Grief or depression?

Dear Crying all the time,

It’s completely normal to still be mourning the loss of someone close to you months later. Grief isn’t always a simple process, and it doesn’t look the same for everyone. There is no “correct” way or set time frame to grieve. It's not unusual to experience grief for a year or even longer, especially when the death is sudden and unexpected, and it’s key for you to give yourself enough time to heal. When it comes to grief, there is acute grief, and in some instances, some people experience prolonged grief. Depression is also a common experience, regardless of whether or not someone has experienced loss. However, there are a few ways to potentially distinguish between the a typical grieving process and a depressive episode.

First, it can be helpful to get a clearer sense of what both of these terms mean. Put simply, grief is a natural response to any loss. It can result in a number of physical, cognitive, emotional, behavioral and spiritual changes and reactions to the loss. However, grief is a process, not a state. Typically, a person will experience what’s called acute grief which occurs in the early aftermath of a death. During this period, the bereaved might experience feelings of intense shock, anguish, anger, guilt, anxiety, despair, loneliness, and fear. This phase is often characterized by behaviors and emotions that might feel unfamiliar or be considered unusual in your non-grieving state, such as frequent and intense crying, preoccupation with thoughts and memories of the deceased person, difficulty concentrating, and a degree of disinterest in other people and in activities of daily life. If, prior to the loss, you would’ve considered yourself relatively mentally and emotionally stable, this sudden and drastic shift might cause alarm and even shame, but it’s perfectly normal during the acute grief stage. You might feel like these overwhelming emotions are permanent and may never go away, but they often reduce in intensity and become less frequent and debilitating once you begin to reach the next stage: integrated grief. It's during this transition that you’ll typically begin to heal and start to feel like yourself again. You’ll adjust to the reality and pain of the loss and your thoughts and memories of the deceased won’t persistently occupy your mind or disrupt other activities. 

In some instances, some people will experience prolonged grief disorder. This is intense longing or preoccupation with the person who passed away that lasts longer than one year for adults and causes problems with functioning. Some of the symptoms associated with this include: 

• Feeling though part of you died
• Sense of disbelief about the death
• Avoidance of reminders that the person is dead
• Intense emotional pain
• Having trouble reintegrating to life
• Emotional numbness
• Feeling that life is meaningless
• Intense loneliness

Generally, depression doesn’t work the same way. It’s not so much a process that improves with time as it is a condition that must be managed and regulated — whether through medication, therapy, counseling, or other healthy coping mechanisms — in order to see improvement. The two most commons forms of depression are major depression and persistent depressive disorder (dysthymia). The symptoms of major depression are usually observed for at least two weeks and typically interfere with one’s ability to work, sleep, study, and eat. Persistent depressive disorder (dysthymia), is a form in which less severe symptoms of depression typically last for at least 2 years. 

Symptoms of depression include:

• Persistent sadness or anxiety
• Feelings of hopelessness, pessimism, emptiness, irritability, frustration‚ restlessness, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies or activities
• Fatigue or decreased energy
• Difficulty sleeping, concentrating, remembering, or making decisions
• Oversleeping
• Changes in appetite or unplanned weight changes
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and that do not ease even with treatment
• Suicide attempts or thoughts of death or suicide

As you may have noticed, there are several overlapping signs, symptoms, and characteristics between grief and depression. Grief and depression can often seem alike, especially to someone who is actively grieving. They may appear similar from the outside and even feel similar on the inside, but there are some ways to distinguish between the grieving process and a depressive episode. The focus with grief is different than with depression. With grief, the focus is on the loss of the person, while depression focuses more on the individual experiencing depression. Another distinction between the two of them is this sense of improvement and gradual regaining of joy and relief from sadness that often comes in the later stage of the grieving process. Some people may also be managing grief and depression; they aren't mutually exclusive. Additionally, understanding what the cause of these feelings are can help ensure you can the treatment that will be most helpful. 

You may find reaching out for support to be helpful with your healing. You may consider talking to a close friend or family member, especially if there is someone who is also suffering from the same or their own loss. If you're worried or frightened of any feelings that you have, if you'd like to be able to talk about your emotions in a comforting environment, or if you feel overwhelmed, stuck, or overcome with sadness, you may want to speak with a mental health professional. There are plenty of resources you can visit to help you further. The Center for Grief Recovery and Therapeutic Services has plenty of different resources for grief and loss, the Depression and Bipolar Support Alliance provides information for those interested in learning more about depression and bipolar disorder, and Anxiety and Depression Association of America lists a ton of blog posts and webinars about depression and anxiety. If you're enrolled at a college or university, you might seek out mental health services on campus or in the local community.

Wishing you solace and comfort during this difficult time,