Is it Grief or Is it Depression?

Grief and depression may have some overlapping symptoms such as sadness, crying, fatigue, reduced concentration, and sleep and appetite disturbances. However, grief and depression are not the same. Grief is a normal reaction to a loss, whereas depression is a clinical condition. Other distinguishing features between grief and depression are as follows (American Psychiatric Association, 2013; Shear, 2012):  

• Although in grief, individuals feel sad and are tearful, the predominant mood in grief is a feeling of emptiness and loss. In contrast, in depression, the depressed mood is persistent, and there is an inability to anticipate happiness or pleasure.

• Bereaved people feel sad because they miss a loved one, whereas individuals with depression feel sad because they see themselves and/or the world as inadequate, flawed, or worthless.

• Self-esteem is preserved in grief, whereas depression is usually characterized by feelings of worthlessness and self-loathing.

• Feelings of guilt in grief are related to one’s perception of failing to say or do something before the person died (e.g., not seeing the deceased person more frequently or not being able to mend a relationship before the person died). In depression, the feelings of guilt are associated with irrational thoughts of taking excessive personal responsibility or that one doesn’t deserve to fare better when others are suffering.

• In grief, positive emotions occur as frequently as negative emotions as early as a week after a loved one dies, whereas in depression, these emotions are rare.

• Depression biases one’s thinking in a negative direction, but grief does not.

• Depression inhibits one’s capacity to relate to other people’s intentions and to care about them. In grief, the desire to be with others and the appreciation for others' efforts are preserved.

• In grief, suicidal thoughts about death or dying are related to the themes of “being with” or “joining” the deceased. In contrast, in depression, these thoughts are triggered by underlying themes of worthlessness, hopelessness, feeling that one is undeserving of life, or the inability to cope with the pain of depression.

If an individual has suffered a recent loss and they are not sure if their grief has evolved into depression, then using the above distinguishing pointers would be helpful. However, be mindful that depression can still occur in the context of bereavement. The Diagnostic and Statistical Manual of Mental Disorders – fourth edition, text revision (DSM-IV TR) excluded depressive symptoms occurring up to a couple of months after a loss as being a sign of a major depressive episode (American Psychiatric Association, 2000). However, depression arising after a loss of a loved one is no different compared to that occurring due to a job loss, recent divorce, or “out of the blue” (Pies, 2014). Moreover, not diagnosing depression during grief can potentially divest such people from getting timely help; professionals may defer treatment until symptoms persist or become more severe. In tandem with these observations, the DSM-5 doesn’t consider bereavement as an exclusion for diagnosing depression.

To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Pies, R. W. (2014). The bereavement exclusion and DSM-5: an update and commentary. Innovations in Clinical Neuroscience, 11(7-8), 19-22.

Shear, M. K. (2012). Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in Clinical Neuroscience, 14, 119-128.