How Is Complicated Grief Different from Depression? Finding the Right Treatment Path

Distinguishing grief, complicated grief, and depression from one another is challenging. If you’re struggling with the loss of a loved one it can be hard to tell if your reaction is normal. People grieve in different ways, but there is a diagnosable and treatable condition known as complicated grief. Even more complicated is the fact that depression can overlap with healthy signs of grief. To get the right treatment for your needs, start with a differential diagnosis from a trained, experienced mental health professional.

Grief is different for everyone, but in general it should lessen with time. Some people feel better after a month, others after several months. If grief takes over your life for a year or more, you may have a mental health condition known as complicated grief. Your negative thoughts and symptoms may also indicate depression.

If you are struggling to overcome a major loss, if grief has overtaken your life and impaired your ability to function, you may have a diagnosable condition. Let an expert in mental health evaluate your symptoms and then set you on the path to a course of treatment that matches your needs.

What Does Grief Look Like?


Grieving is a normal and healthy process of coping with some type of loss, which could be a broken relationship, a death, or even the loss of a job. The emotional suffering that you feel at this time can be very painful, but it is natural and with time should lessen. Some things you may experience while grieving include:

  • Shock, denial, and disbelief
  • Anger
  • Sadness and hopelessness
  • Guilt and shame
  • Emptiness
  • Loss of interest in activities
  • Isolation
  • Crying
  • Emotional ups and downs
  • Physical symptoms, like nausea, fatigue, insomnia, and weight changes

Everyone has a unique experience—one grieving person may be angry and never cry, while another stays away from others and cries for hours. The time it takes for these feelings and symptoms to lessen also varies. However, you should start to feel some relief within months of a loss. The difficult feelings should become less intense, and you should be able to function normally, even while still grieving.

Signs That Grief Has Become Complicated


When normal grief does not subside, when the feelings don’t lose their sharp edge, or when grief actually intensifies months after a loss, you could be struggling with complicated grief. This is a diagnosable mental health condition that is characterized by extended grief, intense and persistent negative emotions, and an inability to adjust to a loss and return to a normal way of life. It’s typically diagnosed a year or more after a loss.

Symptoms of Depression

Many of the feelings of grief and complicated grief, and the resulting behaviors, are similar to those of depression. Major depression may be diagnosed if you have five or more of these symptoms:

  • A depressed mood
  • Loss of interest in activities
  • Changes in appetite or weight
  • Difficulty sleeping or oversleeping
  • Agitated or slowed movements
  • Fatigue
  • Feeling worthless
  • Difficulty thinking, concentrating, and making decisions
  • Thinking about death or suicide often=

To be diagnosed with depression, the five or more symptoms must include either a depressed mood or loss of interest, or both. And you must experience the symptoms persistently, most of the day, every day for two weeks or longer.

Distinguishing Grief, Complicated Grief, and Depression


Clearly, the signs, symptoms, and experiences of normal grieving are similar to those of complicated grief and major depression. It’s not unusual to struggle with a loss and wonder if you really have a deeper problem. Give your grief time, but do be aware that if symptoms get worse or don’t resolve after several months, or if you continue to be unable to function normally, you need to see a mental health professional.

The important distinguishing factors between grief and complicated grief include duration and intensity. Normal grief can be intense but should lessen with time. These negative feelings associated with grieving should not get worse. If they do, and if they prevent you from being able to function, you may have complicated grief. Duration is also important. Intense, negative emotions and thoughts that are debilitating for a year or longer is a sign of complicated grief.

Loss and grief can trigger depression. In fact, 20 percent of people grieving will ultimately develop major depression. You may be at a greater risk for depression after a loss if you have a poor support system, if you have had depression before, or if you misuse substances. While diagnosing someone with depression must be done by a professional, there are some important differences you can look for if you are grieving and worried about depression:

  • Grief causes emptiness and a sense of loss, but does not take away the ability to experience pleasure or happiness.
  • Grief with depression will cause a persistent low mood that makes it difficult to impossible to feel good about anything.
  • The sadness of grief comes and goes in waves, but over time decreases.
  • The sadness of depression is consistent.
  • When grieving, you may be preoccupied by thoughts of your loss, but depression will also cause you to focus on yourself and feeling guilty or worthless.
  • With depression, you will find it difficult to take comfort from loved ones.

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Getting the Right Treatment for Your Needs


Diagnosis is so important, because it leads directly to treatment. A differential diagnosis is the careful selection of one or more conditions as the most accurate diagnosis for a patient when there are overlapping symptoms. Your outcomes from treatment depend on this accuracy.

A study that investigated how to improve the treatment of depression found that one of the most important things clinicians can do is make an accurate differential diagnosis. According to the study, patients received more effective treatment and had better outcomes when healthcare workers considered a broad range of potential diagnoses, including depression, complicated grief, and other mental illnesses.

Insist on a thorough evaluation to get the best diagnosis. If you are not happy with the diagnosis you get, consider a second opinion. It is your right to see other doctors or to see other members of the same treatment team. Your first step in overcoming difficult symptoms and getting function back in your life is to find out if you have depression, complicated grief, or some other combination of mental illness.

Normal grief benefits from good support from loved ones but does not require professional treatment. Complicated grief and depression do require treatment, but strategies are not exactly the same. If you are diagnosed with complicated grief, residential treatment with therapy will be the main focus. Therapy will help you face your loss, process it, and learn to function and enjoy life again.

Depression can also be treated in a residential setting and benefits from therapy. But, while complicated grief can be resolved, depression is chronic. Residential care with therapy and medication, if appropriate, will prepare you for lifelong management of this mental illness.

Grief is a difficult time for anyone, but for some it gets worse. If you—or someone you care about—have been grieving for several months and you aren’t feeling any better, can’t function at home or at work, have lost interest in things you once enjoyed, feel consistently depressed, sad or guilty, or you just don’t feel right, reach out for help. You may have depression or complicated grief, and with an accurate diagnosis, treatment can help.

Bridges to Recovery offers comprehensive treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to lasting wellness.