At a Loss: Normal Mourning or Clinical Depression?
When Does Grief Become Something More?

By Daniel Vaillancourt - WebMD Health

Most people grieve when they lose a loved one, overcome their grief in due time, and carry on. But some instead lapse into a major clinical depression that, if left untreated, may last months or years.

In a study, published in the Journal of Clinical Psychiatry, researchers at the University of California, San Diego (UCSD) found that about 20% of bereaved people were at risk for falling into a major depression. The researchers also found that treating those men and women with an antidepressant relieved their symptoms.

"I don't think grief is a disease," says the study's lead author, Sidney Zisook, MD, professor of psychiatry at UCSD. "It's not a condition for which treatment, per se, is indicated -- and certainly not a condition for which medications are indicated."

But Zisook and other bereavement experts agree that some people -- perhaps those with personal or family histories of the disorder -- are more likely to develop clinical depression when in mourning. "You and I may in fact be walking around with that tendency," says Elliot Wineburg, MD, associate clinical professor of psychiatry at the Mount Sinai School of Medicine in New York City. "And we're pushed over the edge, so to say, by a real experience."

Bereaved or Depressed

Most mourners eventually recover on their own, so Zisook does not recommend doling out pills like candy. "People suffer. It feels terrible. It's very painful?and it does get better over time," he says. "But if you're one of the unlucky ones who develop a depression in the context of grief, that doesn't get better in and of itself over time for most people. Treatment can speed recovery considerably."

Bereavement and depression seem very much alike, so trying to figure exactly what effect a loved one's death has had on you can be complicated. "When you're bereaved, you cry, you feel sad and unhappy," says Zisook. "You feel irritable [and] angry. You may have trouble sleeping. You may have trouble eating. Those are all symptoms of depression."

A major difference is that in bereavement, these things come and go, and are usually triggered by discussions or reminders of the deceased. "In major depression, you have most of those symptoms clustered together and they are there most of the time for a minimum of 2 consecutive weeks."

Thoughts of suicide are a sure red flag. "But you don't have to be hanging on the ledge with your fingers slipping off the windowsill," warns Wineburg. "People confuse the extreme nature of suicide with what are called 'suicidal thoughts': In other words, 'Well, it would be just as well if I were taken away by a painless disease.' Or, 'I can see all the trouble I'm causing other people. It would be better that I wasn't here at all.'"

Wineburg adds: "It doesn't mean one goes around with that all day, but the occasional presence of such thoughts, which are not present in a non-depressed person, are important."

Depression Lasts

How much grief you have is often as meaningful as how bad it is. "The most acute phase of mourning -- the intense despair, sadness, and anxiety -- generally begins lessening within weeks for most people," says Zisook. "The average depression, untreated, will last 6-9 months, and then spontaneously resolve, although a good 20% of people will have a depression that will last for years."

"I think the general expectation in our profession is that somebody who has grief is going to be starting to get better within a month or 2," adds John M. Rathbun, MD, a grief specialist in Fort Wayne, Indiana. "If they're not getting better within a month or 2, then I think that deserves to be investigated."

Friends and family are the most likely to notice dangerous behavior and persuade the depressed person that something more serious than garden-variety grief is going on.

"People with depression are not good at getting help," says Rathbun. "They tend to sit at home and quietly sink into oblivion."

The right course of action for grief-related depression is different for each person.

"I think it's very important to emphasize the role of psychotherapy if a person truly seems to be having difficulty with the task of grieving," says Glenn O. Brynes, MD, psychiatrist in private practice in Baltimore, Maryland. "[If] the person is so overwhelmed by their own feelings that every time you try to talk about things they just burst into tears and can't get beyond that, it may be important to consider an antidepressant as part of the work."

Some may point to research suggesting that antidepressants actually increase suicidal impulses, but Zisook says he thinks doctors can prescribe with confidence. "The absolutely overwhelming consensus from the data is that suicide is associated with depression," he says. "One of the biggest risk factors for successful suicide is untreated depression, and the treatment of depression with medications including Prozac and Prozac-like drugs [Celexa, Paxil, and Zoloft] ? has a very positive effect in decreasing the likelihood of suicide."

 Source: http://www.my.webmd.com