The Difference Between Grief and Depression: How Sad is Sad?
Grief and depression share many characteristics, but they are not the same. Depression is an illness. Normal grief is not. Learn the basic differences between normal grief, complicated grief and clinical depression. Includes information on when to consider seeking professional guidance.
Sometimes we have a natural desire for reunion after the death of someone we love.
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A mourner looks outside and sees the world as poor and empty, while a depressed person looks inward and sees the self that way. From Finding Your Way Through Grief: A Guide for the First Year, page 31.
By Marty Tousley, RN, Certified Bereavement Counselor
When grieving people feel sad we often say that they are depressed, but the sadness from grief is not the same as the sadness of depression because normal grief is not an illness. It is the emotional, psychological, physical and spiritual pain we feel when a person close to us or beloved pet dies. It is a normal human reaction caused by our love and attachment to the one who died. Sadness is an expected part of grief and it is a natural response following the loss.
Depression is a treatable illness and one of several common mood disorders marked by loss of interest or pleasure in living, decreased self-esteem, shame, feelings of hopelessness and despair. Many people suffering from depression cannot imagine ever feeling better. Frequently they cannot imagine a future. The mood disturbance in depression is pervasive and unremitting and any positive mood fluctuation is usually minor without treatment intervention.
Summary from Psychiatric Times:
"Persons with normal grief often experience a mixture of sadness and more pleasant emotions, as they recall memories of the deceased. Anguish and pain are usually experienced in waves or pangs, rather than continuously, as is usually true in major depression. The grieving person typically remains hopeful that things will get better, and is consoled with love and support. In contrast, the clinically depressed patient’s mood is almost uniformly one of gloom, despair, and hopelessness–nearly all day, nearly every day-and rarely responds to consolation."
Grief and Depression Share Many of the Same Features
Both grief and depression are difficult to endure and they share many of the same features: sadness, crying, anger, anxiety, loneliness, social withdrawal, forgetfulness, inability to concentrate, appetite and weight changes, fatigue and poor sleep.
If we live long enough, all of us will experience loss and grief. In the United States, about one in ten men and one in five women will suffer from depression at some point in their lives.
Shame and guilt are common in depression. When they occur in grief they often involve feelings of not having done enough for the deceased before his or her death, or regret over things said and done while the person was alive. In depression, the feelings arise from a fundamental belief that one is wicked or worthless.
Persons who have experienced previous depressions are especially at risk for becoming depressed at times of profound loss. Treating a griever’s clinical depression is a balancing act because sadness is an appropriate, natural response to loss and clinical depression is a mood disorder.
Major depression has the potential to become a medical emergency with risk for suicide. For the most part, grievers do not want to kill themselves, but the threat of suicide from anyone must be taken seriously.
Prolonged Grief Can Become Reactive Depression
Grievers can also lose interest or pleasure in living, and cannot imagine ever feeling better because life is unbearable; but the mood fluctuations come in waves washing over the griever and the dark moods respond to empathy, support and the passage of time. Even in deep raw grief, moments of happy reminiscences are possible.
Grief, although intensely painful and sad, moves us toward learning how to live without our loved one in a forever-changed world. The reactive depression of prolonged grief, however, is a destructive "stuck place" that causes us even more pain because we cannot move forward.
Friends and family often react to sadness by avoidance or becoming eternal cheerleaders because most people cannot tolerate being around melancholia for extended periods of time. Seek out those few who can sit with you and listen without telling you to cheer up or get on with your life.
Note: For some grievers, feelings of loss are crippling and don't improve with time. This is known as complicated grief, sometimes called persistent complex bereavement disorder. It is like being in a continuous amplified state of grief that prevents you from healing and moving forward with your life. Contact your doctor or mental health professional if you have intense grief feelings and problems functioning day to day that don't improve at least one year after the death of your loved one. You deserve to feel better.
How Sad Is Sad?
Grief has no timetable and no absolutes. Grief may be universal, but we all grieve in our own way. How bad do we have to feel before we seek outside help? There are moments in all our lives when we can benefit from professional counseling but only you can decide: How sad is sad?
Syndicated columnist Carolyn Hax offers this advice to a griever suffering from multiple losses and feeling dead inside: "When the numbness and detachment outlast their usefulness, then it is time to get help. So, in this framework, your question becomes: Are you still in a typical healing process, or has your healing process stalled? Is this numbness protective or dangerous? Do not wait for an answer in case the stall is the start of a spiral.”
And paraphrased: Do not treat it as an either-or question in that you either trust you will feel better or you get help. Trust yourself and get help to ensure there is a strong net to catch you as you do this work. (Source: Carolyn Hax: When there's so much loss you can't feel your grief (or much else) anymore, June 16, 2021)
If you have clinical depression or bipolar disorder (*)
Stay on your medication(s).
Try to get regular sleep and eat balanced meals.
Participate in psychotherapy if you can afford it.
Become involved with a support group.
Read and learn about your illness.
When seeing your doctor, never assume competence until it is demonstrated.
Compile a list of questions before any appointment. Question everything.
A Note from Chris
I began writing about grief after my mother died and now I write about pet loss. I became increasingly uneasy with the idea of grief expertise, as it relates to normal, uncomplicated grief. The more I read the grief literature, the more uneasy I became. How could someone else be the expert in my grief?
Grief is a normal human experience, and 80% - 90% of grievers move forward with their lives after the death of a loved one or pet without professional intervention. The exception is complicated grief involving prolonged suffering and/or clinical depression. In this case, grievers usually benefit from the services of licensed mental health professionals. We can all use a little help now and then. Since 10% - 20% of grievers require counseling and grief support, practitioners need to understand the differences between normal and complicated grief.
On a personal note, I am an RN with a degree in psychology, but I no longer want to be a "certified" pet loss grief specialist. I am the expert in my own grief and no one else’s. I can share my experience, strength, heartache, and hope with you on my website, but any help that I offer is in the form of human caring, from one griever to another. You are the expert in your own grief because only you can assign the significance and meaning to your personal loss.
I have read many grief books and have found something of value in most of them. Books can comfort or inform us. Therapy can help us sort it all out. Support groups can let us know that we are not alone. Writing can provide an outlet for strong emotions. Comfort comes in many forms and your grieving heart will tell you what you need, or do not need, to mourn the death of your loved one or pet. Follow your heart.
Other Perspectives on Grief and Complicated Grief
Is it ever possible - or helpful - to label someone's grief process abnormal?
Depression information source for this article:
This is general information about depression and grief. It is not meant as medical advice. Never delay getting help because of something you have read here. Please seek professional guidance if you need it.