Complicated Grief vs. Depression


To the untrained eye, complicated grief and depression may appear to have similar symptoms, but in reality, complicated grief and depression are slightly nuanced. Depression is a disorder, but complicated grief has also quickly become categorized in the same way. The major difference lies in the fact that depression cannot be caused by an emotional state, but rather a chemical influence in the brain, while complicated grief is typically sparked by a traumatic event, such as loss of a loved one. It is important to understand the difference between these two in order to ensure a person receives the proper care for what they are going through. Some shared symptoms of both complicated grief and depression include loss of appetite, trouble sleeping, crying, extreme feelings of sadness, and loss of interest in everyday activities.

What is Complicated Grief?

Complicated grief differs from depression in that complicated grief is specific and can be pinpointed to loss of a loved one. This severe form of grief is often characterized by a long period of sadness. Complicated grief used to be seen as, although a period of emotional turmoil, not worthy of medical attention. However, when grief becomes complicated and extends over a period of time, it can lead to suicidal thoughts and actions the same way depression does. This discovery led doctors to recently consider whether complicated grief should be classified as a disorder. Typical stages of recovering from a loss include acceptance that the loss is real, allowing oneself to properly feel the hurt and pain of the loss, adjustment to life without the lost individual, and the development of new and other relationships that do not try to replace the lost individual but encourage better quality of life. If a person cannot healthily move through these stages, it is likely they are suffering from complicated grief.  

It is important to note that complicated grief does not yet have any discovered biological causes. Environment, personality, and genetics may all play a factor into the degree to which a person feels complicated grief. Complicated grief has been found to activate the part of the brain associated with reward, the nucleus accumbens. This part of the brain longs for the loved one to return, but because they do not, that part of the brain is never fulfilled as the reward for the feelings is never received. This contributes to the explanation for why complicated grief occurs over an extended period of time, because the sensation of always chasing the reward can be compared with addiction. Complicated grief can also spark the amygdala, which is the part of the brain responsible for controlling the processing of emotions. Complicated grief can last a long time because blocking the amygdala allows an individual to avoid dealing with their grief and other emotions.

Symptoms of Complicated Grief?

Complicated grief can last for months or even years and is characterized by physical and emotional pain when a person thinks of their loved one. Additionally, a person may feel numb to emotions besides sadness, as well as a loss of purpose, a loss of trust, and an inability to embrace life. They may have trouble accepting that death is real (feelings of denial), as well as an obsession with the death of a loved one (consistently bringing up the death, extreme focus on reminders of the loved one and/or their death, etc.). If it has been months or even years since the death and a person still has trouble carrying out everyday routines, and a sense of guilt for the death like believing they could have prevented it, or wishing that they had died with the loved one, then these are serious signs of complicated grief. Complicated grief can actually coincide with depression and worsen symptoms of depression.

The symptoms of complicated grief often mimic depression.

What is Depression?

Depression is a mood disorder causing persistent sadness and loss of interest in everyday activities. Depression can be the result of a chemical imbalance. Depressed people often have significantly lower levels of serotonin in their brain, the “regulation” chemical that helps regulate bodily processes like sleep, hunger, and mood. Lower levels of serotonin have been linked to higher risk of suicidal thoughts and actions. Additionally, depression can come about as a result of other issues with the brain. For example, research has found that people suffering from depression often have a smaller hippocampus. The hippocampus regulates emotion, motivation, and learning, so that would explain why depressed individuals often feel listless.

Symptoms of Depression

Symptoms of depression include either insomnia or oversleeping, consistent sadness and anxiety, feelings of guilt, loss of interest in typically enjoyable activities, and suicidal thoughts or actions. Other depression symptoms are trouble with concentration, memory, or decision-making, and extreme feelings of pessimism and hopelessness. Depressed people are often irritable, and display extreme behaviors like sleeping too much or not at all, and overeating or not eating at all. There are also physical pains associated with depression, like persistent headaches and cramps, as well as digestive problems that cannot be fixed even with treatment.

There are also warning signs of suicidal thoughts and actions in a depressed person, which can also appear as side effects of complicated grief. These include a constant obsession with death (in complicated grief, it may still be the death of their loved one, or it can take other forms), as well as extreme mood swings from calmness to sadness, or a falsified happiness. Depressed people with suicidal tendencies may also engage in risky behaviors that could lead to death, like mixing medications or recklessness. One of the largest warning signs of both complicated grief and depression is making comments about how hopeless and worthless life is.

What makes Complicated Grief different from Depression?

Complicated grief differs from depression in that people suffering from Major Depressive Disorder shy away from their support system, isolating themselves. They do not seek comfort from others. Those dealing with complicated grief still look to discuss their feelings, to talk about their loved one and their memories of their loved one, all the while recognizing that their grief is unshakable. For many people suffering with undiagnosed depression, an event that sparks complicated grief may evoke their depression and lead to a diagnosis. On the other side of the coin, past history of depression (even if it has previously been treated), or PTSD can also cause or worsen complicated grief. Additionally, with complicated grief it is clear a person is suffering from a specific traumatic event, like the death of a husband or wife. Depression may, to the untrained eye, seem to have no cause (“I thought he was so happy!”).

Complicated grief and depression also differ in that a person suffering from complicated grief may feel waves of happiness or normalcy when around certain support systems or in certain situations, and then triggering reminders of the loved ones can snap them back into bereavement. For depressed individuals, there is nothing that can change their feelings of extreme sadness, distantness, or hopelessness, and it does not come or go in waves, rather existing as a consistent flatness. People suffering from major depressive disorder can also display feelings of guilt, like those with complicated grief, but the feelings of guilt for a depressed person are not linked to a specific event. A person with complicated grief may feel guilty they did not die along with their loved one, but those with major depressive disorder might feel guilty all the time.

There are ways to treat depression and grief without the use of antidepressants.

How to Treat Complicated Grief and Depression

Therapy is most often recommended as a way to treat complicated grief. Complicated grief therapy often involves the retelling of the loved one’s death. Antidepressants may also be used to help treat complicated grief, if complicated grief has evoked symptoms of depression, thereby worsening grief, or helped a person suffering from complicated grief realize they also suffer from depression. There is also unfortunately no way to prevent complicated grief, just like there is no way to prevent depression. The best advice for catching complicated grief is to begin therapy soon after a loss, especially if a person has previously suffered from depression or symptoms of depression.

Antidepressants are also often recommended for those with complicated grief displaying symptoms of depression, or for people who have been diagnosed with major depressive disorder. Antidepressants also have physical risks such as insomnia, headaches, and joint and muscle pain. They also raise an individual’s risk for blood clotting. There have also been studies that cause researchers to fear that antidepressants raise a person’s tendencies for violent actions and suicidal thoughts and actions.

My Transformations recommends treating depression with TMS therapy, or Transcranial magnetic stimulation (TMS). TMS utilizes magnetic pulses, similar to an MRI, which can stimulate the parts of the brain that regulate mood. This groundbreaking technology has been found to lessen the symptoms of depression, especially those as related to the hippocampus malfunctioning. The magnetic pulses encourage the brain to form new, stronger, and different neural connections, thereby lessening depression symptoms.

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