Grief or depression? How to tell the difference and when to seek help

The NHS says it can be difficult to distinguish between grief and depression because they share many of the same characteristics. Both can bring sadness, tiredness, difficulty concentrating, changes in sleep and appetite and withdrawal from other people. Cruse Bereavement Support makes the point that feelings of sadness and hopelessness are really common after someone dies and that, in everyday life, these feelings are often referred to as depression.

Cruse also stresses that these terms are labels, and that there is no easy way of fitting complicated human feelings into neat categories. Clinical depression is the name for when deep sadness persists over weeks or months, it says, and it is possible to be depressed while grieving.

Because of the overlap, the question is rarely a simple either-or. It is more useful to ask what the experience is like, how it is changing and how much it is stopping you from living your life.

The NHS says grief is an entirely natural response to a loss, whereas depression is an illness. It describes grief as including shock and numbness, overwhelming sadness with lots of crying, tiredness or exhaustion, anger and guilt, and says these feelings may not be there all the time and powerful feelings may appear unexpectedly. It notes that your grief may feel chaotic and out of control but that the feelings will eventually become less intense over time.

In depression, by contrast, the NHS describes low mood, hopelessness and loss of interest that persist for weeks or months and are bad enough to interfere with work, social life and family life. The table summarises points the NHS makes.

The NHS advises seeing a GP if you are struggling to cope with stress, anxiety or low mood, if you have had a low mood for more than 2 weeks, or if things you are trying yourself are not helping. Cruse says that if you notice grief is affecting large parts of your life, for example you cannot get to work or cannot get out of bed, it might be time to reach out for help.

Thoughts of suicide need to be taken seriously straight away. The NHS advises that anyone having them should ask someone for help, speak to a friend, family member or someone they trust, contact NHS 111, go to A&E or make an urgent GP appointment. Cruse notes that suicidal thoughts during grief are more common than people realise. If someone is in immediate danger, call 999.

For most people grief after a death becomes less intense over time. The NHS says that for some people it lasts many months or years, and this is known as prolonged grief disorder or complicated grief. Its symptoms include very difficult feelings such as sadness or guilt that do not get easier as the months go by, spending a lot of time thinking about the person who has died, difficulty accepting the death, not being able to return to everyday activities and suicidal thoughts.

Cruse describes it as intense, long-lasting symptoms of grief, together with ongoing problems coping with life, that go on for more than six months after someone dies, and notes that in the UK people are not usually given the terms as a diagnosis by a doctor. Both sources say it is more likely when the death was traumatic, sudden or unexpected. Cruse also lists risk factors including the relationship with the person who died, family conflict and the loss of a child.

Prolonged grief is not the same as depression, although the two can overlap, and the NHS says to see a GP if you have symptoms of prolonged grief disorder.

A GP will ask about your mood, how long it has lasted, sleep, appetite, energy, concentration, thoughts of harming yourself and how you are managing day to day. They will consider the recent loss and whether symptoms look like an expected grief reaction, depression, prolonged grief or a mixture. The NHS says that doctors describe depression as less severe or more severe depending on the symptoms, how long they last and their impact on daily life.

Questions are usually answered on a simple questionnaire to help gauge severity. If you have lost someone, tell the GP, since that context matters and you should not feel you are wasting their time.

For grief on its own, the NHS suggests talking about your feelings to a friend, family member, healthcare professional or counsellor, considering peer support, regular exercise, a healthy diet with regular meals, setting small achievable targets, and avoiding alcohol, cigarettes, gambling or drugs to relieve grief. Cruse offers bereavement support and information in the UK.

If depression develops, the NHS says treatment usually involves a combination of self-help, talking therapies and medicines. Mild depression may be managed with watchful waiting, guided self-help, exercise or a talking therapy, while moderate to severe depression may involve antidepressants, often with talking therapy. Interpersonal therapy is described by the NHS as focusing on relationship problems, including coping with bereavement, with typically 8 to 16 sessions. If you are 18 or over (or 16 or over in some areas) you can refer yourself to NHS talking therapies for anxiety and depression.

It is also acceptable to have support for grief and treatment for depression at the same time. They are not alternatives.

Cruse says that there are no set stages or time limits to grief, and that people can grow around grief rather than getting over it. The NHS notes that people often talk about stages of grief but may not experience all of them, in any order. Anniversaries, birthdays and seasons can bring a wave back, which does not mean you are going backwards.

Letting people know what you need, keeping small routines of sleep, meals and movement, and allowing yourself rest are protective. If friends or family are worried about you, take it seriously: they may notice changes before you do.