The difference between complicated grief and depression

The difference between complicated grief and depression

Grief is perhaps one of the hardest things to endure in life.

Many people who have never experienced loss believe it to be a whole range of emotional and mental experiences- some of these beliefs are accurate. 

However, most of them are far from the day to day reality of what it’s like to endure the death of a loved one.

What is grief?

According to grief recovery experts John James and Russell Friedman, grief is the conflicting feelings caused by the end of, or change in, a familiar behaviour pattern.

When a loved one dies, it impacts the mental health of those who have been left behind to varying degrees.

Different types

Grief, as James and Friedman suggest, gets induced not only by the death of a loved one but also the ending of a specific behavioural pattern, which includes:

  • The loss of a job
  • The end of a marriage or long-term relationship
  • The end of a friendship
  • The loss of a dream, goal or aspiration
  • Going on vacation
  • Moving house
  • Becoming estranged by family members or loved ones
  • Death of a pet

Loss is different for everyone.

If there is any truth to the saying; ”no two hands are the same” then the same can get applied to grief. Crucially, since each relationship is unique, the grief response for every person will be outstanding also.

For example, siblings who have lost a parent are likely to be grieving very different versions of the person who died.

When loss gets complicated

The death of a loved one often changes the dynamics of a family forever. Depending on the individual circumstances – the death can also cause complicated grief reactions for some people.

Losing a loved one under any circumstance is a lifelong process of healing and adjustment – mental health conditions such as depressive disorder can result from unresolved grief.

Normal vs complicated bereavement

When complicated grief occurs – the person may experience a more profound albeit more complex loss than normal grief.

Emotional Symptoms

Since many of the aspects of grief remain unresolved, the person may experience adverse grief symptoms, all of which involve:

  • Developing issues with anger and an inability to control their rage
  • Unable to talk about the deceased or taking up avoidance behaviours
  • Enshrinement – this may include believing that the person who died is perfect and flawless in some way
  • Bitterness about the loss
  • Feeling detached and numb
  • Intense and persistent longing for the loved one who died
  • Feelings of deep sorrow, pain and rumination over the loss of your loved one
  • Excessively looking for ways to avoid any reminders of the lost loved one
  • Being unable to accept the loss and progress forward
  • Experiencing intense longing for the person who died
  • Suicidal thoughts

Physical symptoms

Whether someone experiences normal grief or complicated grief – the symptoms of grief can also manifest in the physical body -some of these symptoms include:

  • Tiredness and insomnia
  • Feeling higher levels of stress
  • Loss of appetite (or overeating)
  • Compromised immune function

Risk factors

People with complicated grief often have lost a loved one under sudden and tragic circumstances – although complicated reactions can also occur in people whose loved ones have been poorly with a severe or terminal illness.

The situations in which complicated grief usually occurs are often under the following circumstances:

  • Losing a loved one through suicide
  • Witnessing the physical and mental decline of a family member or loved one (such as dementia or severe illness)
  • Seeing the loss in real-time
  • Not being present when the loss occurred
  • People who have a background of substance abuse or mental health disorders
  • People who lose a loved one suddenly or unexpectedly

Further studies

Other studies show that when the healing process of normal grief is interfered with in any way – all this can cause symptoms of depression and complicated grief. 

The above is right for parents who have lost a child and a spouse who has lost their other half.

Other data shows that a complicated grief response is more prevalent in older people.

A study conducted in 2011, which involved approximately 5,741 people- showed that those who belonged to the older generation were more likely to experience complex grief reactions than those who belonged to different age groups.

Major depression

Grief and depression are two different conditions – for example, major depressive disorder (MDD) is a mental health condition that is not related to grief but often features similar symptoms.

At times, grief and depression get interpreted as being the same, but people must understand that both these conditions are entirely different, and so is the treatment.

A major depressive disorder is a mood disorder that gets often referred to as a clinical depression. Those with MDD may experience symptoms such as:

  • Changes in weight, sleep and appetite
  • Loss of interest in daily life and the hobbies and activities they once enjoyed
  • Thoughts of death and suicide
  • Depression
  • Feelings of guilt and worthlessness
  • Difficulty concentrating

Although grief and major depressive disorder are separate mental health issues- the Diagnostic Statistical Manual (the DSM – 5) recognizes that both the conditions can coexist.

Furthermore, grief can trigger a major depressive episode in a person, as can other stressful events.

Grief and depression

Since grief and depression share many symptoms, people must educate themselves about the key differences that are part and parcel of each of these experiences.

Getting a diagnosis for depression early, for instance, is imperative, and might even be lifesaving.

Grief is a normal response to loss as well as a lifelong process of adjustment and healing. Therapies such as bereavement counselling and psychotherapy are often beneficial and allow people to process their grief over time.


We have already established that the symptoms of depression and grief are similar, but let’s look at the differences in more detail.


Many people who have experienced grief will tell you that feelings tend to come in waves.

When someone grieves a deceased loved one – it causes intense sadness, anger, confusion, denial and a whole host of unpleasant feelings and emotions.

The feelings associated with complicated grief may subside only to return with full force.

There are also triggers, such as:

  • Birthdays
  • Death anniversaries
  • Places that a person may have visited with their deceased loved one
  • Specific smells such as a perfume and household detergents

Grief is an essential element of healing, and someone grieving mustn’t repress or bottle up their emotions in any way. 

Reaching out for support from a mental health professional allows people to make space for healing and complete their grief.

Major depression

Depression is a pervasive and persistent condition.

There are plenty of variants of depression such as atypical depression, which features similar symptoms to normal depression but can change according to the person’s mood and surroundings.

For example, atypical depression may induce an uplift in a mood if a person is at a party or other joyous event.

Major depressive disorder, on the other hand, is not usually dependent on a person’s surroundings or external environment.

While grief has a focus for sadness, major depressive disorder features markedly different symptoms such as:

  • Prolonged difficulty carrying out daily activities
  • Hallucinations and delusions
  • Being morbidly preoccupied with worthlessness
  • Feelings of guilt, which are not related to grief in any way
  • Confused speech, and sluggishness
  • Thoughts of suicide


Since complicated grief is a prevalent mental health issue, various treatments help people come to terms with their loss.

Various mental disorders can become part of a griever’s daily life (such as post-traumatic stress disorder), but this doesn’t have to be the case.

Despite how you may feel, it is possible to gain control over the symptoms of depression and grief.

The grieving process is not an easy one, but with the support of a trained professional – it is possible to live a full and happy life again.

For those who are bereaved – treatment usually involves:

  • Bereavement counselling
  • Traumatic grief counselling

Bereavement counselling is extremely useful in helping people come to terms with their loss – this may involve joining a bereavement support group, allowing people to recognize that they are not alone.

A psychodynamic therapist is also useful in helping people to identify their past losses, connecting those losses to their recent bereavement.

Trauma treatment, such as traumatic grief therapy- allows the individual to process any anxiety and maladaptive thoughts and emotions related to a loved ones’ death.

In this setting, a therapist may include specific interpersonal and behavioural treatment methods to help a person overcome their loss.

If you feel as though you may be experiencing any of the above symptoms of grief and depression, then perhaps it’s time to reach out to a mental health professional who can help.

Contact a Tikvah Lake recovery specialist today and find out how we can support you in the healing process.


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