Grief and Depression

What Is the Relationship Between Grief and Depression?

Feelings of sadness and depression are an integral part of grief, but grief itself is not considered a disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) considers the depression associated with bereavement a "normal" reaction to loss, provided it is does not linger too long.

Depression which lingers beyond what is expected could be a sign that the stress of grieving has triggered a Major Depressive Episode. 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.

There is no way to define a "normal" length of bereavement since it varies from person to person and culture to culture. According to the DSM-IV, a diagnosis of Major Depressive Disorder is generally not given unless symptoms have lasted beyond two months.

How to Distinguish Grief From Major Depression?

Grief has several symptoms in common with Major Depressive Disorder including sadness, insomnia, poor appetite and weight loss. 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:

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 symptoms last longer than two months after the loss and the diagnostic criteria are met, the person may be suffering from Major Depressive Disorder. In this case, antidepressants would be an appropriate therapy.

_Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994.

Jacobson, James L. and Alan M. Jacobson. Psychiatric Secrets. 2nd ed. Philadelphia, PA : Hanley & Belfus, Inc., 2001.