— Which Is It?

It’s important to sort out the differences

By Nancy Schimelpfening, MS

Grief and depression share similar symptoms, but each is a distinct experience. Making the distinction between the two is important for knowing how to treat and cope with your symptoms.

This article discusses the difference between grief and depression, focusing specifically on which symptoms overlap and which symptoms are different. It also presents the various treatment options that are commonly used to treat symptoms of depression and, in some cases, to treat the symptoms of grief.

Clinical Perspectives of Grief and Depression

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) removed a “bereavement exclusion” from the diagnosis of major depressive disorder (MDD).1 In the DSM-IV, the bereavement exclusion stated that someone who was in the first couple of months after the death of a loved one generally should not be diagnosed with MDD.

However, the DSM-5 recognizes that while grief and MDD are distinct, they can also coexist. What’s more, grief can sometimes trigger a major depressive episode, just as with other stressful experiences.2

Studies have shown that the extreme stress associated with grief can also trigger medical illnesses—such as heart disease, cancer, and the common cold—as well as psychiatric disorders like depression and anxiety.

In addition, the DSM-5 text revision (DSM-5-TR) added a new diagnosis for people experiencing extreme grief after one year of the death of a loved one. This condition is called prolonged grief disorder (PGD). It is considered a trauma– and stressor-related disorder.

PGD is marked by intense and distressing emotional pain and yearning for the lost loved one, thoughts that are preoccupied with the loss, disruption in one’s sense of identity, emotional numbness, and avoidance of reminders of the loss. PGD symptoms are disruptive to a person’s everyday functioning and ability to reintegrate into life.3

Given the similarities between grief and depression symptoms, there are times when it may be tricky to distinguish between the two. A better understanding of their similarities and differences can help.

Similarities

Grief may have several symptoms in common with the symptoms of major depressive disorder, including:

• Intense sadness
• Insomnia
• Poor appetite
• Weight loss

Differences

Grief tends to decrease over time and occurs in waves that are triggered by thoughts or reminders of its cause. This is how it differs from depression, which is more pervasive and persistent throughout all situations.

In other words, a grieving person may feel relatively better in certain situations, such as when friends and family are around to support them. But triggers like the birthday of a deceased loved one or going to a wedding after having finalized a divorce could cause the feelings to resurface more strongly.

Depression, on the other hand, tends to be present no matter what the circumstances are. (An exception to this would be atypical depression, in which positive events can bring about an improvement in mood.4 A person with atypical depression, however, tends to exhibit symptoms that are the opposite of those commonly experienced with grief, such as sleeping excessively, eating more, and gaining weight.)

Additionally, grief usually causes a person to feel a longing for or an urge to see their lost loved one again; depression tends to result in the opposite. Someone with depression doesn’t necessarily feel the urge to do anything or see anyone.5

Grief

• Intense sadness
• Difficulty accepting that whatever caused the grief occurred
• Excessive focus on the episode of grief or avoidance of it altogether
•  Thoughts of “joining” the deceased
• Sensation of hearing or seeing things related to the loss

MDD

• Feelings of sadness, emptiness, or hopelessness
• Feelings of guilt not related to grief
• Morbid preoccupation with worthlessness
• Sluggishness or hesitant and confused speech
• Prolonged and marked difficulty in carrying out day-to-day activities
• Thoughts of suicide
• Hallucinations and delusions

Anger and irritability can be potential signs of both grief and depression as well.

Treatment for Grief and Depression

There are treatment options for the symptoms of depression and grief. Of course, treatment varies based on a person’s unique circumstances. Be sure to consult with a doctor or mental health professional to discuss what options are best for you.

Therapy

Psychotherapy is a treatment option for both grief and depression. It can be greatly beneficial in helping you process what you are feeling and teach you strategies that can help you cope.6

Grief-specific cognitive behavioral therapy may be helpful for some people with prolonged grief disorder. This therapy method uses similar techniques as cognitive behavioral therapy (CBT), like reframing negative thoughts and learning healthy coping mechanisms. In addition, this type of therapy can help you learn how to maintain a healthy attachment to your lost loved one.7

Interpersonal psychotherapy (IPT) is a treatment method often used for depression but has the potential for treating complicated grief as well. IPT focuses on resolving symptoms, building up relationships, and getting involved in mood-boosting activities.8grief counseling made up of components of both CBT and IPT. In CGT sessions, you may repeat the story of how you lost your loved one as well as set personal goals for yourself and your relationships.9

Medication

Antidepressants are the most common class of medication prescribed to treat depression. Examples include:10

• Selective serotonin reuptake inhibitors (SSRIs): Common brand names include Celexa (citalopram), Lexapro (escitalopram), and Prozac (fluoxetine)
• Selective norepinephrine reuptake inhibitors (SNRIs): Common brand names include Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (deslavenfaxine)
• Tricyclic antidepressants: Common brand names are Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)

For someone experiencing extreme and disruptive symptoms of grief, a doctor might prescribe an antidepressant as well.

It’s most often recommended that for major depressive disorder, you complete a course of medication along with attending therapy sessions at the same time.

Support Groups

Social support can be a powerful tool when you are coping with symptoms of depression or symptoms of grief. Many mental health professionals recommend attending a support group of people who are experiencing similar challenges as you.11

Whether you find a support group for depression or a support group for grief, you may benefit from sharing your experiences with others, receiving their encouragement, and listening to others’ stories.

A Word From Verywell

>While the symptoms of grief and depression are similar, it’s important to talk to a doctor and/or mental health professional who can reach a diagnosis and help you pursue treatment options to cope with your symptoms. Remember, there is relief and there are resources that can help you heal.

Every person grieves differently and there is no right or wrong way to do it. Talk openly with a therapist or someone you trust, and remember that grief is not a sign of weakness.

Likewise, depression is an illness like any other. Reaching out for help when you experience depression symptoms is a sign of strength and can help get you on the road to effective treatment.

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