The Difference Between Grief and Depression

“No one ever told me that grief felt so like fear. I am not afraid, but the sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning. I keep on swallowing. At other times it feels like being mildly drunk, or concussed. There is a sort of invisible blanket between the world and me. I find it hard to take in what anyone says. Or perhaps, hard to want to take it in. It is so uninteresting.” – C.S. Lewis, A Grief Observed

Recently a client was in therapy for depression. She had just lost her son in a tragic car accident a few months back when she asked me if I thought she was depressed. She had no energy, hardly any joy. She thought about her son often, and getting through each day was getting harder. She cried often, and she continually experienced a lack of desire to do much of anything that she previously enjoyed.

She looked at me, and she said, “A part of me died when he died. I am lost. I don’t even know who I am anymore.” Her question was valid, given her circumstances.

I felt the need to help her feel normal, to understand a little more about grief and depression. I said, “Yeh, it can feel like that. You will never be the same.” C.S. Lewis also understood this. He compared grief to an amputation in A Grief Observed. What a fitting description.

I then asked why she thought that she may be getting depressed. She had no idea; she just knew that she was not functioning too well. I began to explain to her about normal grief experiences and educated her on what constitutes a diagnosis of Major Depression, which I will explain here momentarily. First, however, we will discuss grief.

Grief can feel like many things, none of which are pleasant. The pain ebbs and flows, the numbness comes and goes, the anger moves in and out. The confusion comes around again, too. It does not really even happen in five stages. It is cyclical, not linear. Once you have finally accepted it, something happens and you are back at denial.

It is complicated. Sometimes isolating. At times it can last for months and at times it can last years and years. Grief is never the same experience for people. It is always unique based on experiences and personality and family expressions of grief and even coexisting mental health issues.

Because the world of psychology has so often taught that there are five or even seven stages of grief, society has come to think that grief is over when you make it through the last stage, but grief is never over. It just changes. That may need to be said again: Grief is never over. It just changes and yes, you will change with it.

The problem with assuming that there is some way to master grief – to conquer it, if you will – is that when people have not been able to make it through the aforementioned stages, they are often worried. Am I stuck? Am I not moving through this at a healthy pace?

Shouldn’t I be past this by now? Shouldn’t I have cleaned out their room by now? Shouldn’t I be able to laugh again by now, or enjoy life again? Well-meaning people around them might even say that they should be past it, or that they should not continue to think about such things because it only will bring them down.

Then they begin to wonder if they are getting depressed because they are not “further along” in their grief. Though this is a very valid concern, it is also important to understand that grief often resembles depression. When this is the case, the two should be examined carefully and defined clearly.

However, even after discussing the similarities and differences between the two, if you are struggling with loss and need grief counseling, please seek it. Your counselor will be able to help determine if your grief has led to depression to be able to provide the best treatment for you. It is important to note that grief sometimes – but not always – leads to depression.

Let’s talk about the differences and similarities. One person can experience any combination of the symptoms of grief but must meet the DSM-V Criteria to have a diagnosis of Major Depression Disorder.

Grief and Depression: A Comparison

Definitions Grief is defined as “a natural response to any loss, including physical, cognitive, emotional, behavioral and spiritual responses.” The symptoms of grief usually improve with time and often with the help of a professional counselor and a strong support system.

It is important to note that grief (uncomplicated bereavement) can become “complicated grief,” which, unlike uncomplicated grief, does not seem to dissipate with time and can look a lot like depression.

Symptoms of complicated or chronic grief may include:

• Intense sadness
• Anger
• Irritability
• Difficulty accepting that whatever caused the grief really occurred
• Excessive focus on the episode of grief or avoidance of it altogether”

“In extreme cases, someone with complicated grief may engage in self-destructive behaviors or even contemplate or attempt suicide. It is likely due to these symptoms that the DSM no longer includes the bereavement exclusion from the diagnosis of major depression.”

Depression is a “clinical condition that can become deadly if left untreated. To be diagnosed with depression from a medical professional, a person must have a certain number and combination of symptoms. These symptoms must be present nearly every day for at least two weeks.” Depression tends to be more pervasive than grief. Overcoming depression is possible, but not usually without some form of psychotherapy and/or medication.

Similarities 

Grief	Depression
Change in appetite Sleep disturbance Fatigue/exhaustion Tearfulness Difficulty concentrating Avoidance of people and situations Suicidal thoughts or actions Anger, sadness, loneliness Feelings of hopelessness Neglect of hygiene Loss of interest in work or activities Anger at oneself, the deceased person, or at God	Depressed mood or irritability Loss of interest or pleasure in activities Loss of appetite, significant weight loss Sleeping too much or not enough Sluggish movements Fatigue, loss of energy Feelings of worthlessness, guilt Indecisiveness, difficultly concentrating Recurrent thoughts of death or suicide Significant impairment in functioning

 Differences 

Grief	Depression
Identifiable Loss Individual focus on the loss Some ability to feel pleasure “Fluctuating physical symptoms” Comforting to be near others Pleasant and unpleasant emotional experiences Guilt over loss Preserved self-esteem after the loss Thoughts of death are about wanting to be near lost loved one	Not always an identifiable loss Focus on self No ability to feel pleasure “Prolonged and marked physical impairment” Isolation is preferred No pleasant emotional experiences More general feelings of guilt or shame Self-esteem is low, feelings of worthlessness Thoughts of death are related to not being able to cope with life

Treatment

Whether it is normal grief symptoms (uncomplicated bereavement) or Major Depression, grief counseling or other forms of therapy for depression would be very beneficial. It can be easy to isolate, but that usually worsens the problems.

Please do not be afraid to reach out for help in any case. You may be surprised what kind of meaning and healing you can experience when someone comes alongside you in your grieving process.

A Psalm for Grief 

Though many of the Psalms capture the grieving heart, Psalm 13 seems to really show what it can feel like. It can be a healing practice to pray through this Psalm in your grieving process (or your experiences with depression). It helps you to express your feelings and thoughts, but it is also a reminder of who God is despite what you are going through.

How long, O Lord? Will you forget me forever?
How long will you hide your face from me?
How long must I take counsel in my soul
And have sorrow in my heart all the day?

How long shall my enemy be exalted over me?
Consider and answer me, O Lord my God;
Light up my eyes, lest I sleep the sleep of death,
Lest my enemy say, “I have prevailed over him,”
Lest my foes rejoice because I am shaken.

But I have trusted in your steadfast love;
My heart shall rejoice in your salvation.
I will sing to the Lord because He has dealt bountifully with me.

– Psalm 13