Understanding Grief and Depression

When we experience loss, we grieve. Perhaps the most painful and dramatic type of loss is bereavement, the death of someone we love or with whom we have a significant relationship. "Grief is the story of love after loss," says Dr. Katherine Shear, professor of psychiatry at the Columbia University School of Social Work and director of the Center for Complicated Grief. "Sometimes the story is complicated and prolonged."

We presume a grieving person must be very sad and perhaps depressed, but grief is often more complex than sadness. Some of us will get stuck in our grief and be unable to move forward without help. Grief may coincide with or trigger a major depression, but the conditions are different. Understanding those nuances can help identify what kind of help you or a loved one may need.

Research on grief is a growing field, with data mainly based on bereavement, although many losses -- such as a divorce, layoff or medical crisis -- weigh on hearts and minds as well. "Much of what we say about bereavement may well be applicable to other losses," says Dr. Sidney Zisook, distinguished professor of psychiatry at the University of California--San Diego and research scientist with the VA San Diego Healthcare System.

[See: How to Find the Best Mental Health Professional for You.]

Much More Than Sadness

Our society operates on some very outdated notions about grief and loss, says Dr. Therese Rando, clinical director of the Institute for the Study and Treatment of Loss in Warwick, Rhode Island. "We do tend to basically have this assumption that grief means you're sad, you sit in a corner, you cry. That is the way some people's grief manifests itself. It's much more than that."

There's a host of feelings and reactions to grief, says Rando, a clinical psychologist. While some people are sad, others may become angry, irritable, confused, disorganized or perhaps preoccupied with whom they've lost. Grief causes yearning and pining. What we think of as heartache can cause pain in the chest or difficulty in breathing or emptiness in the gut. Migraines may recur or blood pressure may rise. Eating and sleeping patterns can change. Some people may withdraw; others become clingy. Some may lean on alcohol or other substances.

Grief can include positive feelings: Happy memories can shine through a eulogy that evokes laughter as well as tears, Zisook says.

Defining what is "normal" or "ordinary" in grief is a challenge because grief is individual. One person's grief over the loss of a parent may differ from the experience of her sister, Rando says, because they had different relationships. Experts point to 43 factors that influence how an individual grieves, including birth order, age, resilience, cultural beliefs and personality.

A hallmark of grief, Zisook says, is that it oscillates between intense waves or pangs of sadness, pain and loneliness lasting perhaps 10 to 15 minutes and periods of respite. Over weeks and months, the intensity and frequency of those pangs usually diminish, Zisook adds.

For a major loss, grief may never completely end, but it does lessen. "Closure is for business deals and bank accounts," Rando says. You may get closure on expressing certain feelings or understanding the details of how a death occurred, but you may always feel a pang of grief for a relative at the Thanksgiving table or family wedding. The work of grief is to accommodate that loss into your life.

[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]

Getting Stuck in Grief

Sometimes people get stuck in grief, which can display itself in a variety of ways, from physical illness to post-traumatic stress disorder, Rando says.

Since the 1990s, experts have recognized that approximately 7 percent of mourners suffer from what's known variously as complicated grief, persistent or prolonged grief, or persistent complex bereavement disorder. These individuals may experience severe and prolonged grief that can last years or even decades. They may constantly rehash the circumstances of death or their relationship with the deceased, or they may go to great lengths to avoid dealing with the loss at all. It's more likely in those who've lost a spouse or child, or experienced a sudden, unexpected, violent loss, Shear says.

The work of therapy is to identify and address what's interfering with the normal process to integrate that loss, Rando says, adding that grief difficulties are very treatable.

Grief and Depression

Grief and depression can be interlinked. Depression here does not refer to ordinary sadness or the blues, but to the debilitating disease that can be life-threatening. Individuals with a history of depression are more likely to have depression after grief and are more likely to experience complicated grief. People with complicated grief are more likely to have a co-existing depression or develop depression. Here are some clues to differentiate grief from depression:

Source: Ronald W. Pies, Katherine Shear, Sidney Zisook, "Distinguishing Grief, Complicated Grief and Depression," Medscape Psychiatry, Dec. 26, 2014, http://www.medscape.com/viewarticle/836977

Major depression usually requires intervention with medication and/or therapy. Severe issues can be treated successfully through various approaches of grief counseling, and psychologists, psychiatrists and social workers can help, as can support groups, Zisook says.

[See: How Social Workers Help Your Health.]

How to Help a Grieving Friend or Relative

Reach out. "People grieve a whole lot more effectively in the context of support and loving companionship," Zisook says. "We often avoid people that are grieving because we don't know what to say," but we can still say "I care about you" and provide a meal, a hug and a sense of concern and readiness to help.

With prolonged grieving, notice changes in behavior. A griever may avoid activities like church or temple or a weekly golf game.

Openly ask, "How are you dealing with your loss?" and "Are things getting better for you?" Zisook suggests. Listen for answers such as: "Things are getting worse," "I can't stop crying," "I can't function anymore" and "I wish I didn't wake up and could join them in heaven." Ask if they'd consider talking to a professional.

8 Things You Didn't Know About Counseling

Suzanne Allard Levingston is a freelance health reporter at U.S News. You can connect with her on LinkedIn, follow her on Twitter or reach her at salevingston16@gmail.com.