My mom died a few months ago and dad isn’t taking it well. He’s lost interest in food, socializing, not sleeping well, and has guilt about “unfinished business” in their relationship. How can I tell the difference between natural grief and depression?
Dr. Becker attended medical school at the University of Wisconsin, and completed his psychiatric residency at Yale University. Afterward, he served as director of adolescent services at the Yale Psychiatric Institute until relocating to the Bay Area in 1995. Since then, he has been the medical director of behavioral health services at Mills-Peninsula Health Services. His clinical practice focuses primarily on the evaluation and treatment of adolescents. Research interests include substance use disorders, personality pathology, and adolescent psychopathology.
I am sorry to hear of your recent loss. The relationship between grief and depression is a complex one – and, interestingly, one that has been revisited in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. The response to any significant loss (including bereavement) may involve intense sadness, changes in sleep or appetite, loss of interest in usual activities, and feelings of guilt. These symptoms are generally expectable and are likely to resolve with time.
However, when such symptoms persist beyond a few months’ duration, they may represent the onset of a major depressive episode. Although it is much more common for grief symptoms to resolve within a few months, the stress of a significant loss can sometimes precipitate a major depressive episode. Such a progression – from grief to clinical depression – is more likely when individuals have previously experienced a major depressive episode.
As a general rule, the acute grief response will usually persist for only a few weeks or months. When symptoms last longer than this, it is worth considering whether a major depressive episode may have developed. And in cases where individuals have a prior history of major depression, then one should perhaps – even earlier on – be suspicious of such a progression.
In my experience, grief reactions tend to be at their worst within the first few weeks after the loss – then symptoms show gradual but persistent improvement. When grief precipitates clinical depression, I have found that symptoms are often more profound a month or two after the loss than they were initially.
Most primary care physicians are quite familiar with the diagnosis and routine management of major depressive disorder. If you have questions about your father’s condition, I would recommend that you have him consult with his physician. If differentiating between grief and clinical depression is difficult in your father’s case, his physician may refer him to a psychiatrist for a more specialized evaluation.
If your father’s health care providers believe that he is experiencing the onset of clinical depression, they will likely recommend some form of treatment – either medication or psychotherapy, or both. If, on the other hand, his symptoms are believed to reflect a grief response, such treatments are less likely to be helpful – although grief support groups, and other social supports, may be quite helpful.