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

Understanding the Difference Between Grief and Depression

Holding hands with a grieving friend
What is the difference between grief and depression?. Peopleimages/Getty Images

When It's Difficult to Decide If It's Grief or Depression

Grief and depression share similar symptoms, but they're distinct experiences. Since the symptoms can be so much alike, how can you tell the difference, and does it matter? Attempting to make the distinction is important for several reasons. With depression, making the diagnosis and seeking treatment can be literally life saving. At the same time, experiencing grief due to bereavement is not only normal, but can be very healing.

Since the two are similar, and grief can sometimes lead to depression, what do you need to know?

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

There are often times when it may be difficult to distinguish between grief and major depression. For example, if someone has recently been diagnosed with cancer, it can be difficult to know if the sadness they are experiencing is due to their fears of the future or if they are instead experiencing an episode of major depression.

It becomes more important when talking about treatment. We know that depression is common with cancer, and the suicide rate for people with cancer is high, especially shortly after they are diagnosed. Yet we don't want to use medications to treat normal grief, especially at a time when other medications, such as chemotherapy drugs, are often needed. There are many other examples of times when this distinction could be important. So what are some similarities and differences?

How Grief and Depression are Similar

Grief has several symptoms in common with the symptoms of major depressive disorder, including intense sadness, insomnia, poor appetite, and weight loss. In fact, the symptoms of grief and depression can appear remarkable similar.

With grief it is normal to experience sadness and to cry. It is normal to experience changes in sleep patterns, energy levels and appetite. It is normal to have difficulty concentration and to have moments of anger, loneliness, and more. A difference, however, is that these feelings usually begin to debate over time.

That is, unless, someone develops complicated grief.

What is Complicated Grief?

Complicated grief, unlike uncomplicated grief, does not seem to dissipate with time. Symptoms of complicated or chronic grief may include intense sadness, anger, or irritability. A person may have difficulty accepting that whatever caused her grief really occurred. She may focus excessively on the episode of grief or not face it at all. She may engage in self-destructive behaviors or even contemplate or attempt suicide. It is likely due to these symptoms of complicated or prolonged grief that the newer DSM-5 removed the bereavement exclusion from the diagnosis of major depression.

How Grief Differs From Depression

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 Differences Between Grief and Depression

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 Medications?

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.

Coping with Grief vs Depression

If you are wondering if you are experiencing grief or major depression, it is very important to talk to your loved ones and find a caring therapist who can help you. Untreated depression is not only dangerous, but can rob you of days that your lost loved one would long for you to enjoy.

If you feel that your symptoms are related to normal grieving, they will probably improve in time. Grief is our body's way of working through difficult and traumatic experiences. In this sense, it would be doing someone a disservice to try to "get rid of" grief. Every person grieves differently and there is no right or wrong way to grieve. If you are facing grief in your life, make sure you can talk openly to a friend or family member. Consider talking to a member of the clergy or a therapist. It is not a sign of weakness to seek out help in coping with your loss, and you make think of your need instead as a testament to the strength of your love or the beauty of a loved one who is lost. In addition, here are 10 tips to help yourself in times of grief.

Sources:

Assareh, A., Sharpley, C., McFarlane, J., and P. Sachdev. Biological Determinants of Depression Following Bereavement. Neuroscience and Biobehavioral Reviews. 2015. 49:171-81.

Shear, M. Clinical Practice: Complicated Grief. The New England Journal of Medicine. 2015. 372(2):153-60.

Zisokook, S., and K. Shear. Grief and Bereavement: What Psychiatrists Need to Know. World Psychiatry. 2009. 8(2):67-74.

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