When does grief become clinical depression: and what is the difference?

Symptoms of grief can mirror those of depression, and indeed, depression and low mood is an integral part of the grieving process, but when does grief become depression and what is the difference?

Grief is always triggered by loss whilst depression can be triggered by loss (which is called reactive depression), but it is also triggered in other ways such hormonal changes (teenage, pre- and post- natal and menopausal depression), the advent of dark winter months (seasonal affective disorder), and the result of chronic stress. Sometimes depression is triggered for no apparent reason.

Depression is thought to have a genetic and biological (chemical) element; it can run in families and is linked with addictions such as alcoholism and substance misuse (because alcohol and substances such as Cannabis act as chemical depressants in the brain). Grief affects those who have lost a loved one which is most of us at some time in our life, whereas some people live their lives having never experienced depression at all.

Both depression and grief are typically characterised by raw emotions and waves of overwhelming sadness, despair, guilt, anger, helplessness, anxiety, uncertainty, vulnerability and feeling lost. However, sometimes those suffering from severe depression feel nothing at all; they just feel numb, they might want to cry but can’t.

During grief, which is a natural process of adjustment, feelings evolve and change, wax and wane. When grieving, some days feel brighter than others, and we can laugh with others or smile as we remember the person we have lost and the happy times together. Depression is progressive, and the sadness and low mood is often unrelentingly. We begin to feel stuck, helpless and hopeless and find it increasingly difficult to function. When depressed, it is very difficult to think back to happy times.

Depression, unlike grief, involves low self-worth, self-criticism and self-isolation. Whilst bereaved people ask themselves “If only…” and “why…?” and focus on the deceased, depressed people tell themselves “I failed, I am worthless, what is the point?” and their focus is on themselves. Depressed people are very sensitive and take things personally. Bereaved people are sensitive and consider things from the point of view of the deceased. They will tend to spend time alone in reflection and quiet contemplation about their loved one as well as seeking out others to connect with and share memories together. Depressed people tend to isolate, detach and avoid others, they often find it hard to be around others or accept support and connection.

In grief, culture, context and rituals are important (funerals, memorials, marking anniversaries, honouring and celebrating the deceased’s life etc.), and can be creative, poignant and meaningful which enables the grief process. When depressed, this becomes less important due to a decrease in motivation and energy. Therefore, significant dates, events and rituals can be overlooked or avoided.

Grief has purpose, the mind is busy reconfiguring and regrouping, during grief we may be learning new skills, evolving and growing and in doing so, we may re-evaluate our own life. Grief can take us out of ourselves and out of our comfort zone; in doing so it can increase our confidence levels.

Depression is self -defeating and puts everyday life on hold. There is a negative world view and pattern of withdrawing which is not aligned with our personal growth and development. This prevents our confidence developing and erodes the confidence we had.

Clinical depression is usually treated with medication, psychotherapy and lifestyle changes; but it can recur, and relapse is common without effective treatment. Grief naturally remits, emotional pain gradually lessens, and grief does not usually require medication or psychotherapy, although counselling and support can be helpful. Grief only usually recurs (or relapses) following another bereavement.

Each bereavement process can be different, depending on the nature of the relationship and attachment with the person who died. Someone’s grief and bereavement process for a close family member may be different than the grief they have for a friend or a pet because each relationship is unique. Episodes of recurring depression within the same person usually follow the same pattern as before.

In grief people sometimes sense their loved one near them or hear their voice which can be comforting. When depressed this can cause distress, be interpreted negatively and / or evolve into psychotic depression where contact with reality is completely lost.

Signs that grief could be turning into clinical depression are a persistent low mood which is unrelenting, increased isolation, and decreased confidence and self-worth. It becomes increasingly difficult to function and places or situations which act as reminders of what happened are avoided, as are tasks such as sorting through belongings, ending phone contracts etc). The reality of the loss (even when the death occurred some time ago) is so difficult to accept, avoidance helps to deny it happened. Appetite, sleep and simple decision making are all affected. Loved ones may notice or comment that the depressed person doesn’t seem like themselves.

Those who may be more likely to experience clinical depression after a bereavement are those whose loved one died in traumatic, shocking, sudden, unexpected or unexplained circumstances: for example: death caused by road traffic accidents, murder or suicide are more likely to result in clinical depression than death which occurs through old age. Those who have a previous history of depression or other mental health problems are more likely to become depressed following a bereavement as are those who are already isolated and without emotional support.

If concerned your grief is turning into depression, make an appointment to see your GP for an assessment and to talk through treatment recommendations. It might be wise to ask for a double appointment so that you have enough time to talk.

Melanie Phelps is a Chartered Counselling Psychologist and Associate Fellow of the British Psychological Society. She has worked for Cruse Bereavement Care and has many years’ experience with people who have suffered traumatic grief and depression. She teaches and supervises counsellors and holds a part time post at Surrey University. Melanie is based in Surrey and offers face to face as well as Skype and phone appointments.

You can contact her by email: Melanie@privatepsychologist.co.uk
Or phone: 07932 140027