Grief and Depression
We tend to use the term ‘depression’ as a catch-all word for times we feel lower than our usual selves. However, depression in psychology is typically used as part of major depression – a psychological disorder. What differentiates depression and regular sadness is depression is something we feel beyond what people typically feel in response to loss. Depression lasts longer, is more pervasive (i.e., fills up more of your day), and includes certain number of symptoms as a threshold. It is important to properly distinguish between normal sadness and depression because it allows us to recognize if there’s an inherent problem (or if what you are feeling makes perfect sense) and decide on whether to seek treatment. We also don’t want to pathologize something that everyone feels at some point in their lives (i.e., sadness). Diagnoses should be helpful, not stigmatizing.
Grief, or bereavement, refers to a period of adjustment after loss of a loved one. This is a very normal process and we do not want to conflate grief with disordered mood. Depression and grief (i.e., feelings of bereavement after a loved one passes away) can have very similar symptoms. However, there are a few distinct differences that are helpful to know. We’ll first start by talking about the features of depression.
Symptoms of Depression
Symptoms of depression include:
– Depressed mood
– Anhedonia (loss of pleasure or enjoyment in things previously enjoyed)
– Difficulty sleeping/sleeping too much
– Changes in appetite/weight
– Psychomotor agitation / psychomotor slowing
– Feelings of guilt or feeling worthless
– Concentration difficulties
– suicidal ideation
*To be diagnosed, must have 5 or more symptoms, with one of them being depressed mood and/or anhedonia. The episode must last at least 2 weeks, with these symptoms being present most of the day, nearly every day.
Features of Grief
– Intense sorrow and emotional pain
– Preoccupation with the deceased in terms of thoughts and emotions
– Preoccupation with the circumstances of the death
– Feeling bitterness or anger or emotional numbness in response to loss
Differences between depression and grief
Here, I’ll talk about differences between depression and grief in three different domains: emotions, thoughts, and self-esteem.
1. Emotions. Emotions in grief tends to be sorrowful – these so called ‘pangs of grief’ from the loss of a loved one. These are intense sensations that ebb and flow with periods where the person feels okay. The pangs also become fewer and further between as time goes on. Moreover, the person can also experience times of happiness and positive emotions in between periods of sorrow. On the other hand, depression tends to be much more consistent in its affect – people with depression generally find it hard to feel much of anything (or else, feel low and depressed) through long stretches of time. Therefore, in terms of emotional volatility, grief goes through periods of ups and downs, whereas depression stays flat and low.
2. Thoughts. Thoughts associated with grief are typically preoccupations about the deceased. If there are any negative thoughts about the oneself, it’s usually in relation to the other person: “I should have been there for them”, “I should have spent more time with that person – I feel like a failure because I could have made them happier”. If there are thoughts about death, it can be related to ‘joining the other person’. On the other hand, depressive thoughts are more focused on the self: “I am a bad person”, “I feel worthless”. If there are thoughts about death, then they are generally to ‘end the pain’.
3. Self-esteem. Self-esteem in grief is usually intact. If there is loss of self-esteem, it’s associated with feeling as though they could have done more for the other person. In depression, self-esteem is typically low and based off self-criticism regarding their own worth.
Can grief/bereavement eventually become a disorder?
Yes. The Diagnostic Manual of Statistical of Mental Disorders indicates that people whose grief lasts longer than 12 months and continues to significantly impact their everyday lives would meet criteria for Persistent Complex Bereavement Disorder (PCBD). This is currently listed as a condition for under further study. Here’s a link discussing PCBD and its symptoms in more detail: https://www.theravive.com/therapedia/persistent-complex-bereavement-disorder-dsm–5
Ways to deal with grief and depression
Sometimes knowledge is worth its weight in gold. Once you know what you’re dealing with, you can begin to evaluate what might be the best way to deal with your grief or depression moving forward. Ultimately, what you think might be most helpful depends on you. For grief, some people might lean on social supports, journal, or go into grief counselling. They may also simply realize that grief is a natural process and it’s okay to feel sorrow at certain times. This understanding can be comfortable in and of itself. For people battling depression, psychotherapy or medication may be particularly helpful. I would encourage people to visit their primary care provider to see what the best treatment option may be. If you are interested, please see a couple evidence-based strategies to improve mood using thought records and behavioural activation.
The relevant links below provide comprehensive information on different resource for suicide prevention. Please take a look below if you are struggling with suicidal thoughts (or know of someone who is):
https://www.canada.ca/en/public-health/services/suicide-prevention/warning-signs.html – Canadian resources
https://www.nimh.nih.gov/health/topics/suicide-prevention – United States resources
https://ontario.cmha.ca/documents/understanding-suicide-and-finding-help/ – Ontario resources
https://www.cdc.gov/suicide/resources/index.html – Center for Disease Control and Prevention
https://afsp.org/suicide-prevention-resources – American Foundation for Suicide prevention
If you are in crisis, please call your nearest crisis line or call the emergency line. Call 112 for the common emergency telephone number.