Stage Four Depression

I remarked to a friend a few months ago that I feel my depression was at a stage four level. That is, that it was incurable and that at this point, it was just a matter of time before it killed me.

No, I don’t have a plan. Please don’t call the police on me. I’m not saying that I’m in imminent danger. But I’m in danger nonetheless. Depression is dangerous. It is often fatal, and I’ve written before here about tiresome it is to hear people offer me the same old same old treatments.

Medication. Check. Haven’t found one that does anything but make my life worse.

Therapy. Sometimes helps. Sometimes makes things worse.

Have you tried exercise? (Cue me laughing hysterically)

Do you have a good sleep routine? Yes, thanks.

I am very, very good at checklists and I’ve been working the checklists on depression for about two decades now. They aren’t working for me. Which is why I’ve started calling my depression “stage four.”

I don’t really have hope for a better future at this point. Hope to me seems the antithesis of depression. Other people insist I should be hopeful. Things will get better, they insist.

Yes, I respond. But they will also get worse. It’s the getting worse part that concerns me.

In 2023, I began to accept the stage four depression and as a result of that, I made sure that I had a legal will so that if/when I die, my children will get what assets I have remaining and also that it will make things clear and easy for them. I have a few bequests, but that isn’t the real reason I made a will. Maybe a part of the reason I did it was less me being responsible and more me taking myself seriously. It is seriously a danger that I will not survive stage four depression.

In 2023, I began writing a “suicide journal” where I recorded my suicidal thoughts. I cannot recommend this exercise and have since stopped it because I think writing down how awful I feel actually makes things worse, not better. The only way I’ve found to actually decrease my suicidal thoughts is to treat them as pesky, annoying things that will go away if I give them as little attention as possible. But this isn’t a cure.

One of the other things I did this year was to set a date in 2024 that I promised I would live to, in case life actually did get better as everyone said it would. And then I made a list of things I absolutely had to finish before I was allowed to die. A list of ten things, of which I have accomplished eight so far.

Sometimes I imagine living into a future where I grow old. My mother is 93 and there’s a strong maternal line of long life. It’s possible that I could reach that age. On some days, it even feels likely. I’m healthy and fit and other than the stage four depression, don’t seem to have any disease that’s likely to shorten my life significantly.

It’s not that I want to die, either. I don’t want anyone I actually know to find my body, for instance. That seems like a terrible thing to leave behind.

I just don’t know how to want to live. I don’t really understand why people cling so fiercely to life. What is it that makes it so sweet? My father, until the moment he was actively dying, would keep insisting that he wanted to stay alive because he liked being alive. I don’t really understand that. Why?

Again, this is not me asking for help or blaming anyone. I’m just trying to write things down in the hopes that it helps someone else for me to write down their experience. Maybe someone out there will feel more seen. Maybe someone will show this essay to someone they love and say—this is how I feel. I have stage four depression, too.

Maybe that is the one thing that keeps me alive for now, this hope that I can help someone else. It is a truth about myself that perhaps is part of the depression that I care a lot less about helping myself than about helping other people.