Each year, over two million people die in the U.S., leaving behind scores of others who will mourn their departure. Bereavement, the deep grief following the death of a loved one, is a normal response to loss.
For some people, however, the natural feelings of grief such as guilt, insomnia, numbness, and crying may result in more serious conditions including complicated grief and major depressive disorder.
Normal Symptoms of Grief
Grief differs from normal sadness in both duration and intensity. Individuals experiencing normal sadness are most often able to describe why they are sad, function normally in the world, and usually able to overcome their sadness within a relatively short period of time (perhaps within a month).
A person mourning the loss of a loved one may experience the following intense feelings for days, weeks, or even months following the loss of a parent, spouse, sibling or friend (and sometimes a pet as well):
- guilt about things they did or did not do before the person died
- thoughts such as "I wish I would have died instead."
- imagining they've seen or heard the dead person
- having trouble sleeping
- changes in eating and exercise habits
- social isolation
When Does Grief Become Depression?
If a bereaved person experiences the following symptoms, it is time to seek help:
- lack of concentration and inability to focus
- extreme feelings of worthlessness or guilt
- anxiety or depressed feelings that get worse rather than better with time
- trouble sleeping that lasts longer than six weeks
- extreme weight gain or loss
- unexplained physical symptoms
- suicidal thoughts
Defining Complicated Grief Disorder
It is completely natural for mourners to question their own mortality. Feelings of hopelessness and ?helplessness are part of the grieving process, but they may also be symptoms of depression.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5)—referred to as the "psychiatrist's bible"—will attempt to clarify the murky line between bereavement and depression when it comes out in 2013.
One proposed change in the DSM is the introduction of a new category known as complicated grief disorder. Complicated grief disorder, also called traumatic or prolonged grief, proposes that common symptoms of severe mourning such as pining for the deceased, difficulty moving on, and anger about the loss be treated as a more serious disorder when they last for more than six months.
Diagnosis for complicated grief disorder is expected to be based on two criteria.
First, the grieving person must be yearning for the deceased daily and to a crippling degree.
Second, the person must be suffering from five of the following symptoms to the point where they interfere with her ability to function normally:
- difficulty accepting the loss
- feeling stunned, dazed, or shocked by the loss
- bitterness or anger related to the loss
- numbness since the loss
- difficulty moving on with life
- extreme confusion about one's role in life
- avoiding anything that is a reminder of the death
- inability to trust others since the death occurred
- feeling that life is meaningless now
The Risk to Caregivers
The risk of developing complicated grief or depression is especially high among caregivers.
Around 20 percent of bereaved caregivers experience psychiatric symptoms consistent with a serious mood disorder. Studies have found that pre-bereavement—the feelings a caregiver experiences prior the death of a loved one—can determine a person's susceptibility to depression after the ill person passes away.
As with most illnesses and disorders, prevention is usually the best medicine. If there is a suspicion that a caregiver may be having trouble coping, asking a few important questions may help:
- Do you feel overwhelmed by the responsibilities of being a caregiver?
- Do you feel isolated from your family and friends?
- Are you emotionally prepared for the death of your loved one?
- Have you felt sad, anxious, or depressed for much of the time in the past month?
If the caregiver answers in the affirmative to any of the above questions, she should seek the help of a qualified counselor or mental health professional.
Preventing Depression After a Loss
Once grief becomes clinical depression, it cannot be overcome by the bereaved and must be treated by a physician or mental health professional.
Treatment for depression usually involves medications such as antidepressants, some form of psychotherapy such as interpersonal or cognitive behavioral therapy, or both.
There are, however, ways people may help prevent their grief from becoming depression in the first place. Grief expert Dr. J. William Worden suggests the following tasks:
- accept the reality of the loss and know the person will no longer be part of daily life
- work through the pain of grief by facing difficult feelings
- adjust to a different reality by doing things differently such as taking up new hobbies or giving up ones that are painful reminders of the loved one
- move on with life by "investing time and energy into living again”
Other ways to help stave off depression include:
- performing some form of physical exercise for at least 30 minutes every other day
- engaging in pleasurable activities or hobbies weekly
- connecting with friends and family
- practicing stress-relieving activities such as deep breathing
- getting between seven to nine hours of sleep each night
- eating a healthy diet
- avoiding alcohol, drugs, and caffeine