When Does Grief Become Depression?

iVillage expert Gail Saltz, M.D., talks about the fine line between grief and depression and when it's time for professional help

Grief is a normal reaction to a significant loss. It can be the loss of an important person in your life, or even the loss something else important to you like your home or your health. Though it is painful, grieving is actually healthy -- you need to do it in order to accept the loss and move on with your life.

The length of time that people grieve varies, but most people have intense symptoms for about two months. Then they gradually subside for about a year (sometimes longer). In the beginning, grief looks a lot like clinical depression and the way you cope is generally the same: Talking to others about how you feel, having loved ones distract you at times, staying away from alcohol and drugs and taking care of yourself by getting enough sleep, eating well and exercising.

When Grief Gets Complicated

For some people, though, grief becomes so unbearably painful and debilitating -- or lasts for so long -- that they develop what we call complicated grief. Normal grief starts to fade and improve, while complicated grief stays the same several months or more, and can even get worse.

If you have complicated grief, you may be debilitated by sadness and unable to move on with life. The intensity of longing is so overwhelming or becomes so pervasive that it can become difficult to function in all areas of your life. You may withdraw from others, feel that life isn’t worth living or remain profoundly sad, bitter or angry. Sometimes complicated grief causes a person to feel guilty, as though he or she is to blame for the loss.

While we don’t know why some people develop complicated grief, we do know that some situations can up the risk, like an unexpected loss, a lack of social support, a history of childhood trauma or separation anxiety, a dependence on the lost person, a general inability to adapt to life changes or if the loss was a suicide.

How to treat it

Complicated grief needs treatment. The goal is to be able to accept the loss, adjust to the new situation and become involved in new relationships. Depending on your specific symptoms -- the inability to function, intense sadness that does not improve, suicidal thoughts -- different kinds of treatments can be useful. Psychotherapy can help with processing the loss, accepting it, building coping skills, moving forward in life and reaching out to others for comfort. Support groups based on similar losses may help by being with others who truly feel as you do. Widows often seek the support of other widows. Sometimes medications are prescribed for symptoms, such as antidepressants for mood.

In the meantime, if you are grieving, there are steps you can take to help yourself:

  • Exercise to help relieve depression
  • Get plenty of sleep
  • Avoid alcohol and drugs (some people can fall into substance abuse while struggling with grief)
  • Stay connected to family, friends and religious supports (that can make one of the biggest differences in the dealing with grief)

And remember that the first year after experiencing a loss is typically the most difficult, especially around holidays or other special occasions that reminds you of your loved one (or whatever you lost). Plan ahead for these events, so that you can acknowledge the loss in a way that feels comfortable to you and allows you to reach out for the support you may need.

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