Major depression and complicated grief
It’s common for people to have sadness, pain, anger, bouts of crying, and a depressed mood after a loved one dies. It’s important to know about normal grief responses so that you can know if the bereaved person might be getting worse—going into a major depression.
About 1 in 5 bereaved people will develop major depression (also called clinical depression). This can often be helped by therapy and medicines. People at highest risk for clinical depression include those who have been depressed before, those with no support system, those who have had problems with alcohol or drug abuse, or those who have other major life stresses.
Symptoms of major depression not explained by normal bereavement may include:
- Constant thoughts of being worthless or hopeless
- Ongoing thoughts of death or suicide (other than thoughts that they would be better off dead or should have died with their loved one)
- Being unable to perform day-to-day activities
- Intense guilt over things done or not done at the time of the loved one’s death
- Delusions (beliefs that are not true)
- Hallucinations (hearing voices or seeing things that are not there), except for “visions” in which the person briefly hears or sees the deceased
- Slower body responses and reactions
- Extreme weight loss
If symptoms like these last more than 2 months after the loss, the bereaved person is likely to benefit from professional help. If the person tries to hurt him- or herself, or has a plan to do so, they need help right away.
In some people, the grieving process can go on for a long time. This happens more often in those who were very close to the deceased. It’s most often caused by attempts to deny or get away from the pain or trying to avoid letting go.
If normal mourning does not occur, or if the mourning goes on for a long time without any progress, it’s called “complicated grief” or “unresolved grief.” Symptoms of this may include:
- Continued disbelief in the death of the loved one
- Being unable to accept the death
- Flashbacks, nightmares, or memories that keep intruding into thoughts over time
- Severe and prolonged grief symptoms such as anger, sadness, or depression
- Keeping a fantasy relationship with the deceased with the feeling that he or she is always present and watching
- Continuous yearning and searching for the deceased
- Unusual symptoms that seem unrelated to the death (physical symptoms, strange or abnormal behavior)
- Breaking off all social contacts
For some people who are taking care of a loved one with a long-term illness, complicated grief can actually start while their loved one is still alive. Caregivers under severe stress, especially if the caregiver’s outlook is bleak, may be at higher risk of having abnormal grief even before the death.
If you or anyone close to the deceased has any of the above symptoms of major depression or complicated grief, talk with a qualified health or mental health professional. Certain kinds of mental health treatment have been shown to help people with complicated grief. Treatment is important, since people with complicated grief are at risk of their emotional illness getting worse, and are at higher risk of committing suicide. Clinical trials are looking at what kinds of treatment are most helpful with complicated grief.
Last Medical Review: 12/14/2012
Last Revised: 02/04/2013