Grief vs. Depression: Understanding the Difference

What Is Grief?

Grief is a normal response to significant loss. We might tend to think that grief only occurs in response to an actual death, but other major losses (e.g., a relationship, job, physical abilities, sense of safety in the world, etc.) can also trigger a grief reaction. Grief can be experienced in emotional, spiritual, and physical ways. It can cause problems with a person’s ability to think clearly (i.e., grief brain) and major disruptions in different areas of someone’s life, including relationships, financial security, and daily living routines.¹

Types of Grief

Grief is described by therapists in a few different ways, depending on the type of symptoms presenting, how long they have lasted, and how debilitating they are to the individual.

The three most commonly used terms to describe grief are:

Uncomplicated Grief

For the majority of individuals, symptoms of uncomplicated grief will begin to resolve within six months following the loss, allowing one to begin to cope with grief and loss and return to life in an adaptive way. Nevertheless, it isn’t uncommon for intense grief symptoms to return at the anniversary of the loss (i.e., the anniversary effect) or other important dates like birthdays and holidays.²

Grief has been described as a process that occurs in “fits and starts.”⁶ Its intensity varies, sometimes from moment to moment, in terms of how it affects someone’s ability to function in different areas of daily life. Fortunately, uncomplicated grief typically also allows moments of comfort, peace, humor, and joy.

In the days and weeks following an important loss, someone is likely to experience acute grief, which involves intense and sometimes overwhelmingly painful emotions, such as sadness, anger, fear, or regret.⁶

During the acute grief phase, someone might also experience:

• Preoccupying memories and thoughts of the loved one who has died
• Difficulties with concentration
• Problems with sleep, appetite, and energy level
• Lack of interest in/withdrawal from people and activities

Over time, grief moves into the integrated grief phase, which is characterized by intermittent “waves” of grief symptoms that might be triggered by situations, important dates, feelings, or memories related to the loss.⁶ During this phase, the person begins to heal and adapt to the changes that have occurred as a result of the loss, rediscovering purpose and meaning as they re-engage in daily life and relationships.

This is also a time when the bereaved often finds ways to remember and stay connected to their deceased loved one, including through dreams, sentimental objects, memorial activities on death anniversaries or continued conversations in their minds with their loved ones.

Complicated Grief

The term complicated grief is used by mental health professionals to describe a situation in which an individual’s grief symptoms have not improved within six months post-loss. This is also referred to as delayed grief. In such cases, one’s symptoms remain intense, persistent, and cause significant functioning difficulties in one’s life.

Complicated grief is characterized by intense distress that persists beyond 6 months following the loss and prevents someone from returning to pre-loss levels of functioning and emotional well-being.¹³

Additionally, one or more of the following symptoms might be present:^5,6,13,14,15

• Disbelief of or lack of willingness to accept the loss, possibly accompanied by anger and bitterness
• A deep longing or yearning for the loved one who has died
• Experiencing life as unbearable since the loss
• Profound loneliness
• Avoidance of things, places, thoughts, or feelings that remind one of the deceased
• Recurring intrusive thoughts and feelings about the deceased

Approximately 10-20% of grieving adults experience complicated grief.^4,5,6 It has been suggested that, in such cases, the grief process has become complicated or “stuck,” due to physical illness, trauma, or depression.³

Persistent Complex Bereavement Disorder (PCBD)

PCBD is a psychiatric diagnosis that is made when a person has become “stuck” in their grieving process for a period of at least 12 months following the death of the loved one (or for bereaved children, the time period would be beyond 6 months). PCBD has been found to occur in approximately 2-5% of individuals who are suffering from grief.⁷

This diagnosis would be appropriate in these situations:⁷

• When someone suffers from intensely distressing grief, related to the death of a loved one
• When someone experiences difficulties in functioning in one or more areas of their life

In addition to sharing the symptoms indicated for complicated grief, PCBD is further characterized by:⁷

• Distressing preoccupation with the way in which the loved one died
• Difficulty recalling positive memories of the loved one
• Feelings of self-blame, guilt, shame, etc. related to the loved one and/or their death
• Wanting to die in order to be reunited with the deceased
• Lack of interest in life

What Is Depression?

Depression is one of the most common mental health diagnoses. It is characterized by many symptoms including sadness, hopelessness, feelings of worthlessness, and sometimes suicidal ideation. Designated depressive symptoms must occur for at least 2 weeks to be diagnosed as depression. Depression can cause physical symptoms as well, like fatigue, body aches, and gastrointestinal distress. It can negatively impact relationships, quality of life, thoughts, emotions, and behaviors.

There are several causes and risk factors for depression, including:

• Genetics: If a close relative has depression it creates a risk for inheriting it.
• Disruptions in brain chemistry
• Major life changes or ongoing stress
• Environmental causes like trauma: Examples include exposure to violence, neglect, or abuse.
• Medical diagnoses like heart attacks, cancer, or progressive degenerative diseases like Parkinson’s Disease.

Signs & Symptoms of Depression

Given that clinical depression has been identified among 28-34% of people who are grieving loss of a loved one, it is imperative that it be identified and treated as soon as possible to address this painful and potentially disabling illness.^5,13

Someone who is grieving should be professionally assessed for depression if they have been experiencing a pervasive depressed mood (i.e., sadness, hopelessness, despair) or a loss of interest or enjoyment in things (for a period of 2 weeks or longer) that used to provide pleasure.

Depression symptoms include:⁷

• Depression and weight gain
• Changes in sleep
• Fatigue or low energy
• Feelings of worthlessness
• Difficulties with concentration, decision-making, or thinking
• Thoughts of death and/or suicide
• Preoccupation with the loss
• Poor appetite

When Grief Triggers Depression

Bereavement-related depression is distinct from uncomplicated grief, complicated grief, and PCBD.^13,14 It has been proposed that the significant stress that occurs following an important loss in one’s life can trigger the onset of depression. Thus, it is possible that one might experience both grief and clinical depression at the same time. Depression has been found to occur in 28-34% of people who are grieving loss of a loved one.^1,5

Significant stressors can be the trigger for the onset of mental illness. Thus, a major loss in one’s life that causes grief can also lead to the development of clinical depression. It is important to be able to tell grief and depression apart, and to know what symptoms indicate the need for professional support.

Grief Vs. Depression: Similarities & Differences

Uncomplicated grief and depression share some similarities in symptoms that can often lead to confusion about whether someone is dealing with grief, depression, or both.

Symptoms shared by both grief and depression include:^6,17

• Low mood (i.e., feeling down or in low spirits)
• Sadness
• Uncontrollable crying
• Social withdrawal
• Problems with sleep, appetite, and energy level
• Poor memory
• Somatic symptoms (e.g., nausea, headaches)
• Reduced interest in life

Despite the similarities, there are also key differences between grief and depression, which can help to differentiate whether someone is dealing with one or the other – or both:⁷

The Grieving Process

Despite the popularity of the idea of “stages of grieving,” it has been clearly demonstrated that there is no one way to grieve, nor are there clear stages that one must go through to grieve.^8,9,10 Instead, it has been suggested that uncomplicated grief is characterized by the successful completion of “grief tasks,” whereas disordered grief occurs when one has significant difficulty completing these tasks.

Grief tasks often include:¹¹

• Accepting the loss
• Working through the pain associated with the loss
• Readjusting to living in the world without the deceased loved one
• Finding some way to maintain connection with the deceased
• Finding a renewed sense of purpose and meaning in life.

The intense grief-related distress that immediately follows a significant loss typically peaks and then starts to decrease within six months following the loss.⁸ Regardless of the proposed grief tasks, it is important to recognize that each person will experience grief in their own unique way.¹²

Treatment For Grief vs. Depression

The recommended treatments for grief vary depending upon the type of grief someone is dealing with. Furthermore, treatment for depression also differs from the treatments for grief:

• Treatment for uncomplicated grief: No formal treatment is recommended, as it typically resolves on its own.¹⁸ Some might benefit from support provided by family, friends, faith-based counselors, or peer support groups.10
• Treatment for complicated grief: Individual or group grief counseling that focuses specifically on the areas of the grief process where the person is feeling stuck.^{16,19,20,21,22}
• Treatment for PCBD: Individual or group therapy that uses interventions that assist someone to:²
  • Face avoided situations, thoughts, and memories connected with the loss
  • Identify and change thoughts that are getting in the way of accepting the loss and adjusting to it
  • Resume engagement in life to once again find meaning and enjoyment
• Treatment for depression: Treatment for depression usually includes supportive, individualized psychotherapy with psychoeducation about depression and grief, and a medical assessment regarding whether medication for depression would be appropriate.^6,17,23

Can Support Groups Help With Grief & Depression?

Support groups are a powerful tool that can help with coping with both grief and depression. They can provide validation and comfort by allowing someone to talk with people who have shared experiences. Support groups help normalize feelings and help you to feel less alone when experiencing grief or depression. In addition, people can share tips and resources that may be valuable in helping learn how to cope with your depression and/or bereavement. Depression can occur while grieving. Participation in support groups can be done in person or online. These groups may be led by a peer or a mental health professional.

There are many available places to go to find support groups in your area to help with grief and depression. Here are some good resources to get you started:

• National Association of Mental Illness (NAMI): Offers peer led support groups, education, and resources across the country.
• Mental Health America: Offers information on local support groups to attend in person. Groups can be led by health care professionals or peers.
• Check with your local mental health center, your doctor, or hospital if it has a psychiatric unit to learn about support groups for depression.
• Depression and Grief help – SAMHSA: Call 1-800-662-HELP (4357) to learn about mental health services in your area.
• Griefshare: Has groups with professional and peer support.
• Hospice Foundation of America: Offers information on grief groups related to different types of loss.

How to Find a Therapist

If you’re not sure how to find a therapist, you can start by asking your primary care provider for a referral or confide in a trusted loved one whom you know has gone to therapy. Another simple solution is to use an online therapist directory where you can sort by specialty (like grief or depression), location, and insurance coverage.

Final Thoughts on Grief Vs. Depression

The outlook for those suffering from grief and/or depression continues to be positive. Uncomplicated grief tends to resolve naturally without any form of professional intervention within six months post-loss. Those experiencing complicated grief or PCBD, with or without depression, will likely benefit from individual or group therapy, and a medical assessment.