Grief, Depression, or Both?

As human beings, we each react differently to stressful situations or significant loss. As a psychiatrist, my role is to help a person process her feelings to assess how much they are negatively impacting the quality of her life and to explore the various options (medications, talk therapy, support groups, self-help activities) that may help relieve some of the suffering.

From an “academic” standpoint, the teaching is that grief and depression are differentiated primarily by the predominant symptoms, the time course of those symptoms, the severity of impairment in functioning, and most importantly, whether those symptoms meet “diagnostic criteria” for a depressive episode, which I will explain below. (Note: I realize the word “symptoms” seems very clinical and sterile but it is the word physicians use).

Briefly, depression is diagnosed when an individual experiences five or more symptoms (from a list of 9 possible symptoms) nearly every day for at least a period of two weeks and causes significant distress or impairment in social, occupational, or other areas of functioning. One of the symptoms must be EITHER depressed mood most of the day, nearly every day, OR diminished interest or pleasure in most activities nearly every day.

The predominant features of grief are feelings of loss, emptiness, and intense sadness that come and go and usually are triggered by reminders (both internal and external). The feelings of grief usually become less severe or intense as time passes. Most people who are grieving are able to feel joy even if it is short lived. It is not uncommon to see humor and positive emotions in people who are grieving, which is not typical of the persistent unhappiness and anhedonia (loss of interest or pleasure) associated with a depressed episode.

The predominant features of depression are low mood and inability to anticipate happiness or pleasure which is persistent and does not “come and go” with reminders or triggers of the deceased (or other significant loss such as person, pet, personal item, house, etc). The table below compares depression and grief.