Skip to main content

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 under (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, whereas 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 intention and to care about them. In grief, the desire to be with others and appreciation for the efforts of others is preserved.
  • In grief, suicidal thoughts about death or dying are related to the themes of “being with” or “joining” the deceased, whereas in depression these thoughts are triggered by underlying themes of worthlessness, hopelessness, feeling that one is undeserving of life, or 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 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 arising due to a job loss or 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.


Comments

Popular posts from this blog

7 Practical and Proven Ways to Curb Your Overthinking

What is overthinking? The Merriam-Webster dictionary defines overthinking as "to put too much time into thinking about or analyzing (something) in a way that is more harmful than helpful." Surprisingly, even a non-psychological lexicon considers overthinking more harmful than helpful. In psychological jargon, overthinking usually involves misinterpretation or misattribution of situations, past events, memories, and even feelings. Some common types of overthinking patterns, also called irrational thoughts or cognitive distortions, include all-or-none thinking (always/never thinking), jumping to conclusions without substantial evidence, disqualifying the positives, magnifying things out of proportion, catastrophizing (assuming the worst-case scenario), taking things personally, using negative self-labels (e.g., “I am a loser”), and should/must thinking (imposing rules on yourself or others). While we all engage in these overthinking patterns periodically, sometimes these irrat

Safety Plan: An Evidence-Based Tool for Suicide Prevention

According to the World Health Organization (WHO), every 40 seconds a person dies by suicide somewhere in the world and over 800,000 people die due to suicide every year. When it comes to therapeutic approaches that have shown to reduce suicide attempts, there are only a handful of evidence-based treatments. One of these treatments is cognitive-behavioral therapy (Brown & Jager-Hyman, 2014). A safety plan is a key element of the cognitive-behavioral approaches that has been widely and effectively used for preventing suicide. In a nutshell, a safety plan is a document that is developed though collaboration between the person at risk of suicide and a treatment provider and consists of a prioritized written list of coping strategies and supportive resources that a suicidal person can use before or during a suicidal crisis (Stanley & Brown, 2008). A study comparing Safety Planning Intervention with usual care found a 45% reduction in suicidal behaviors and the double the odds

Behavioral Activation: A Simple and Proven Treatment for Depression

What is Behavioral Activation? When it comes to treating depression, most mental health professionals talk about either medications or therapies such as cognitive therapy. These are, no doubt, clinically relevant treatments for depression. However, with the recent emphasis on treating the "chemical imbalance," simple treatments for depression such as behavioral activation have been sidelined. Behavioral activation is an evidenced-based treatment for depression and complements other treatments of depression (American Psychiatric Association, 2010). In fact, research demonstrates that in individuals with severe depression, behavioral activation is comparable to antidepressant medication and better than Cognitive Behavioral Therapy (Dimidjian et al., 2006). Avoidance is a key target for change in behavioral activation. The lack of energy and motivation in depression can result in people with depression either cutting back on pleasurable activities or not enjoying them as they