Depression Versus Grief

Most people come to see me with multiple matters that they want to address in addition to their grief.  Some matters are situational.  Some issues are related to family dynamics or work.  Some people are experiencing complicating factors as they try to grapple with loss.  Rarely is it just one thing that brings people into my office.

A lot of people ask me about the differences between grief, prolonged grief, ptsd, anxiety and depression.  The article below hopes to help you understand a little bit more about these conditions which can stand alone or accompany one another.  I’m happy to go into more detail with you during your sessions with me.  (I’m a psych nerd who loves to teach.)

Grief and Depression

At some point in most of our lives, we will lose someone that we love.  They may leave us through death, estrangement, abandonment, divorce, or a breakup. This will most likely result in a normal reaction called grief.  We can also experience grief over other losses, such as losing a job, losing a home to a house fire, or receiving a serious diagnosis.  Grief can be about losing life as we’ve known it.  

Grief tends to come and go in waves which are triggered by thoughts and reminders of the deceased or the trauma of the loss.  Over time, the poignancy of this emotion subsides as we gradually return to functioning.  Loss integrates into our lives as we learn how to carry our grief.  Grief’s sadness is focused on loss. 

About 86% of people over the age of 16 have experienced the death of a loved one.

Depression, however, is different from grief.

Depression is a chronic medical illness that impacts how a person thinks, feels, and behaves causing persistent and pervasive sadness.  Depression typically focuses internally on a person’s helplessness, hopelessness, and personal failings.  Thoughts are almost constantly negative.  Depression typically includes corrosive feelings of worthlessness and self-loathing.  In extreme forms, it can look like failing to care for one’s basic needs and suicidal thoughts and feelings. 

Roughly 10% of Americans experience Major Depressive Disorder annually and about 16% will experience it at least once in their lifetime.

It is expected that a person who is grieving will feel depressed and the reaction to the loss may resemble a depressive episode. The two conditions, however, are different.

Anxiety

It is normal for a person to experience the emotion of anxiety. Intense, persistent and excessive worries about everyday situations, however, may indicate a clinical level that is a medical health condition. 

About 19% of adults in America experience a clinical level of anxiety during the past year.  About 30% of adults will experience it at least once in their lifetime. 

There are several subtypes that include Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Panic Disorder and phobias (like an irrational fear of frogs, for example).

Anxiety and depression seem to coexist frequently.  In fact, roughly 60% of adults with one condition have the other.  When this happens, people tend to have a lower quality of life and struggle to function. Having both conditions tends to increase the severity and chronicity of symptoms. Both conditions respond well to mental health therapy and effective medication management.

Mental health clinicians (such as licensed mental health counselors, clinical psychologists and psychiatrists) are able to determine if a person has depression and/or anxiety in addition to grief. Treatments for anxiety, grief, prolonged grief and depression are handled differently.

Prolonged Grief Disorder and Post Traumatic Stress Disorder

Prolonged Grief Disorder (PGD) is a form of grief that has not resolved in a time frame that is anticipated according to cultural, religious and social norms.  Those suffering from PGD continue to focus on the deceased to such a great extent that it impacts functioning in their daily lives for longer than a year.  Those with PGD feel lost and alone, having difficulty accepting the reality of the loss. The future feels bleak and empty, unable to feel a sense of purpose and meaning in life, feeling as if they will never experience happiness again.  Their health and relationships are negatively impacted.  Concentration is difficult because their thoughts and feelings are dominated by grief. PGD happens to about 10-20% of those suffering from loss.

It is estimated that about 15-50% of those who have PGD also meet the criteria for Post Traumatic Stress Disorder (PTSD), especially after traumatic loss such as due to disaster or sudden violent loss. 

FAQ and Random Psych Nerd Facts

Can I have both depression and grief?

Yes.  You can also have depression, grief and anxiety at the same time, too. 

Will medication help me cope with grief, prolonged grief disorder and/or depression?

Perhaps. 

Taking medication for depression and/or grief is a very personal decision and should be discussed in depth with your primary health doctor or psychiatrist.  Everyone’s response to antidepressant medications differs as do their needs in treatment.  Some people may find it takes the edge off their mood, help with sleep and appetite.  Others may feel emotionally flat and find that it interferes with experiencing feelings they need to work through.  Some find it beneficial short term, long term or not helpful at all.  So, perhaps. Consult your doctors.

Will I ever feel normal again?

That’s a philosophical question because, what is normal, really?  Will you feel better?  There is hope (clinical studies show) that yes, you can. 

Studies show that there are things you can do that have potential to positively impact your wellness: become actively involved in mental health counseling; receive social support outside of therapy; exercise regularly; have adequate, restorative sleep; eat a healthy diet; attend to your health and wellness.  Grief, however, is something that stays with us in some form or another, and that is normal.

What does this “new normal” phrase mean?

“New normal” is a term that people use to explain that grief will transform you and life will be functional again, but things will be different than how they were prior to the loss of your loved one(s).

Do you write prescriptions or letters of endorsement for emotional support pets?  I have a pet [dog, cat, llama, snake, tarantula, etc.] who gives me great comfort.

Although I’m very happy that you’ve found a pet who gives you comfort, I do not personally offer that service.  Although I’m really curious to hear about the pet spider. 

Derailed Psych Nerd Facts: Arachnophobia is an intense, irrational fear of spiders that is estimated to occur somewhere between 3-15% of the US population.  Approximately 90% of arachnophobes are female whose fear typically develops in childhood.  About 50% of Americans feel some fear around snakes but do not a full-blown phobia (ophidiophobia).  And it is estimated that about 9% of the global population has an irrational fear of frogs (ranidaphobia).

Can I bring a family member or friend into therapy with me for support?

Yes.  One of the hopes of treatment is that you have a supportive circle of support around you.  It’s helpful to talk about what is normal grief and how they can support you as you negotiate all of this.  We can talk about how a combination of individual and family therapy can work for you.

My person died recently and I can’t seem to function.  Am I broken?

No, I don’t think that’s the word I’d use.  Most likely this way you are feeling is a temporary state, not a permanent condition.   I’d encourage you to get in touch with me and/or your primary care doctor to talk about what you’re experiencing so we can help support you through your difficult time. 

I live in [another state than Washington or Montana].  Can you help me?

Sorry, but right now, no. Currently I am only licensed to provide care to those who are in the states of Washington or Montana.  I provide: in-person therapy in my office located in Enumclaw WA; telehealth; and, a hybrid of both.  Your emotional support tarantula is welcome to attend your appointment if you’re in a telehealth session and they are with you, not me.  Please do not bring frogs into my Enumclaw office.  Please.

Disclaimer:  This article is for discussion and informational purposes only.  It is not a guide to diagnose any of the above conditions.  Only a qualified mental health professional can diagnose and treat these conditions.  If you or someone you care about is experiencing symptoms of depression, anxiety, prolonged grief, PTSD or any other concerning mental health symptoms, please contact a qualified mental health professional. 

The Suicide Crisis Line is 988.  In the event of an emergency, call 911.