as well as to reduce their pain. Although studies have found promise for its effects on IBD, researchers added that high-quality evidence is lacking, as is advice as to the proper dose and mode of administration.

Glaucoma

Individuals with high eye pressure, also known as intraocular pressure (IOP), are at a greater risk of developing glaucoma. Several studies have looked at the impact of cannabinoids on IOP. Many have found that these cannabis derivatives help lower IOP in both humans and animals, making them a potential glaucoma treatment.

Huntington’s Disease

Huntington’s disease causes a breakdown of nerve cells in the brain. Cannabigerol appears to have a positive effect on cell viability while also protecting certain cells (N2a cells) from the toxic effects of excitatory neurotransmitters that, when activated too long, lead to cell death.

Cancer

A 2021 meta-analysis reports that CBG appears to not only stop breast cancer cells from increasing in numbers but may also kill off inflammatory cells associated with this cancer type.

Bacterial Infections

A 2020 study on the antibiotic potential of cannabis found that CBG has antibacterial properties, especially against methicillin-resistant strains of Staphylococcus aureus. Staphylococcus aureus is also known as MRSA, a drug-resistant bacteria that causes staph infections.

How CBG is Consumed

The most common form of commercially available CBG is oil, but it is rare and expensive. As an alternative, broad-spectrum CBD oils contain almost all the cannabinoids of cannabis.

Broad-spectrum CBD oils also contain compounds called terpenes, which are responsible for the plant’s smell and are found in many plants, including fruit and herbs. Using cannabinoids together with terpenes is said to increase their combined effectiveness through a phenomenon called the entourage effect.

Some people consume CBG by smoking marijuana. While this is one way to ingest CBG, marijuana addiction is possible. This is classified as cannabis use disorder and can negatively affect your mental and physical health while also hurting your personal and social relationships.

Side Effects of CBG

Some people experience side effects when taking CBG, with some of the most common being:

• Dry mouth
• Sleepiness
• Increased appetite
• Dry eyes

CBG vs. CBD

CBG shares many similarities with CBD:

• Both act on the endocannabinoid system.
• Neither is psychoactive, meaning they don’t produce a “high.”
• Each one can counteract THC’s psychotropic effects.

One of the biggest differences between CBD and CBG is their prevalence within the cannabis plant. Remember that most cannabis plants contain only 1% CBG. Conversely, their level of CBD is much higher, with some research indicating that CBD is the second-most abundant compound found within these plants.

CBG also interacts differently with the endocannabinoid system than CBD. CBG binds directly to both CB1 and CB2 receptors and might deliver its benefits to the system more efficiently.

The biopsychosocial model is an approach to understanding mental and physical health through a multi-systems lens, understanding the influence of biology, psychology, and social environment. Dr. George Engel and Dr. John Romano developed this model in the 1970s, but the concept of this has existed in medicine for centuries.

A biopsychosocial approach to healthcare understands that these systems overlap and interact to impact each individual’s well-being and risk for illness, and understanding these systems can lead to more effective treatment. It also recognizes the importance of patient self-awareness, relationships with providers in the healthcare system, and individual life context.

Dr. Akeem Marsh, MD, physician and author of Not Just Bad Kids, described the biopsychosocial model as “at its core, centering around social determinants of mental health in connection with the ‘standard’ biomedical and psychological models. One of the more common ways in which it is represented when using the model is through the four ‘Ps’ of case formulation: predisposing, precipitating, perpetuating, and protective factors.”

Learn more about how providers can use the biopsychosocial model to offer holistic care and how clients and patients can benefit from this approach.

What Are the Three Aspects of the Biopsychosocial Model?

When understanding an individual’s physical and mental health through the biopsychosocial model, we consider physiological factors such as genetics and illness pathology (biological); thoughts, emotions, and behavior (psychological); and socioeconomic components, social support, and culture (social). How do each of these components inform the model as a whole?

Biological

“Biology” refers to our genetics, physical health, and the functioning of our organ systems. Our physical well-being impacts our mental health for multiple reasons. First, our brain is an organ and can become unwell just like any other organ. Second, physical health conditions can wear on mental health. For example, chronic pain can lead to symptoms of depression.

Additionally, just like we can have genetic predisposition to a physical disability, mental health has genetic roots as well. According to Dr. Marsh, “Genetics are the most basic level by which mental health is influenced, and on some level has an impact for everyone.” In other words, “Whatever the phenotypical expression, genetics does play a role to some degree.” The expression is in turn influenced by the environment.

Psychological

Mental health is health, and one’s psychological well-being impacts both mental and physical health. Unhealthy and maladaptive moods, thoughts, and behaviors can all be symptoms of mental health conditions, and in turn can contribute to our overall health. Mental health and behavior can be cyclical; for example, an individual who self-isolates as a symptom of depression may experience increased depressive symptoms as a result of isolation.

Routine physical activity is known to promote positive mental wellness, while inadequate or excessive physical activity can contribute to different types of mental health struggles.

—
DR. AKEEM MARSH

Addressing these symptoms is key in improving mental health.

Social

Dr. Marsh shares the impact of external factors on health: “The expression [of genetics] is in turn influenced by environment.” Changes in one’s environment can impact mental health, both positively and negatively. In the previous example of depression and isolation, individuals who have appropriate social support experience fewer mental health issues compared to those without this support.

How the Biopsychosocial Model Impacts Mental Health

Traditionally, healthcare has focused primarily on the medical and biological side of the patient’s needs, and mental health care has focused on the psychological side. While it makes logical sense to address manifesting symptoms, a holistic approach to care that aims to address the social as well as the psychological and biological contributions to illness can be more health-promoting.

Sometimes, for instance, addressing an underlying social need or environmental stressor can improve mental health more effectively than other psychological or biological treatments. This may allow for less-invasive treatments and interventions, and it can improve the individual’s well-being in a way that non-holistic models overlook.

Criticism of the Biopsychosocial Model

Although many providers support a holistic approach to care and implement the biopsychosocial model in practice, like any model it has limitations. Dr. Marsh notes that there are concerns about its evidence backing: “Some people believe that [the biopsychosocial model] is not scientific, as in it has not quite met the ‘gold standard’ of being validated through multiple randomized trials, as it is a uniquely challenging study prospect.” How can researchers study controlled variables in a model that requires holistic care that takes individual needs into account?

At the same time, the model has many strengths and can benefit patients in the healthcare and mental health systems: “It has been researched extensively and shown positive results when applied in different ways,” Dr. Marsh said.

How Healthcare Professionals Use the Biopsychosocial Model

Mental health professionals who utilize the biopsychosocial model in practice include extensive medical history, family history, genetics, and social factors in assessments in addition to psychological information.

Additionally, they use this information to ensure that all of the client’s needs are met, as many medical issues can manifest with mental health symptoms. Therapy services to treat, for example, depression caused by an under-functioning thyroid is unlikely to be effective.

This model lets providers see the whole person beyond their presenting symptoms.

How Clients and Patients Can Use the Biopsychosocial Model

While the biopsychosocial model has its place in the healthcare and mental healthcare systems, individuals might also implement tenants of this model in their own lives. This means being aware of how environmental factors impact their mental and physical health, as well as how their genetics and medical history in turn influence behaviors, thoughts, and emotions.

It can help individuals better understand themselves as complex, whole beings as well. “I believe that [the biopsychosocial model] could enhance their self-awareness and understanding of themselves, along with broadening their personal sense of what issues or challenges may be going on with them,” says Dr. Marsh.

An emotional breakdown, also known as a nervous breakdown, mental breakdown, or mental health crisis, is a period of severe emotional distress, during which a person may feel paralyzed and entirely incapable of coping with challenges, says Sabrina Romanoff, PsyD, a clinical psychologist and professor at Yeshiva University.

Metaphorically speaking, an emotional breakdown can be likened to a total tire blowout that has a car stranded on the side of the road, according to the Huntsman Mental Health Institute at the University of Utah.

“What makes an emotional breakdown distinct is that there are almost always intense symptoms of stress and paralysis where the person finds themselves incapable of functioning,” says Dr. Romanoff.

This article explores the symptoms and causes of an emotional breakdown, as well as some steps you can take if you’re experiencing a mental health crisis.

Symptoms of an Emotional Breakdown

These are some of the thoughts you may have if you’re experiencing an emotional breakdown:

• “I’m losing control.”
• “Everything is going wrong and I don’t know what to do.”
• “I’m mentally, physically, and emotionally overwhelmed.”
• “I’m stuck and cannot function.”
• “It’s not going to be all right.”
• “I can’t do this. I give up.”
• “I just want it to end.”

Additionally, you may also experience certain emotional and physical symptoms while you’re approaching or experiencing an emotional breakdown.

Emotional Symptoms

According to Dr. Romanoff, an emotional breakdown may be accompanied by emotional symptoms such as feeling:

• On edge
• An extreme sense of doom
• Low energy and fatigue
• Intense sadness, worry, anxiety, fear, or nervousness
• Guilt, worthlessness, powerlessness, or shame
• Anger, irritability, mood swings, or emotional outbursts
• Loss of interest in activities
• Isolation and a tendency to avoid work and social settings
• Changes in the way you view the world, yourself, and others
• Thoughts of self-harm or suicide

Physical Symptoms

According to Dr. Romanoff, an emotional breakdown may be accompanied by physical symptoms such as:

• Dizziness
• Sweating
• Nightmares
• Muscle tension
• Difficulty breathing
• Irregular heartbeat
• Poor eating habits
• Shaking and tremors
• Insomnia or hypersomnia
• Gastrointestinal symptoms such as cramps or an upset stomach

Causes of an Emotional Breakdown

These are some of the potential causes of an emotional breakdown, according to Dr. Romanoff:

• Death of a loved one
• Family turmoil
• Financial difficulties
• Loss of a job or business
• Personal tragedy or setback
• Racism, discrimination, or hate crimes
• Relationship difficulties, such as a fight, breakup, or divorce
• Severe injury or illness
• Trauma 
• Violence
• Work or school stress

Everyone’s tolerance for stress is different. Every individual has their own “set point” beyond which they can’t handle things anymore.

Diagnosing an Emotional Breakdown

A healthcare provider can complete a comprehensive evaluation, suggest treatment options, and work with you to develop a treatment plan to address your symptoms.

There is no diagnosis for an emotional breakdown in mental health manuals such as the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems: 11th Revision (ICD 11), says Dr. Romanoff. 

Depending on your symptoms and their intensity, your healthcare provider will determine whether you have a mental health condition such as a depressive disorder, an anxiety disorder, or an acute stress disorder, and provide treatment accordingly, she explains. 

If not, they can still provide therapy and support that can help you cope with the challenges you’re experiencing.

Coping With an Emotional Breakdown

Dr. Romanoff suggests some steps that can help you cope with an emotional breakdown.

Get Some Perspective

Take a step back from the stressor and try to get some perspective on it. This could mean talking to an objective person, a friend, or a trusted loved one to help you view the situation from a different lens and find alternative ways to cope. 

Focus on Self-Care

Focus on self-care and then re-approach the situation instead of trying to white-knuckle yourself through a problem.

Usually, it’s the basic small steps that make the biggest difference. This includes getting at least seven hours of sleep per night, eating healthy whole foods, and exercising. These are crucial elements that are universally needed for effective functioning.

When we face stressors, we tend to neglect some of those domains, which only weakens our ability to cope and makes them assume the stressor is much worse than it is in reality.

Once you have these things down, you will probably find that your perspective on the stressor has improved, and your perceived ability to cope with it has increased. 

Seek Treatment and Support

If you’re experiencing an emotional breakdown or struggling to cope, it can be helpful to see a mental healthcare provider. They will be able to determine whether you have a mental health condition and offer treatment accordingly. If not, they can still help you put your challenges in perspective and help you develop the coping skills you need to face them.