What Is the Difference Between Grief and Depression?

Grief and Depression Are Different, but Can Occur Together

Woman Grieving
Woman Grieving. David McNew / Stringer / Getty Images

Grief and depression share some similar symptoms, but they're distinct experiences. Find out how grief and depression are similar, and what keeps them distinct.

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 be trigger-related. In other words, the person may feel relatively better while in certain situations, such as when friends and family and 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 pervasive, with the person rarely getting any relief from their symptoms. 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 death other than feelings he or she would be better off dead or should have died with the deceased person
  • 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 other than thinking he or she hears the voice of or sees the deceased 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 grief-related anxiety is so severe that it interferes with daily life, anti-anxiety medication may be helpful.
  • 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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