Depression vs. Complicated Grief

When the latest version of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-V)—the so-called "psychiatrist's bible"— is released in 2013, it will include a new disorder known as complicated grief.

Although complicated grief (CG) shares many symptoms with major depression, many researchers have concluded that there are significant differences between the two and note the two conditions often require different treatments. 

When Normal Grief Becomes Complicated

Grief is a normal part of bereavement. The death of a loved one—especially someone close to the bereaved such as a partner or spouse—is always difficult. Mourners typically experience acute grief for a period—usually around six months—after which time the pain of the loss begins to subside. Of course, feelings of sadness may never go away, but most of the time grief will run its course and will not require clinical treatment. 

Sometimes, however, the stress of a loss can be so severe that the symptoms become more, rather than less, intense over time. Complicated grief may not only erode the mental health of a person but her physical health as well. When does normal grief become CG? Typically it when there is:

  • an inability to accept the loss and adjust to life after a period of six months or more
  • denial, disbelief, bitterness, or anger about the loss
  • intense yearning for the deceased person
  • preoccupation with thoughts of the deceased person
  • avoidance of reminders of the loss such as shared activities
  • inability to function normally
  • physical symptoms similar to those of the illness or injury that caused the death of the loved one
  • alcohol and/or drug abuse
  • sleeping problems
  • suicidal ideation

Symptoms of Depression vs. Complicated Grief

Depression often involves a general, pervasive sadness and a lack of interest in formerly pleasurable activities. A depressed person will also usually obsess over past failures and/or misdeeds as well.

With complicated grief, on the other hand, a person's sadness is almost entirely focused on the deceased and usually involves preoccupation with that person. A mourner suffering from CG will often recall the deceased in an unrealistically positive way or idealize that person's work, hobbies, or accomplishments. However, one of the biggest obstacles to separating the disorders is that there is often an overlap. Studies estimate the overlap between complicated grief and depression at somewhere over 20 percent. Add post-traumatic stress disorder (PTSD) to the mix and it shoots up to 50 percent.

Risk Factors for Developing Complicated Grief

Any loss may trigger complicated grief, however the likelihood is increased if:

  • the death of a loved one was either unexpected, sudden, traumatic, violent, or random
  • the death was from a prolonged illness such as Alzheimer’s disease or cancer
  • the loss was of a child
  • the bereaved believed the death could have been prevented
  • the relationship with the deceased person was overly dependent, angry, or ambivalent
  • the bereaved was suffering from an illness that coincided with the death of the loved one
  • the mourner suffered more than one loss within a short period of time
  • the mourner lacks social support

How Complicated Grief Affects the Brain

A 2010 study from Johns Hopkins University found that sufferers of complicated grief, unlike those with depression, have increased activity in the nucleus accumbens—the part of the brain associated with emotional "rewards." The research suggests that CG is a form of "addiction to happy memories" about the deceased. That "addiction" may be an indication as to why antidepressants such as selective serotonin re-uptake inhibitors (SSRIs) only have mixed results when treating CG. While SSRIs affect the neurotransmitter serotonin, a different neurotransmitter—dopamine—acts on the nucleus accumbens.

Getting Past Complicated Grief

As with depression, individuals with complicated grief are at an increased risk for other health problems and suicide. Also, as with depression, sufferers of CG are unlikely to get better on their own.

According to a 2005 study published in the Journal of the American Medical Association, suffers of complicated grief responded extremely well to a type of psychotherapy specifically designed for the disorder. The strategies of the complicated-grief treatment dealt with "adaptive coping" techniques such as learning to adjust the loss, restoring one's own life, and looking toward the future. Participants developed future goals and then set about putting the goals into action. At the end of the study, 51 percent of patients had improved compared to only 28 percent of those who received only traditional interpersonal psychotherapy treatment. Other studies have found that those suffering from CG may benefit from forming new friendships and from bereavement support groups. Bereaved individuals may find such a support group by contacting a hospital, hospice or suicide prevention center as well as online.