Beyond Grief: Recognizing Major Depression

Beyond Grief: Recognizing Major Depression

The emotions that come along with grief are hard. To put it lightly — it’s draining, dark, confusing and can be very lonely. It is important to let yourself feel these feelings through the process. To acknowledge that this is grief — the fog will start to slowly lift. Going through the stages of grief in which ever order they come to you in what ever time frame it takes for you — is important.

Grief is a normal reaction to loss but sometimes the lines between grief and major depression can be blurred. Depression can only be diagnosed if certain symptoms have been apparent for over 2 months — trying to diagnose before that is likely due to bereavement. There are many overlapping symptoms that can make differentiating  the two difficult, but there is one key difference between them:

Grief tends to be more trigger-related and situational after 2-3 months. For a large chunk of time you are functioning okay and feel relatively ‘better’ when around family, friends and in comfortable situations. It’s not until you get to the triggers that you begin to feel the symptoms of grief. Triggers can be dates, or leading up to dates, seeing a baby or pregnant woman, pregnancy announcements or television, songs — what ever it is for you.

Major depression tends to be a lot more persuasive, lingering and not-trigger related. There is little relief from the symptoms and there is no evidence of things going in the ‘better’ direction. Thoughts of sadness tends to start to creep into all areas of your life — an overall feeling of guilt, worthlessness not related to the loss of your child.

Diagnostic Criteria for Major Depression (DSM-IV):

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note:  Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

  • (1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  • (2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
  • (3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
  • (4) insomnia or hypersomnia nearly every day
  • (5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  • (6) fatigue or loss of energy nearly every day
  • (7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  • (8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  • (9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation

If you are worried that what you or a loved one could be dealing with major depression on top of grief please go speak with your doctor.

Photo credit: adapted from ePi.Longo | Flickr

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Devan McGuinness

is the founder of the online resource Unspoken Grief , which is dedicated to breaking the silence of perinatal grief for those directly and indirectly affected by miscarriage, stillbirth and neonatal death. Using her own experience of surviving 12 miscarriages, Devan has been actively supporting and encouraging others who are wading through the challenges associated with perinatal and neonatal loss.

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