Delineating Between Depression and Grief: Key to Treatment

Is it prolonged grief or MDD? Expert shares insights at premiere annual meeting.

CONFERENCE REPORTER

Delineating between major depressive disorder (MDD) and grief is essential to putting your patient on their path to healing, according to a speaker at the 2022 Annual Psychiatric TimesTM World CME Conference, being held in San Diego this week.

M. Katherine Shear, MD, who is professor of psychiatry with Columbia School of Social Work, discussed bereavement, grief, and depression in a special report on MDD held during the meeting.

She noted that it is important to note that “MDD and grief aren’t the same,” and that a thorough initial assessment and differential diagnosis are both essential to best treat your patients.

Shear provided a framework for assessing grief severity to help delineate grief from depression, noting that the Inventory of Complicated Grief includes 19 items within a 5-point scale, which assesses emotional, cognitive, or behavioral symptoms. A score of more than 30 is considered “clinically significant” grief symptoms. Similarly, the Work and Social Adjustment Scale details 5 items to help identify grief, and a score of 10 or more can be deemed clinically significant impairment due to grief.

Commonly reported symptoms related to grief include: yearning for the person who has died, disbelief, pangs of intense emotion, avoidance or reminders of the loss, sense of confusion, feeling disconnected, being self-critical, and difficulty managing strong emotions, Shear explained. Those patients who report that they are experiencing yearning/longing and are preoccupied with the loss, and also report at least three of the mentioned grief symptoms for more than a year since the loss occurred may be dealing with prolonged grief disorder.

“When these symptoms are persistent and they don’t come and go, and they stay in a way that’s interfering with their lives, that’s when we have prolonged grief disorder,” Shear said.

There are some key distinguishing factors between grief and depression, Shear said, noting that patients who are experiencing grief often have happy, pleasant memories intermixed with emotional pain, loss of interest, guilt, and self-blame related and centered on longing for the deceased. Similarly, in patients experiencing grief, suicidality is related to longing for reunion and or not wanting to live without the decesased. In contrast, in patients with depression, emotional pain is often pervasive, as is loss of interest and pleasure.Guilt and self-blame in patients with depression are often related to feelings of worthlessness or being a “bad person,” and suicidality is related to feelings of hopelessness.

With those differences in mind, Shear noted, it is key to tailor the therapeutic approach for each patient using evidence-informed treatment.

“We do have good treatments for prolonged grief disorder therapy,” she said, with new treatments frequently emerging. Grief specific cognitive-behavioral therapy, interpersonal psychotherapy and complicated grief treatment are all options that have been explored patients, many with strong results.

Shear encouraged the psychiatric professionals in attendance at the meeting to facilitate the patient’s adaptation to the loss by helping them understand and accept their grief, manage their emotions, strengthening their relationships, and connect with their memories of the person who died, while also seeing a promising future for themselves.

Addressing impediments, including disbelief, protest, counterfactual thinking, caregiver self- blame, and avoidance of situations that remind them about the person who passed, in addition to avoiding closeness to others, can all help the patient reach healing milestones.

Shear encouraged health care providers seeking more information on grief to visit https:prolongedgrief.columbia.edu.

Learn more from Dr Shear here.

Reference

Shear KM. Bereavement and depression. Presented at: 2022 Annual Psychiatric TimesTM World CME Conference. Aug. 11-13, 2022. San Diego.