Depression vs. Complicated Grief

Depression vs. Complicated Grief


Depression is a constant feeling of negativity that stems from a chemical imbalance in the brain. There are many types of depression, and someone with depression may feel the symptoms briefly or over many years. Emotional influences like stress don’t cause depression, but they can intensify it. Depression is often treated with medication and therapy.

Complicated grief (CG), on the other hand, is caused by the death of someone close to you. CG, sometimes called persistent complex bereavement disorder, is much stronger than normal grief. Many people go through several stages of grieving after losing a loved one. With CG, you may have trouble moving on for months, years, or more. You may also find yourself avoiding social contact, losing motivation to do daily tasks, or wishing that you had died, too. If you feel these things after losing a loved one, you may need to see your doctor to talk about treatment for your CG.

What Is Complicated Grief?

CG has many different descriptions. The most common one is that it’s acute grief that causes long periods of suffering after losing a loved one. Many doctors believe that it’s related to adjustment disorder, which happens when you show a long and intense response to a stressor. Many doctors are now discovering that CG has many features of a disorder. Doctors once avoided giving treatment to people who were grieving. Grief has long been considered a personal, non-medical struggle. However, new evidence shows that CG can make you feel worthless and suicidal, which is similar to depression. Because of this, doctors now seek to treat complicated grief like a disorder, suggesting therapies and treatments to lessen the draining hurt of grief.

No exact number exists for how many people have or have had CG. According to a study, between 10 to 20 percent of people who grieve have severe enough symptoms to be thought of as having CG.

How CG Differs from Depression

Unlike CG, depression is a clinical disorder that starts in the brain. Many different types of depression exist. Major depressive disorder (MDD) is one of the most recognizable. MDD has symptoms that can last for years and can interfere with your daily life. Another type of depression is psychotic depression, which is depression with psychosis. This can cause hallucinations, for example. Another type of depression is postpartum depression, which happens when you have depression after giving birth. Depression can also happen as a result of grief. Depression symptoms can worsen after an event like the death of a loved one. The symptoms of depression and grief can overlap, but they’re treated in different ways.

Depression is well-documented. According to the National Institute of Mental Health (NIMH), nearly 7 percent of adults in the United States experience depression each year.

Causes of Complicated Grief

CG is most commonly caused by the death of someone you love. If your significant other or a close family member dies suddenly, you may have trouble accepting your loss. You may feel intense sadness for years. Your relationships with friends, family, and coworkers may suffer. You may even completely withdraw from your personal and professional life.

CG doesn’t have any identified biological causes. Like depression, it may happen because of:

  • genetics
  • body chemistry
  • personality
  • your environment

Symptoms of Complicated Grief

Grieving is a normal process. However, it can worsen your quality of life and involve more serious symptoms when it lasts for a long time. These symptoms can include:

  • a powerful pain when you think of your lost loved one
  • a heightened focus on reminders of your lost loved one
  • an overall feeling of numbness
  • a feeling of bitterness when you think about your loss
  • a loss of purpose or motivation
  • a loss of trust in friends, family, and acquaintances
  • an inability to enjoy life

If you have these symptoms for months or years, you may need to ask your doctor about treatment for CG.

Symptoms of depression can be similar to CG. If you’ve been diagnosed with depression, CG can make your symptoms worse. In addition to CG symptoms listed above, depression can cause other unique symptoms, such as:

  • constant sadness, anxiety, or feelings of emptiness
  • feelings of guilt or helplessness
  • loss of interest in hobbies
  • insomnia or oversleeping
  • suicidal thoughts or suicide attempts
  • physical aches that don’t go away with treatment

You can have symptoms of both CG and depression at the same time. However, CG and depression must be treated differently.

Risk Factors

CG is most commonly caused by an unexpected or sudden death of a loved one, especially the death of a friend, child, or other family member. Violent deaths, such as from car accidents or natural disasters, can also cause CG.

A history of trauma or abuse can cause your normal grief to develop into CG as your mind and body struggle to accept your sudden loss. A previously dependent relationship to your lost loved one can also cause you distress that complicates your grief.

How Complicated Grief Affects Your Brain

CG has been shown to activate parts of the brain associated with reward. One study found that CG stimulates the nucleus accumbens, which plays a part in your expectation of a reward. This part of the brain usually causes an extreme yearning for the lost loved one that’s never satisfied. This could explain why CG can last for a long time, as it can be likened to an addiction.

Another study showed that CG can also stimulate your brain’s amygdala, causing avoidance behaviors. This could further explain why CG can be prolonged, as it can cause you to avoid confronting or accepting the loss of a loved one. This avoidance is often coupled with the extreme yearning, worsening the addictive behaviors that can happen if you experience this condition.

Treatment Options and Coping

Your doctor may recommend therapy to treat your CG. Complicated grief therapy (CGT) involves techniques like repeatedly telling the story of your loved one’s death. CGT may also help you focus on building your personal relationships and reaching your personal goals.

Research shows that antidepressants can help treat CG if you’re also having therapy. Depression symptoms can result from CG and make your grief worse. CG can also worsen pre-existing depression. Antidepressants can help restore the brain imbalances that cause depression and help you through your grief. Talk to your doctor about antidepressants, and decide if antidepressants are the right choice for helping you confront and accept your loss.

You Asked, We Answered

  • My brother went through a tragic accident last year. Fortunately, he survived, but he will never be the same again. He is paralyzed and unable to speak or respond to me in any way. I’ve been struggling and feeling depressed ever since his accident. Is it possible to have complicated grief if your loved one didn’t necessarily pass?- Anonymous
  • It is noted that complicated grief may occur in response to other meaningful situations that do not involve death (these are sometimes referred to as non-bereavement losses). Some examples of these losses can include separation of a loved one through a divorce, or a loss of a job, pet, property, etc. In your case, you describe a situation involving loss of your brother as you knew him. In this case, the relationship that you once had with your brother (the ability to go places, converse, etc.) has been lost. Therefore, yes, you may be experiencing complicated grief.

    - Dr. Timothy J. Legg

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