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Normal or Not? The Distinction between Grief and Depression

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Recently a client came to my office following the death of her husband. When asked what brought her to therapy, she responded by saying her adult children had suggested she come. “Why?” I asked, for which she replied, “They are worried that I might be depressed.” In fact, many people who are grieving a loss wonder if they are grieving correctly. “Is this normal?” is one of the most common questions asked by my grieving clients.

What is “normal” grief?

The experience of a loss by death is a universal human experience frequently associated with a period of grief and mourning.  Grieving involves mental, emotional, and physical symptoms. It is understandable to feel sadness and sorrow, anxiety, loneliness, guilt, anger, and even relief following a loss. The bereaved person might also experience denial, or disbelief that the person is not coming back. They are likely to get confused easily, have a hard time making decision, feel a sense of helplessness and have a hard time maintaining attention and staying focused on simple tasks. Physical reactions are also common and can include changes in appetite, difficulty sleeping or sleeping too much, difficulty relaxing, or general fatigue.  Other common reactions are isolation or social withdrawal, no longer enjoying activities that were once enjoyable, crying jags, and vivid dreams or nightmares.

Although the grief experience is typically recognized by professionals as an entirely normal and expected emotional response to a loss, the literature has yet to show consensus on a distinct course and duration of a typical grief response. Additional variability in a person’s grief is due to a number of factors such as the quality of the relationship with the person who died, the bereaved person’s coping resources, and the nature and the context of the loss.

As such, an individual’s grief reaction is as unique as the individual himself or herself.

What is Depression?

Everyone occasionally feels sad or blue, especially in cases of increased stress or times of major life transition. But, the presence of a Major Depressive Episode causes significant interference with daily life and causes pain for not only the individual, but for those around him or her. Depression is the most commonly diagnosed mental health condition, and should be taken seriously.

Although a Major Depressive Disorder can only be diagnosed by a doctor, there are signs and symptoms to be aware of and know when to ask for help. Signs and symptoms of depression must last at least two weeks and include:

  • Sadness or depressed mood for most of the day on most days
  • Markedly diminished interest in pleasure for all, or almost all activities that were once enjoyable
  • Changes in weight or appetite
  • Chronic insomnia or excessive sleep
  • Restlesness
  • Fatigue or loss of energy nearly every day
  • Feelings of hopelessness, worthlessness and/or excessive guilt
  • Problems with concentration or making decisions
  • Recurring thoughts of death or suicide, suicide plan, or suicide attempt

The Difference:

Those who are grief-stricken often experience symptoms that are very similar to symptoms of depression such as intense sadness, tearfulness, and problems sleeping, concentrating, eating and interacting with others. However, there are some important differences.

  • Numerous studies have shown that grief rarely produces low self-esteem and a sense of worthlessness that is common in depression.
  • Although bereaved individuals may fantasize about being reunited with a lost loved one, they do not generally experience the explicit and persistent thoughts of suicide that can occur in depression.
  • Unlike those suffering from depression, bereaved persons intuitively understand that time, space, and support is required for healing and adjusting to life following the loss of a loved one.

In general, the bereaved person will be hurting a great deal, but will have the capacity for enjoyment out of some aspects of life, are able to be consoled by friends or family, and experience positive feelings and memories along with painful ones.

In Conclusion…

After talking to my widowed client, I discovered that her husband had struggled with a life-threatening illness for many years and during this time she was his primary caregiver. Furthermore, I learned that my client had been widowed only three months prior to coming to therapy. It is for these reasons and more that I was able to confidently assure her that considering what she had been through, her grief reaction was “normal.”

My knowledge and experience tells me that grief following the loss of a loved one is an understandable reaction that reflects the amount of love that we have for the deceased. However, there are some signs to be aware of that represent a more serious condition. Whether or not a person is suffering from Grief or Depression, therapy can help to provide a safe place to express oneself and enlist the support of a neutral third party to help navigate through the complicated and difficult journey of bereavement.

Footnote:

To learn more about grief and loss, and for valuable resources please visit our ‘Resources’ page. For a more in-depth look at Grief and Depression, and the implications for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) please view Dr. Perper’s scholarly article soon to be published in the San Diego Psychological Association’s newsletter.

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