When the grieving process remains interruptive for an extended period of time and does not seem to be diminishing, it may be helpful to determine if you are experiencing healthy grief, clinical depression/major depressive disorder, or the more uncommon prolonged grief disorder. Each situation requires a different approach in order to reach a place of healing.
What is Normal?
The loss of a loved one is something nearly everyone encounters over the course of a lifetime; it’s part of the human experience. With such intense and complex feelings of despair, anger, sadness, confusion, and sometimes even guilt, it’s no wonder each person’s bereavement looks different.
But how do you recognize when the grieving process has crossed into a danger zone? How do you determine when the duration and depth of grief indicate a need for professional support?
If you are in mourning and realize you can’t tell if your feelings are “normal” or something more, there are clues that it might be time to reach out for help. Perhaps months, or even years, have passed since your loss. People who care about you are starting to express concern that you should be “getting over it” and are worried you may be stuck in the past. If you feel numb or hung up somewhere in the grieving process, it’s important to examine whether your journey may be leading you down a path to clinical depression.
When Healthy Grief Becomes Clinical Depression
There are some major similarities between healthy bereavement-related grief and clinical depression, although they are separate clinical entities. For starters, both come with feelings of profound sadness. Grief and clinical depression may both manifest physical symptoms such as too much or too little sleep, lack of appetite, or a general inability to perform daily tasks. During the typical grieving process, these feelings and behaviors are perfectly normal.
What is not normal, however, is behavior indicating clinical depression, such as shutting others out of your life. Those who are grieving in a healthy way accept support from friends and family. Those with clinical depression tend to isolate themselves, turning down offers of physical, mental, emotional, or spiritual care. While experiencing depression, feelings of worthlessness may dominate their thinking.
In addition, for those who struggled with clinical depression before a loss, the death of a loved one can act as fuel for it. [1]
Grief Cycles vs. Depression Despair
For more than fifty years, the work of Dr. Elisabeth Kubler-Ross was the gold standard for defining the bereavement process. We have heard of her “five stages” of grief, including:
- Denial: shock and numbness
- Anger: anger at self or the one who died
- Bargaining: resisting the inevitable
- Depression: hopelessness
- Acceptance: pain eases [2]
Not every grieving person experiences every stage listed here, but most do pass through each phase at some point. You may have realized that the process is not necessarily linear. We don’t move smoothly from denial to anger to bargaining, and so forth. In fact, each step is quite unpredictable, often described as coming in waves. Even the “depression” stage of the healthy grieving process may be assumed to ebb and flow during the days of bereavement.
Clinical depression does not come and go. It is a protracted illness that affects the brain, robbing millions of people of the joy of life. A depressed person may experience feelings of hopelessness, trouble with decision-making, sleeping too much or too little, major appetite changes, or thoughts of self-harm. For those with clinical depression, assuming the depression stage of grief is all you are experiencing may delay much-needed interventions. [3] It’s important to be honest with your doctor if any of these signs of depression appear. [4]
When Grief Becomes Something Else: Prolonged Grief Disorder
In 2022, The American Psychiatric Association recognized prolonged grief disorder (PGD) as a diagnosis, differentiating it from major depressive disorder or the typical grieving process.
Primary indicators of prolonged grief disorder include:
- Intense thoughts of your loved one
- Significant increase in distress rather than the expected decrease
- Notable inability to perform daily tasks [5]
Approximately 7 to 10% of people in bereavement will develop prolonged grief disorder. Those at highest risk include:
- Older women with lower socio-economic status
- People with mood disorders or unresolved childhood trauma
- Those who experience sudden loss from such causes as suicide or accident [6]
Not surprisingly, 63 percent of adults with prolonged grief symptoms have co-occurring depression. [7] If you have been experiencing any or all of these debilitating symptoms for more than a year, it may be time to discuss prolonged grief disorder with a mental health professional.
Grief vs. Clinical Depression vs. Prolonged Grief Disorder
| Feature | Grief [8] | Depression [9] | PGD [10] |
|---|---|---|---|
| Primary Emotion | Feelings of sadness and yearning related to a specific loss | Persistent sadness, hopelessness, and loss of interest not always tied to a specific event | Intense longing and preoccupation with the deceased, persisting over time |
| Duration | Gradually diminishes over weeks to months; intensity often lessens with time | Symptoms last at least two weeks, present most of the day, nearly every day and may persist for months or years without treatment | Symptoms persist for at least 12 months (or longer) and cause significant impairment |
| Trigger | Typically follows a loss (death, relationship, job, etc.) | May arise with or without an identifiable trigger | Triggered by loss, usually death of a loved one |
| Symptoms | Sadness, crying, yearning, but also moments of positive emotion and memories | Persistent low mood, loss of pleasure, sleep/appetite changes | Persistent longing, difficulty moving on, emotional numbness, avoidance of reminders |
| Self-Esteem | Usually maintained | Often diminished, with feelings of worthlessness or guilt | May remain intact, but life feels empty or meaningless without the deceased |
| Response to Support | Comforted by social support and remembrance | Limited response to support; social withdrawal is common | Support may help, but symptoms persist despite time and assistance |
| Risk of Self-Harm | Rare, unless complicated by depression or other mental health issues | Increased risk of self-harm and suicidal thoughts | Risk may increase if disorder leads to depression or hopelessness |
Hope Remains
Psychotherapy and whole-person treatment remain the first choices of interventions for the normal grieving process. Other options to help process your emotions in bereavement include:
- Stay engaged with your support system of friends, family, or community groups.
- Seek out a therapist specializing in grief recovery.
- Check with your local librarian for books that support and encourage you.
- Be mindful of your physical health with adequate sleep, nutrition, and exercise. [11]
If you are experiencing clinical depression triggered or worsened by a loss, it’s vital to seek professional support. Trained counselors can help walk you through the very complex emotional process and provide the hope you need to keep going.
Bereavement-related depression does carry a suicide risk. If you are having thoughts of self-harm and are concerned you may act on them, please seek help. Someone at the 988 Suicide & Crisis Lifeline is waiting to talk to you with free, confidential, 24/7 support. Dial 988 to speak to someone today.
Frequently Asked Questions
I am working through the normal grieving process. What can I do on my own to move toward healing?
Journaling about your loss can be an effective way to process thoughts and feelings. Whether you grab a notebook and start free-writing, compose a letter to your loved one expressing things you wish you had said, or take a moment to reframe your mindset through gratitude, writing can be an exceptionally healing process. [12]
My self-esteem has taken a hit since the death of my spouse. I can’t remember the last time I had a positive thought about myself. Could this be a symptom of depression?
Yes, a negative opinion about oneself is one differentiator between the healthy grieving process and clinical depression. If you find yourself overcome by feelings of guilt or worthlessness, it is likely time to reach out for professional help.
My loved one died without warning last year, and the shock still seems to be keeping me from moving on with life. Is this normal?
Research shows those who experience unanticipated loss as a result of such trauma as a suicide or accident are at higher risk for prolonged grief disorder. If intense thoughts of your loved one are still interfering with daily tasks, it may be time to seek professional help.
I was recently laid off and am experiencing the same set of emotions I worked through when my father died. Am I dealing with grief over the loss of my job?
It is quite possible. Sometimes grief is triggered over things other than the death of a loved one. Any unwanted life change such as job loss, divorce, illness, or financial trouble can start the grieving process.
We Can Help
If you are having difficulty processing emotions you are experiencing after a loss, we stand ready to help. At The Center • A Place of HOPE our team of experts addresses grief and depression concerns using a multidisciplinary, Whole Person Care approach. This proven, comprehensive model was created by our founder, Dr. Gregory Jantz, in the 1980s. During the intake and treatment process, we take into account factors from six life domains:
- Emotional well-being: Processing the trauma and anxiety associated with your grieving.
- Physical health: Addressing medical concerns that may be exacerbating symptoms or hindering recovery.
- Spiritual peace: Finding meaning and connection on your faith journey.
- Relational happiness: Making and rebuilding bonds with loved ones and friends.
- Nutritional vitality: Supporting overall health to back your emotional recovery.
- Intellectual growth: Understanding where you are in the grieving process and how to move forward.
At The Center • A Place of HOPE our Whole Person Care program bridges the gap between standard outpatient and inpatient treatment, offering full-day therapy six days a week with supportive local housing. It combines structure and intensity with personal responsibility outside program hours. Most clients stay 2 to 6 weeks, with some extending up to 8 weeks based on individual needs.
Grief is a natural part of life, but prolonged depression as a result of loss is not. If you are ready to take the first step toward finding a place of peace and productivity, reach out today. Our compassionate intake specialists will guide you through the process to better manage the pain you are experiencing. Please call today, 8 AM to 5 PM PT, or complete our online form to request a callback.
References
- https://www.health.harvard.edu/blog/can-grief-morph-into-depression-201203214511
- https://www.aplaceofhope.com/what-are-the-five-stages-of-grief-after-a-significant-loss/
- https://www.aplaceofhope.com/understanding-the-depression-stage-of-grief/
- https://odphp.health.gov/myhealthfinder/doctor-visits/screening-tests/talk-your-doctor-about-depression
- https://www.samhsa.gov/communities/coping-bereavement-grief
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8475918/
- Lenferink et al. “Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis”. 2021. Journal of Affective Disorders.
- https://medlineplus.gov/ency/article/001530.htm
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4204469/
- https://www.ncbi.nlm.nih.gov/books/NBK507832/
- https://www.nia.nih.gov/health/grief-and-mourning/coping-grief-and-loss
- https://www.aplaceofhope.com/how-journaling-can-help-with-grief-and-loss/
