What is the Difference Between Depression and Grief?

One of the most controversial things the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) did was remove the bereavement exclusion from the depression diagnosis. Previously, people grieving the loss of a loved one couldn’t be diagnosed with depression for two months after the loss. Now, however, this is no longer the case. Now, even a person grieving the loss of a loved one can be diagnosed with depression.

And some people say this is a further medicalizing of normal emotion. I, however, would argue that there was a good reason for this change and that skilled clinicians can tell the difference between grief and depression. Here are some ways grief and depression differ.

Why Remove the Bereavement Exclusion?

The logic here is actually very simple. It was recognized that the bereavement period could not be quantified and two months certainly wasn’t a long enough period for some people. Bereavement experts noted that the period of bereavement can last for up to two years and varies tremendously between people. And because there is no reasonable set period for bereavement, having a dictated exclusion didn’t make sense. It’s now up to a clinician’s judgement to tell the difference between grief and depression.

And don’t get me wrong, this can be a challenging differentiation to make, but one Psychiatric Times article, After Bereavement, Is It “Normal Grief” or Major Depression? outlines ten pairs of statements designed to help the clinician make that differentiation.

Telling the Difference between Grief and Depression

While grief and depression have crossover symptoms, to be sure, Dr. Ronald Pies suggests that people suffering from grief and those suffering from depression match certain “prototypes.” He uses ten pairs of statements to tell the difference between depression and grief. For each pair, a person is asked to identify which statement fits their state of mind better.

1. I am filled with despair nearly all the time, and I almost always feel hopeless about the future. OR I feel sadness a lot of the time, but I believe that eventually, things will get better.
2. My sadness or depressed mood is nearly constant, and it isn’t improved by any positive events, activities, or people. OR My sadness or depressed mood usually comes in “waves” or “pangs,” and there are events, activities, or people who help me feel better.
3. I will probably never get back to feeling like my “old self” again. OR Things are really tough now, but I’m hopeful that with time I will feel more like my “old self.”
4. When friends or family call or visit and try to cheer me up, I don’t feel anything or I may feel even worse. OR When friends or family call or visit and try to cheer me up, I usually “perk up” for a while and enjoy the social contact.
5. I often have persistent thoughts or impulses about ending my life, and I often think I’d be better off dead. OR I sometimes feel like a part of me has been lost and I wish I could be reunited with the person or part of my life I am missing, but I still think life is worth living.

(See all ten pairs of statements here.)

If you’ve ever experienced depression (or grief) you can probably identify that the former statements indicate depression while the latter statements indicate grief. And, in my mind, the difference is actually quite clear.

Depression vs. Bereavement

Of course, depression can occur during the bereavement period and bereavement can morph into depression so sometimes this must be treated. But overall, I’d say that identifying grief means identifying a natural state of pain that you simply must live through to get through whereas identifying depression is identifying an illness that requires treatment and nothing in the DSM changes this.

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