Depression is a serious disease. Grief is part of the human condition. Let’s give each the appropriate care and treatment.

Lack of emotion. Sadness. Uncontrollable crying. Irritability. Loss of appetite. Despair. Exhaustion. Isolation.

This list sounds like the classic description of someone suffering from clinical depression. But think again: depression and bereavement can present with the same symptoms. The truth is there are a whole host of uncomfortable — even painful — emotions that those who have suffered a loss must wade through following the death of a loved one.

The DSM Controversy Over Diagnosing Depression: The Bereavement Exclusion

The most recent version of the Diagnostic and Statistical Manual (DSM) for physicians allows for the diagnosis of clinical depression at any time, including immediately following the death of someone close to the patient. Earlier versions of DSM required a waiting period, so that diagnosticians could separate out the grief of bereavement from depression. The waiting period allowed for the dissipation of emotions that are normal and expected responses to a loss.

Society’s recent acceptance of the prevalence of mental illness has also become a shortcut for both patients and medical professionals. Depression is an illness that can be treated with medication, so asking for or prescribing medications are often the first impulses.

Physical Expressions of Bereavement Mirror Depression

“As a society, we don’t know how to be with difficult emotions,” says Donna Hartmann, bereavement coordinator for Crossroads Hospice & Palliative Care.

“Medication evens out the highs and lows of depression, so in some ways, it’s the easy way out. The problem is that emotions don’t go away; they dwell within us and can even cause physical pain until acknowledged and expressed.”

Still, Donna emphasizes, “We can’t swallow our feelings like we swallow a pill.”

It takes physical energy to hold in our grief. Holding back tears can produce a lump-in-the-throat sensation. “Keeping it together” and acting normally can cause headaches, indigestion and aches. In more serious cases, the bereaved can develop stress cardiomyopathy¹, cardiac conditions² and weakened immune systems³. Sometimes coping mechanisms, like smoking or drinking alcohol, can increase the risk for developing cancer.

Emotion — and Lots of It — is a Normal Part of Bereavement and Needs to be Addressed

The very word “emotion” implies movement; emotions need to move and flow, especially for those who’ve lost someone they love.

Individuals may respond “I’m fine” when asked how they are feeling, but bereavement counselors liken “FINE” to mean frazzled, irritated, neurotic and exhausted. Some of the other symptoms of bereavement that may mimic depression are:

• Anxiety
• Crying
• Feeling lost and empty
• Impatience
• Pulling away from comfort or touch
• Sadness
• Guilt

Alternatively, major depressive disorder may be marked by suicidal thoughts, persistent negativity and feelings of worthlessness. These may be red flags indicating need for intervention.

What Should be Tried First, Before Diagnosing Depression in the Bereaved?

Bereavement counselors would like to substitute the prescription pad with a referral form to grief counseling. Often, processing feelings in a safe setting is the fastest path to alleviating symptoms. Thousands of people have attended the Grief Recovery Method® Program, a 12-week program that is offered for free to Crossroads patients and the community.

When considering bereavement vs depression, consider this: Depression is a serious disease. Bereavement, including grief, is part of the human condition. Let’s give each the appropriate care and treatment, and let the very normal bereavement process take place.

If you would like to refer a patient or friend to Crossroads’ Grief Recovery Program in your area, please call 1-888-564-3405 or click here.

REFERENCES

http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/conditions/stress_cardiomyopathy/index.html

²Mostofsky E, Maclure M, Sherwood, J, Toffler G, Muller J, Mittleman M Risk of acute myocardial infarction after the death of a significant person in one’s life. Circulation. 2012;125:491-496

³Vitlic A, Khanfer R, Lord J, Carroll D, Phillips A. Bereavement reduces neutrophil oxidative burst only in older adults: role of the HPA axis and immunesenescence. Immunity & Ageing. 2014;11:13