The Important Difference Between Grief and Depression

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Lisa Marie Presley recently wrote a moving essay in People magazine about her son’s death by suicide in 2020. “My and my three daughters’ lives as we knew it were completely detonated and destroyed by his death… Grief is something you will have to carry with you for the rest of your life, in spite of what certain people or our culture wants us to believe. You do not ‘get over it,’ you do not ‘move on,’ period.” She goes on to describe the loneliness and even stigmatization that those mourning the loss of a loved one often feel.

Mourning Is a Natural Reaction After a Tragic Loss

Many people are confused about how to distinguish between “normal” grieving and depression that needs to be treated. After all, mourning a loss, especially of a child, spouse, parent, or close friend, is bound to elicit deep feelings of sadness and regret. It is natural that everyday routines are disrupted and things that may have previously been important suddenly seem less so. And the loss of a loved one is not something that, as Presley notes, is ever forgotten.

So how do you differentiate between “normal” bereavement and depression that needs to be treated? In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.), the diagnosis of persistent complex bereavement disorder is assigned to individuals who experience an unusually disabling or prolonged response to bereavement. This diagnosis has sparked plenty of controversy, with concerns about the idea of medicalizing grief and determining what is an appropriate amount of time for someone to grieve. After all, many people long for their loved one for the rest of their lives, a wish with which most of us can empathize.

Symptoms That Determine a Diagnosis of Clinical Depression

It's important to know that a diagnosis of major depression, a condition that usually needs to be treated with medication, is not based on how long someone is missing and mourning a loved one but rather on the presence and intensity of physical, emotional, and cognitive symptoms a month or longer after experiencing a loss. People who are clinically depressed suffer from relentless feelings of gloom and hopelessness, chronic ruminating thoughts, eating and sleeping problems, and lethargy. They typically have difficulty concentrating, making decisions, and relating to others. They may feel numb and act detached, unable to enjoy any of their previous sources of pleasure. In the worst scenario, they may have destructive thoughts and behaviors.

People suffering from major depression generally feel like they can't function. They must seek treatment, as they are at risk of ruining their work lives, relationships with family, friends, and colleagues, and not just their mental health but also their physical health.

Engagement vs. Disengagement

A person who is mourning experiences intermittent breaks of humor and can relate to others amidst their sadness. They continue to be engaged with the people in their lives and can envision a future. Some mourners actually derive a sense of purpose from their loss and create or donate to a charity in remembrance of a deceased loved one. In Presley’s case, she penned an essay in order to help people understand the plight of those who have suffered the loss of a child.

The clinically depressed individual, on the other hand, is too impaired and too lacking in energy and resilience to even imagine taking positive steps to improve the future. While they may rationalize and attribute their inability to feel hopeful and be productive to the loss of their loved one, the devastating paralysis that is holding them back is endangering their personal and professional lives.

Treatment Approaches to Address Mourning vs. Depression

People often don’t realize that mourning and depression are different. Mourning is the stuff of psychotherapy. Mourners often have unresolved feelings of guilt, ambivalence, or confusion about how to live their life after the death of a loved one that need to be worked through. While they feel very sad, they are able to function in the world, fulfill their work and family responsibilities, and, gradually, talk about and process their grief.

Major depression, on the other hand, is usually due to psychobiology. It affects one's mood, cognition, and physical being to such an extent that people feel paralyzed. Their endless negative ruminating thoughts and lethargy make them so bogged down that it's impossible for them to reflect clearly, plan for the future, or work productively in psychotherapy. People who are severely depressed tend to get "stuck" in their psychotherapy and "unstuck" when the biological component of depression, often with medication, is treated. For those who have been depressed, it is usually only then that they can fully mourn and process their loss. The good news: depression is highly treatable.

To find a therapist, visit the Psychology Today Therapy Directory.

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