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Q: Our father died a few months ago, leaving only my sister and me in our immediate family. My sister was very close to Dad and spent lots of time with him. I am concerned about her. How do I know the difference between grief and depression?

When people are coping with the death of someone significant in their lives, it can be difficult to know whether they are experiencing grief or depression. The Canadian Psychological Association describes the difference between the two:

“Grief is often described as a longing for the person, a lack of acceptance of the death, memories that just come out of nowhere at any time or place, a preoccupation with thinking about the person, tearfulness, and sensing the presence of the person. Depression is seen as a prolonged physical lethargy and fatigue, or emotional distress for reasons other than the death.”

To decide whether your sister is grieving or is depressed, first consider her general emotional state. Typically, people who are grieving have a range of moods and feelings. They may feel extreme sadness, yet they may also experience pleasure and maintain a sense of humour. They may also feel anger, directing it inwardly or at friends and family. People who are depressed usually have low moods, and their feelings don’t vary greatly. They tend to direct their anger mostly towards themselves, and they show little evidence of pleasure or a sense of humour.

It’s also important to consider how your sister is feeling about herself. Feelings of regret or guilt are commonly associated with loss. Grieving people tend to focus on the loss, experiencing it emotionally, socially and physically. This can disrupt family dynamics, relationships, roles and responsibilities, and finances. Depressed people tend to feel excessive guilt about things they should or shouldn’t have done. If your sister is depressed, the loss may confirm feelings of worthlessness.

When grieving, people often wish to be left alone, but they will respond to offers of support and interaction. When depressed, people may either be afraid of being alone or be unresponsive to others. Keep an eye on how much time your sister spends alone and whether she sees friends and family.

The characteristics of grief and depression do overlap, and sometimes there is no hard line between them. Symptoms such as sadness, difficulty in sleeping, poor appetite and weight loss are common to both. Grief, however, tends to be trigger-related. A grieving person may feel better in certain situations, such as when friends, family and others are around to support her. But triggers, such as the deceased loved one's birthday, may cause strong feelings to resurface. Major depression, on the other hand, tends to be all-encompassing. A depressed person rarely gets any relief of her symptoms and may show a noticeable change in daily functioning. She may struggle to get up and dressed in the morning, or be unable to concentrate or participate in activities she used to enjoy.

The Canadian Psychological Association lists the following indicators to help friends and family know when grief becomes a problem:

  • a lasting loss of interest in social interactions, activities and work;
  • furious hostility;
  • poor judgment;
  • agitated depressive symptoms (overactive behaviour combined with sadness);
  • continued bitter self accusation - “it’s my fault.”

Such indicators, particularly the persistence of these symptoms over time, may indicate that a person is experiencing complicated grief or clinical depression. The Mayo Clinic’s website provides good summary of complicated grief.

If you have concerns about your sister’s well-being, it’s important to involve a health care team. The team can determine whether she is clinically depressed, and help find the type of support and care she may need.

See also: Depression and Grief Work

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