For me it's usually when I become actively suicidal and develop concrete plans to off myself. However, the last time I went inpatient, it was due to severe fatigue and leaden paralysis due to the depression. I simply could not move. I was pretty much trapped in bed most of the day. When I was up, I was stuck on the couch. I was unable to feed myself - literally could not lift the fork. I had suicidal thoughts but could never have moved enough to act on them. But once I stopped eating it became apparent that I needed to go in.

I'm with many others who tend to put off going inpatient. I downplay the severity of my illness and keep saying "I'll be fine." and that I'll pull out of it myself. Once I'm at the hospital and can begin to come out of it, I realize just how far gone I really was. So if you're questioning whether or not it's time to go in, it probably is.