Everyone experiences sadness or low mood at some point in their lives. This can be caused by a variety of life experience, or even just a small change in the balance of neurotransmitters in the brain. This experience does not inherently mean that a person has developed a form of depression or experienced a level of trauma that might cause extended feelings of sadness.
There are two types of extended low mood, which many people can confuse: grief and major depression. Although grief and loss can trigger major depression, the two mental health conditions do not have exactly the same symptoms and involve different therapeutic approaches.
Grief and Bereavement
Grief is the feeling of sadness, numbness, and/or anger that follows a major loss. Loss of a loved one, receiving a diagnosis of terminal illness or experiencing permanent disability, loss of a job, or the demise of a relationship can lead to grief. Grief and mourning are normal reactions to losing something or someone important. Bereavement is specifically the loss of a loved one due to death.
The experience of grief is different for everyone, although there are a few stages of grief that appear to be common in many people. These stages or symptoms do not occur in a specific order and can appear concurrently. The stages of grief are:
- Denial, numbness, or disbelief
- Anger or blame (of self, others, or both)
- Sadness, crying, loneliness, or low mood (temporary depression)
- Acceptance or coming to terms with the loss
While many people believe the stages or symptoms of grief are firmly codified, much of the experience of grief depends on what type of loss occurred. These general five symptoms can be broken down into more specific physical, mental, and emotional symptoms.
Physical symptoms of grief include:
- Nausea or upset stomach, sometimes in the “pit of stomach”
- Tightness in chest or throat, as if breathing is difficult
- Oversensitivity to noise
- Surreal or dissociated feelings
- Muscle weakness
- Lack of energy, fatigue, or increased need for sleep
Mental symptoms of grief can include:
- Preoccupation or being easily distracted
- Feeling like the person is still there
Emotional grief symptoms can include:
- Anxiety or fear
- Blaming oneself or others for the loss
In the case of bereavement specifically, the experience of a loved one’s death can be influenced by whether the person died suddenly or if their death was expected due to chronic illness. Since bereavement is a type of grief, symptoms are very similar, although during the most intense moments of the mourning period, they can appear similar to symptoms of major depression. Some of these symptoms include appetite and weight changes, insomnia, and prolonged periods of sadness. In some instances, bereavement and grief can trigger or contribute to major depression.
In contrast to grief and bereavement, in which symptoms typically ease over time, major depression is defined as sadness, loss of interest, and fatigue that cyclically appear and disappear, or that does not lessen much with time. Major depression can be treated with medication, therapy, or both; however, all people experiencing this condition typically need professional help. Major depression is sometimes also referred to as clinical or medical depression.
This mental health condition affects about 6.7 percent of US adults, ages 18 and older; however, between 20 and 25 percent of adults suffer an episode of clinical depression as some point in their lives, and this can sometimes be related to grief or bereavement. Almost twice as many women receive diagnoses of major depression compared to men.
There are several potential symptoms of major depression. To meet diagnostic criteria, a person must experience at least five of the following symptoms nearly every day for about two weeks.
- Depressed mood (sadness, emptiness, numbness, or feeling tearful or irritated; in children, persistent irritability)
- Loss of interest in, or inability to feel pleasure from, normal activities or hobbies
- Weight loss or gain due to changes in appetite
- Insomnia, an increased need for sleep, or changes to sleep schedule
- Slowed behavior or feeling restless
- Loss of energy
- Feeling worthless or guilty for no or little reason
- Difficulty concentrating and making decisions
- Recurrent suicidal thoughts or attempted suicide
When Grief Becomes Major Depression
There are many potential root causes of major depression, including genetics, environment, and history of trauma. However, major depression is typically considered to begin when neurotransmitters in the brain become imbalanced, affecting the individual’s sleeping, eating, and work and personal habits. Hormones can change too. This suite of chemical changes can be difficult to address.
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Typical distinguishing aspects between grief and major depression include:
- Feelings of grief typically occur in waves, for a few weeks, and then begin to decrease in frequency and intensity over months or years. Grief can be mixed with positive memories. Major depression is a consistent feeling of sadness, numbness, worthlessness, and lack of interest in activities for two weeks or more.
- While in mourning, a person may feel sad, lonely, fatigued, or numb, but retain their sense of self-worth. While struggling with major depression, however, the individual’s self-esteem suffers.
Grief and bereavement can also be caused by trauma. The loss of a loved one is a major life event that can trigger chemical changes in the brain. If these do not slowly adjust back to normal levels over time, that means grief and bereavement are becoming major depression.
Symptoms that grief has become major depression include:
- Feeling like life is not worth living
- Feeling worthless due to the loss of a loved one
- Self-blame for their loved one’s loss
- Feeling numb and disconnected from life and others for more than a few weeks
- Difficulty performing daily activities for more than a few weeks
- Auditory or visual hallucinations of the loved one, which can trigger sadness or numbness
Getting Help for Major Depression and Prolonged Grief
If a psychiatric condition like depression remains untreated, then the mental health issue can lead to other co-occurring problems, including substance abuse, dependence, or addiction. Emotional and physical pain are common occurrences in people who struggle with major depression, and the individual may self-medicate in order to overcome these experiences. This can include a dependence on narcotic painkillers, benzodiazepines for insomnia, or alcohol.
A person may not receive a diagnosis of major depression until after they have developed a substance abuse problem. Fortunately, medical professionals are developing a better understanding of co-occurring mental health and substance abuse disorders, so there are more, and better, rehabilitation programs set up to treat these conditions together.