By: Kelly Daugherty, LCSW-R, GC-C, BC-TMH
The next topic for the blog series: Grief and Loss is about the difference between grief and depression.
Grief is the feelings associated with a loss and is a normal and natural response. This loss could be due to the death of a loved one, someone moving away, loss of income, loss of a relationship, etc. Normal symptoms of grief include sadness, fatigue, loss of interest in activities, issues with sleep, low energy, memory issues, weight gain or loss and more as identified in the previous blog on normal grief symptoms.
The DSM-5 states the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
As you can see there are similarities between grief and depression and why someone grieving may be misdiagnosed by a therapist or MD not trained in grief. So how do you know whether it is grief or depression and what makes them different? The biggest difference is assessing whether someone experienced a major loss recently.
Grief tends to be experienced in waves and the individual experiences grief bursts and this tends to decrease over time. Grief is easily triggered by sounds, smells or certain events like a birthday, anniversary, etc. Most grieving individuals stay connected to people and can feel moments of happiness as well as be able to engage in their normal life after the initial period of loss-oriented grief. Grief is a wide range of feelings including sadness, anger, guilt, relief, and confusion. Someone grieving due to the death of a loved one may become preoccupied with death and focused on reuniting with their loved one.
Depression is more persistent. Someone that is depressed usually feels depressed all day long and doesn’t get to take breaks from their depressed feelings. Someone with depression has a hard time with activities of daily living including bathing, maintaining their home and going to work. Depression leaves people feeling hopeless, helpless and not able to seek support and may become suicidal to escape the feelings of hopelessness. Someone depressed may have not recently experienced a major loss. The focus is on the self of the depressed person rather than focused on a loss.
Several factors impact grief that may cause a person to become depressed or experience complicated grief (as reviewed in the previous blog). These factors may include past losses, traumas, and other stressors. These factors should be monitored by a therapist or medical professional to determine if a grieving individual is experiencing depression. As a therapist, it is important to assess these factors as well their emotional response to their loss.
The next topic of this blog series will focus on what to not say to someone grieving.