Learning how to tell the difference between grief and depression can help greatly in the recovery process of the person experiencing either of these responses.

Grief and depression are two related but different responses that are frequently confused for each other.

Grief is the body's normal response to a loss.

Clinical Psychologist and Grief Expert Dr. Therese Rando's definition of grief includes "the psychological, behavioral, social, and physical reaction to the loss of someone or something that is closely tied to a person's identity."

Depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended time.

The identifying symptom of depression is that the person is feeling the constant, overwhelming feelings of sadness, loss, anger or frustration for the majority of the day for at least two weeks.

Is it Grief or Depression?

Many people who are experiencing grief, the normal response to loss or a death, may think that they are really experiencing depression.

On the other hand, people who think they may be experiencing depression may actually be experiencing a normal grief response.

Someone who develops a major depression following the death of a loved one may benefit from seeking out the help of a health care provider or grief counselor who can help in telling the two processes apart.

Characteristics of Grief

Grief and loss expert Dr. Kirsti Dyer has characterized grief as follows:

• A normal complicated response to loss that causes distress
• May experience some physical symptoms of distress
• Still able to look toward the future
• Passive wish for death
• Associated with disease progression
• Retains capacity for pleasure
• Still able to express feelings and humor
• Comes in waves
• Can cope with distress on own or with supportive listening
• Pharmacotherapy for grief is an exception, not the rule

Signs and Symptoms of Grief

Dr. David Casarett, Dr. Jean Kutner and Dr. Janet Abraham in their review article Life after Death: A Practical Approach to Grief and Bereavement prepared for the End-of-life Care Consensus Panel of ACP-ASIM wrote grief is characterized by the following signs and symptoms:

Psychological symptoms that include:

• Helplessness
• Sadness
• Anxiety
• Disbelief
• Apathy
• Irritability
• Poor Concentration
• Numbness
• Denial

Physical symptoms that include:

• Change in weight - gain or loss
• Fatigue
• Headache
• Palpitations
• Chest Pain
• Stomach ache
• Intestinal distress

More about Grief

After experiencing a major loss, many people experience a normal grief response. The normal grief response is often an intense emotional and physical response to the loss, which may come in waves and is not present all the time.

It is important to realize that the grief response does not usually turn into depression, most people are able to adjust to the death. With time, the grieving person learns to adjust to their life that has been changed by the death or loss.

The concern that the person may be developing depression occurs when the normal grief response does not improve within a few weeks of the loss, or the symptoms get worse. In this case the person may be experiencing complicated grief or depression.

Characteristics of Depression

Grief and loss expert Dr. Kirsti Dyer has characterized depression as follows:

• Generalized distress – loss of interest, pleasure
• Somatic distress, hopelessness, guilt
• No sense of positive future
• Bored, lack of interest and expression
• Suicidal ideation not uncommon
• Persistent flat affect, negative self-image
• Advanced disease and pain
• Change in capacity to enjoy life or things that were formerly pleasurable
• Constant, unremitting
• Often requires intervention with medication, therapy
• May require combined psychosocial interventions and pharmacotherapy

More on Depression

Dr. George Tesar in an online book chapter on Depression and Other Mood Disorders writes that with depression the symptoms are present nearly every day and persist for the majority of the day for at least two weeks, occurring together during the same time frame, and causing a level of distress or impairment that interferes with important aspects of daily life e.g. work, self care and social activities.

Other concerning symptoms of depression include:

• Persistent sad, anxious, or empty mood.
• Sleeping too much or too little, middle-of-the night or early morning waking.
• Reduced appetite and weight loss or increased appetite and weight gain.
• Loss of interest or pleasure in activities, including sex.
• Irritability or restlessness.
• Difficulty thinking, concentrating, remembering or making decisions.
• Fatigue or loss of energy.
• Thoughts of death or suicide.
• Feeling inappropriate guilt, hopelessness or worthlessness.

Anyone who is talking about committing suicide or homicide, is abusing drugs or alcohol or engaging in self destructive behavior should seek immediate medical treatment.

Grief vs. Depression

If the normal grief response lasts for several weeks, or the symptoms get worse rather than better, the grieving person may be developing a true clinical depression or other mental health problems. Remember the key in deciding whether it is grief or depression is the length of time the person has experienced symptoms--majority of the day for at least two weeks--and the intensity of the symptoms.

The National Mental Health Association offers a confidential Depression Screening test.

If in doubt, the grieving person needs to seek medical treatment for an evaluation by a health care professional or grief counselor who can help make the final decision if whether it is grief or depression.

Sources:

Casarett D, Kutner JS, Abrahm J. Life after Death: A Practical Approach to Grief and Bereavement. Ann Intern Med 2001;134:208-215.

Tesar G. 2002. Depression and Other Mood Disorders. Cleveland Clinic. Disease Management Project.

Rando TA. Treatment of Complicated Mourning. Champaign, IL: Research Press, 1993. 203-8.

The Center for Palliative Care Education. Module 6: Psychosocial & Psychiatric Issues. Psychiatric Issues in HIV/AIDS Palliative Care (PowerPoint). Training Curriculum.

Dyer KA. March 2004. Understanding the Grief Response and Creative Ways to Cope. Presentation for Hospice of the Sierra, Visiting Nurses' Association.