How Do You Know If It's Grief or Depression?

Understanding the difference and when they occur together

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Grief and depression share some similar symptoms, but they're distinct experiences. 

Depression, Grief, and the DSM

The 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) removed a "bereavement exclusion" from the diagnosis of major depressive disorder (MDD). In the DSM-IV, the "bereavement exclusion" stated that someone who was in the first few weeks after the death of a loved one should not be diagnosed with MDD.

However, the DSM-5 recognizes that while grief and MDD are distinct, they can also coexist and, in fact, grief can sometimes trigger a major depressive episode, just as other stressful experiences, such as the loss of a job, can.

Studies have shown that the extreme stress associated with grief can trigger both medical illnesses, such as heart disease, cancer, and the common cold, as well as psychiatric disorders like depression and anxiety.

How to Distinguish Grief From Major Depression

Grief has several symptoms in common with major depressive disorder, including intense sadness, insomnia, poor appetite, and weight loss. But they also share important differences. 

Where they differ is that grief tends to decrease over time and occurs in waves that are triggered by thoughts or reminders of the deceased loved one. In other words, the person may feel relatively better while in certain situations, such as when friends and family are around to support them.

But triggers, like the deceased loved one's birthday, could cause the feelings to resurface more strongly.

Major depression, on the other hand, tends to be more persistent and pervasive. An exception to this would be atypical depression, in which positive events can bring about an improvement in mood.

A person with atypical depression, however, tends to exhibit symptoms that are the opposite of those commonly experienced with grief, such as sleeping excessively, eating more, and gaining weight.

Other clues that it may be major depressive disorder include:

  • feelings of guilt not related to the loved one's death
  • thoughts of suicide—although in grief there can be thoughts of "joining" the deceased
  • morbid preoccupation with worthlessness (grief does not usually erode self-confidence)
  • sluggishness or hesitant and confused speech
  • prolonged and marked difficulty in carrying out the activities of day-to-day living
  • hallucinations and delusions; however, some people in grief may have the sensation of seeing or hearing the dead person

Should Grief Be Treated With Psychiatric Medication?

While grief can be extremely painful, there is generally no medical indication to treat it. Some exceptions, however, are:

  • If the person is experiencing sleep problems, short-term use of prescription sleep aids may be helpful.
  • If the person meets the diagnostic criteria for MDD, antidepressants may be prescribed as part of that therapy.

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