Spotting Major Depression in the Grieving
An expert provides advice on when you should intervene
Someone you love is grieving. They seem terribly sad, they cry a lot and after a few weeks you start to wonder whether they are “stuck” or may need professional help. Do they? Let’s look more closely at the difference between normal grief and complicated grief or major depression.
It is important to understand that the clear majority of people navigate their way through grief without major dysfunctions. But that doesn’t mean it’s easy. Even in normal grief, physical, emotional, cognitive and spiritual responses can seem almost overwhelming, at least temporarily.
Sudden deaths with no warning can cause more intense symptoms initially, since there was no time to prepare and no gradual grieving as the loved one slowly dies.
Yet with any death, even with losses that are anticipated and that involve opportunity for closure and goodbyes, you may observe that sadness, longing and other grief expressions remain for a very long time. And because the point of healing is not to forget but to carry a loved one’s memory into the future as an integral part of who you are, grieving people may get “ambushed” months or years later by reminders of the deceased. Some people call this a “sudden temporary upsurge of grief.”
The more symptoms you observe, the greater the chance that intervention is needed.
In normal grief, though, especially after the initial weeks, the symptoms come and go at various points rather than being constant companions, and grieving people gradually and increasingly return to a normal degree of functioning in the world.
In fact, Margaret Stroebe and Henk Schut, two prominent researchers in the field of psychology and thanatology (the scientific study of death and associated practices), developed the “dual process model” of coping with grief. They found that this pattern of alternately engaging with and withdrawing from grief is a normal process. They say it allows people to remember and miss a loved one while simultaneously going on to live fully and, once again, find enjoyment in activities, life, and other loved ones.
When Grief Becomes Severe Depression
In some cases, grievers may struggle with more profound and complicated grief that can signal depression. In a recent interview, Helen Harris, a licensed clinical social worker and associate professor at Baylor University in Waco, Texas, explained one major difference: With normal grief, the intensity of the physical, emotional, cognitive and spiritual responses fluctuates and gradually subsides.
But complex loss, Harris says, (which includes experiences such as sudden or violent death, multiple losses in a relatively short time frame, death with an unresolved relationship, suicide and other trauma-related deaths) can result in complicated grief, where the depth of these responses intensifies over time rather than fluctuating or decreasing, and may eventually develop into “clinical depression.”
Mayo Clinic defines clinical depression as a severe form of illness, also known as "major depressive disorder." It is significant enough to cause noticeable problems in relationships with others and in day-to-day activities such as work, school, family or social activities.
Warning signs that indicate a person may require professional help or be sinking into severe depression include:
- Chronic deep sadness
- Excessive sleeping, barely sleeping at all or the inability to get out of bed
- Rapid weight loss or gain
- Lack of any pleasure or interest in activities or relationships
- Sustained trouble focusing, concentrating or engaging in life
- Deterioration of personal hygiene
- Recurring thoughts of death or suicide, especially if they develop a suicide plan
- Generalized guilt, self-loathing and loss of self-esteem
- Use of substances to medicate their emotional pain
The more of these symptoms you observe, the greater the chance that intervention is needed. Start with the family physician, who can gather information on the severity and duration of symptoms and refer people to appropriate therapists.
Even for normal but intense grief, many people find it helpful to talk to an experienced therapist who is objective and doesn’t carry the “baggage” that family and friends may have. In the more severe cases, licensed professionals treat clinical depression with talk therapy, medication or usually a combination of the two. When trauma is part of the loss experience, trauma therapy is indicated as well.
Remember that despite the sadness and deep sense of loss, most people will eventually get through their grief, assimilate the loss into their life and regain a sense of purpose and joy. They are often aided in this task by their already-existing network of family and friends plus available support groups, good books on grief and online resources.
Yet, you provide invaluable service to those you care about when you are knowledgeable about and prepared for those “sometimes” cases when extra help may turn the corner or even save a life.