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Grief and depression share some of the same features (low mood, sadness, and social withdrawal), making clinical depression sometimes difficult to diagnose in the context of bereavement.34While many believe that some form of depression is a normal consequence of bereavement, there are also clear differences between the two states.34,60
- Painful feelings come in waves, often intermixed with positive memories of the deceased (emotional ups and downs).
- Individual variability and fluctuation with progressive cognitive and behavioural adjustments until a satisfying life can be resumed (emotional downs become less frequent and less deep).
- Self-esteem is usually preserved.34,60
- Mood and ideation are almost constantly negative.
- Pervasive difficulty in experiencing positive feelings.
- Recognisable and stable cluster of debilitating symptoms.
- Feelings of worthlessness and self-loathing are common.34,60
Depression may be screened for using standard screening tests and diagnosed based on recognised criteria. Note that using standardised psychiatric measures has greater sensitivity in detecting depression than unassisted GP judgements.61
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has removed 'bereavement exclusion', which meant that depression could not be diagnosed within the first two months after the death of a loved one.40 This was done to prevent major depression from being overlooked and appropriately treated.60
The key to successful treatment is the recognition that bereavement related depression is similar to other types of major depression. Both drug (antidepressant) and non-drug therapies may be effective.60