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Complicated Grief vs. Depression

Overview

Depression is a constant feeling of sadness which is believed to stem 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 major depressive disorder, 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 longer. 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.

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Complicated grief

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 is 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. One estimate states that 10 million people in the United States likely have severe enough symptoms to be thought of as having CG.

Depression

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, known in the medical community as major depressive disorder with psychotic features. This can cause hallucinations. 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.

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Causes

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

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 the 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
  • physical aches that don’t go away with treatment
  • suicidal thoughts or suicide attempts

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

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

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Risk factors

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, and depending on the circumstances, may result in another condition known as post-traumatic stress disorder (PTSD).

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 with your lost loved one can also cause you distress that complicates your grief.

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Effects on your brain

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 extreme yearning, worsening the addictive behaviors that can happen if you experience this condition.

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Treatments

Treatment options and coping

Your doctor may recommend therapy to treat your CG. Complicated grief therapy (CGT) involves techniques such as 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 undergoing therapy. Depression symptoms can result from CG and make your grief worse. CG can also worsen pre-existing depression. Antidepressants can help relieve the brain imbalances that cause depression and help you through your grief.

Takeaway

Talk with your doctor

If you’ve lost a loved one and can’t seem to get over it, you may be experiencing CG. Your first step should be to talk to your doctor. They can help determine if you have CG or depression, and what might be the best way to treat it.

Talk to your doctor about therapy and antidepressants. Your doctor can help you decide if these treatments are the right choice for helping you confront and accept your loss.

  • 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
  • Complicated grief may occur in response to other meaningful situations that don’t involve death. These are sometimes referred to as “non-bereavement losses.” Some examples of these losses can include being separated from a loved one through a divorce, or a loss of a job, pet, or property. In your case, you describe a situation involving the loss of your brother as you knew him. In this case, the relationship that you once had with your brother, which included being able to go places or converse, has been lost. Therefore, yes, you may be experiencing complicated grief.

    - Timothy J. Legg, PhD, CRNP
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