What is the difference between grief and depression, and how can you tell which one you are facing after a loss? Read about prolonged grief and support.
Let us imagine a woman who lost her husband eight months ago. The prayers for the fortieth day have been recited, the fifty-second day has passed, and the visitors have long since gone home. The people around her have started saying, "Pull yourself together, life goes on." Yet she still cannot sleep at night, cannot bring herself to move her husband's slippers from beside the door, and bursts into tears several times a day. The question in her mind is this: "Is this still grief, or have I fallen into depression?" This question occurs to many people who have suffered a loss and to those close to them. The difference between grief and depression is not always easy to see, because both can involve deep sadness, sleeplessness, lack of motivation and withdrawal. In this article I look at the signs that set the two experiences apart, when grief can become stuck, and at what point getting support matters.
What Is Grief? A Natural Response to Loss
Grief is the natural and universal process we go through when we lose someone we love, or something that was very important to us. It is not an illness; it is the reflection of love and attachment in the face of loss. In grief, contradictory emotions such as sadness, longing, anger, guilt, bewilderment and, at times, even relief can exist side by side.
One of the defining features of grief is that it comes in waves. A person may be relatively calm one moment, and then a song, a smell, a dish or the handwriting of the person who has died can trigger an intense wave of pain. Over time these waves become less frequent and less intense; but they can grow stronger again, especially on anniversaries, religious holidays and special days.
Grief has no set timetable. Some people return to their daily lives within a few months, while for others the process lasts much longer. Whether the loss was sudden, how close the relationship was, the person's sources of support and their previous losses all affect how long it takes. For more information about the stages and natural course of grief, you can take a look at the article on the grieving process.
What Is the Difference Between Grief and Depression?
Grief and depression can look similar from the outside: in both, the person is sad, cries, may have disrupted sleep and appetite, and may withdraw from social life. But there are important differences in the inner world.
The focus of the pain
In grief, the person who has been lost is at the centre of the pain. The person misses them, thinks about memories connected with them, and laments, "If only we could have talked one more time." In depression, however, the pain is more widespread and vague; a general pessimism about oneself, life and the future dominates. The sadness is not about a particular person but has spread to everything.
The course of emotions
In grief, emotions fluctuate. Between moments of intense pain, the person may remember something and smile, share in a grandchild's joy, or find enjoyment, however briefly. In depression, the mood is more constant; a grey veil covers almost every moment, and positive moments become very rare.
How you see yourself
This is perhaps one of the most important differences. In grief, the person usually preserves their sense of self-worth. They may feel guilt, but this guilt mostly focuses on specific issues related to the person who has died: "If only I had taken him to the doctor sooner." In depression, by contrast, the person sees themselves in general as worthless, inadequate or a burden: "I'm of no use at all", "Everyone would be better off without me."
Thoughts of death
Someone who is grieving may sometimes think, "If only I had gone with them" or "I want to be reunited with them." These thoughts usually reflect a longing to be together again with the person who has died. In depression, thoughts of death arise more from the person feeling worthless, from a sense that living is unbearable, or from a belief that they are a burden to those around them. In both cases, thoughts of death must be taken seriously.
The relationship with memories
In grief, memories both hurt and console. The person looks at photographs, tells stories and wants to remember the person they have lost. In depression, the person often withdraws from memories just as they withdraw from everything else, and nothing consoles them.
Grief is love looking for somewhere to go; depression is very often a silence in which that love cannot reach even the person themselves.
Signs That Show the Difference Between Grief and Depression: A Brief Comparison
The summary below may help in telling the two experiences apart. However, this comparison is not a diagnostic tool; it simply offers a framework for awareness.
- In grief, pain comes in waves; in depression, the mood is persistently low.
- In grief, thoughts centre on the person who has died; in depression, the person thinks negatively about themselves and the future.
- In grief, a sense of self-worth is usually preserved; in depression, worthlessness and intense self-criticism are prominent.
- In grief, brief moments of enjoyment and humour are possible; in depression, the capacity for enjoyment generally decreases.
- In grief, memories can console; in depression, nothing consoles.
These two states are not mutually exclusive. A loss can trigger depression, particularly in people with a previous history of depression or who are under intense stress. In other words, a person may be grieving and experiencing depression at the same time. If you are curious about the general symptoms of depression, the article on symptoms of depression can guide you.
How can loved ones notice the difference?
If you are close to someone who is grieving, you can pay attention to certain clues in order to observe the difference between grief and depression. If the person can cry and also recount a memory with a smile when talking about the loved one they have lost, and if their face lights up, even briefly, while playing with a grandchild, this usually points to the natural course of grief. If, on the other hand, months have passed and the person hardly responds to anything, has stopped looking after themselves altogether, and says things like "I'm of no use, I'm just a burden to you", more care is needed. In such a situation, rather than pushing them with "Pull yourself together", it is more helpful to let them feel that you are by their side and to gently suggest that they talk to a specialist.
Prolonged Grief: When Does Grief Become Stuck?
In some people, rather than softening over time, grief becomes stuck where it is. In current diagnostic systems, this condition is defined as "prolonged grief disorder". The American Psychiatric Association's diagnostic manual includes the criterion that, for adults, at least twelve months must have passed since the loss. However, this diagnosis can only be made through an assessment by a specialist.
Features commonly seen in prolonged grief include:
- Intense longing for the person who has died lasting throughout the day, or being constantly preoccupied with thoughts about them
- Marked difficulty in accepting the death; the sense that "they'll walk through the door at any moment" persisting even as months pass
- Feeling as though a part of one's own identity has died too
- Intensely avoiding everything that is a reminder of the loss or, conversely, becoming excessively attached to the belongings and places of the person who has died
- Intense difficulty in rejoining life, making plans or forming new relationships
- A sense that life is meaningless, or of being emotionally numb
Sudden and unexpected deaths, losses following suicide, the loss of a child and losses suffered in collective disasters such as the 6 February 2023 earthquakes can lead grief to follow a more complicated course. If you are struggling to accept the reality of the loss, the article on being unable to accept a death may also help.
Grief in Turkey: Rituals, Expectations and Pressures
In Turkey, grief has a strong social dimension. Condolence visits, the sharing of halva, mevlit prayer gatherings, and the commemorations held on the fortieth and fifty-second days ensure that the bereaved person is not left alone. These rituals form a valuable support network and make the first weeks of grief bearable.
However, the end of these rituals can sometimes also send an invisible message that "time is up". Once the crowd has dispersed, the person may enter their hardest period alone. Remarks from those around them such as "That's enough now, pull yourself together", "Don't cry, you'll hurt the soul of the departed" or "A real man doesn't cry" can lead the grieving person to suppress their feelings and become isolated. Some people, on the other hand, fear being criticised for not grieving "enough"; laughing too soon, going back to work too early or no longer wearing black may be judged.
These pressures can disrupt the natural course of grief. In a person who cannot live through their emotions, grief may become more prone to turning into a depressive picture. That is why it is important to allow yourself to live your own grief according to your own needs, not according to other people's timetables.
How Can You Support Yourself After a Loss?
Make room for your emotions
Every emotion you feel in grief, including anger, guilt or relief, is an understandable response to loss. Rather than suppressing these emotions, give them time. Allow yourself, at a certain point in the day, to think about the person you have lost, to write them a letter or to look at their photographs.
Keep basic routines going
Basic needs such as meals, sleep and short walks can be neglected in the first months of grief. Yet when the body is neglected, the emotional burden becomes even heavier. Small, regular routines provide something to hold on to during a chaotic period.
Continue the bond in a different form
Grief is not about breaking the bond with the person who has died, but about transforming that bond into a new form. Cooking a dish they loved, doing a charitable deed in their name, visiting their grave or telling your children about them lets you feel that the love continues.
Prepare in advance for difficult days
Days such as religious holidays, birthdays and the anniversary of the death are predictable difficulties. Thinking in advance about how you want to spend these days, planning who you will be with and giving yourself space can lighten the burden of those days.
Talk and ask for support
Find a few people to whom you can talk about your loss and who will listen without judging you. Sometimes the grieving person hides their feelings so as not to upset those around them. Yet shared pain becomes easier to carry.
When Should You Seek Professional Support?
It is not essential to see a specialist in order to grieve; many people carry their grief with the help of their social support. However, it is important to talk to a mental health professional in the following situations:
- Despite months passing, the intensity of the pain is not decreasing at all, or is even increasing
- You cannot keep up with your daily responsibilities, your work or looking after yourself
- Intense feelings of worthlessness, hopelessness and guilt have taken over your life
- You are trying to suppress the pain with alcohol or other substances
- You are thinking of ending your life or harming yourself in order to be reunited with the person you have lost
These signs do not in themselves mean a diagnosis; however, they call for attention and support. If you are having thoughts of harming yourself or do not feel safe, please call 112 (emergency services) straight away.
How Are Grief and Depression Approached in Therapy?
In therapy, the first step is to understand whether the picture the person is experiencing is a natural grieving process, prolonged grief, depression, or a combination of these. This distinction determines which path will be followed. In natural grief, therapy accompanies the person so that they can live through their emotions in a safe setting and make sense of the loss.
If depression is to the fore, cognitive behavioural therapy methods are used: thoughts such as "My life is over", "I can't live without them" or "It's all my fault" are examined, and through behavioural activation, the person's gradual return to life is supported. In prolonged grief, work focuses on accepting the reality of the loss, slowly facing avoided memories and building a healthy inner bond with the person who has died. Where necessary, an assessment by a psychiatrist is also included in the process. You can find information about the work carried out in this area on the depression and mood page.
Frequently Asked Questions
How long does grief last, and when should it end?
There is no end date for grief that applies to everyone. For most people the intensity of the pain decreases over time, but the absence of the person who has died may be felt from time to time throughout life. What matters is not that the pain ends completely, but that the person is able to rejoin their life.
Is what I am going through in the first weeks after a loss depression?
In the first weeks, intense sadness, sleeplessness, loss of appetite and bouts of crying are natural responses to loss and do not in themselves mean depression. However, if even during this period there are intense feelings of worthlessness or thoughts of harming yourself, it is important to get support without waiting.
Is it wrong to laugh or have fun after a loss?
No. In grief, laughing, enjoying things and taking part in life between moments of pain is natural and part of healthy grieving. It does not mean that you have forgotten the person who has died or did not love them enough.
Can a loss from years ago lead to depression today?
Yes. Grief that was never fully lived through, or that was suppressed, can be revived years later by another loss, an anniversary or a difficult period of life. In situations like this, working through the old loss with a specialist can help you understand your present mood.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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