Symptoms of 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)
- 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 aren’t 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 might include:
- Continued disbelief in the death of the loved one, or emotional numbness over the loss
- Unable to accept the death
- Feeling preoccupied with the loved one or how they died
- Intense sorrow and emotional pain, sometimes including bitterness or anger
- Unable to enjoy good memories about the loved one
- Blaming oneself for the death
- Wishing to die to be with the loved one
- Excessively avoiding reminders of their loss
- Continuous yearning and longing for the deceased
- Feeling alone, detached from others, or distrustful of others since the death
- Trouble pursuing interests or planning for the future after the death of the loved one
- Feeling that life is meaningless or empty without the loved one
- Loss of identity or purpose in life, feeling like part of themselves died with the loved one
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 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.
Coping with loss
Ideally, a bereaved person will be able to work through the process of grieving. With time and support, they’ll accept and make sense of the loss, work through the pain, and adjust to a new life and identity.
If you or someone you know has lost a loved one, the following tips may help you cope with the loss:
- Let yourself feel the pain and all the other emotions, too. Don’t tell yourself how to feel or let others tell you how you should feel.
- Be patient with the process. Don’t pressure yourself with expectations. Accept that you need to experience your pain, your emotions, and your own way of healing − all in your own time. Don’t judge your emotions or compare yourself to others. Remember that no one else can tell you how you should mourn or when to stop.
- Acknowledge your feelings, even the ones you don’t like. Let yourself cry. You need to do both for healing.
- Get support. Talk about your loss, your memories, and your experience of the life and death of your loved one. Don’t think you are protecting your family and friends by not expressing your sadness. Ask others for what you need. Find and talk to others who have lost a loved one.
- Try to maintain your normal lifestyle. Don’t make any major life changes (for example, moving, changing jobs, changing important relationships) during the first year of bereavement. This will let you keep your roots and some sense of security.
- Take care of yourself. Eat well and exercise. Physical activity is a good way to release tension. Allow yourself physical pleasures that help you renew yourself, like hot baths, naps, and favorite foods.
- Avoid drinking too much alcohol or using other drugs. This can harm your body as well as dull your emotions. It’s also likely to slow your recovery and may cause new problems.
- Forgive yourself for all the things you did or didn’t say or do. Compassion and forgiveness for yourself and others is important in healing.
- Give yourself a break from grief. You must work through it, but you don’t need to focus on grief all the time. Find distractions like going to a movie, dinner, or a ball game; reading a good book; listening to music; or getting a massage or manicure.
- Prepare for holidays, birthdays, and anniversaries knowing that strong feelings may come back. Decide if you want to keep certain traditions or create new ones. Plan in advance how you want to spend your time and with whom. Do something to honor the memory of your loved one.
- Join a bereavement support group. Other people can encourage, guide, and comfort you. They can also offer practical advice and information, and help you feel less alone. If you can’t find a group near you, online groups may be helpful.
- When you feel ready, do something creative. Some options include:
- Write a letter to the person who died to say everything you wish you could say to them.
- Start keeping a journal.
- Make a scrapbook.
- Paint pictures.
- Plant flowers or trees.
- Involve yourself in a cause or activity that the deceased loved.
Family changes after a loss
When a loved one dies, it affects all their family members and loved ones. Each family finds its own ways of coping with death. A family’s attitudes and reactions are shaped by cultural and spiritual values as well as by the relationships among family members. It takes time for a bereaved family to regain its balance.
It’s important that each family member be able to grieve with one another to help the family cope. Each person will experience the loss differently and have different needs. As hard as it may be, it’s important for family members to be open and honest when talking with each other. This is not the time for family members to hide their emotions to try and protect one another.
The loss of one person in a family means that roles in the family will change. Family members will need to talk about the effects of this change and work out the shift in responsibilities. This time of change is stressful for everyone. This is a time to be even more gentle and patient with each other.
Losing a child
Facing the death of a child may be the hardest thing a parent ever has to do. People who have lost a child have stronger grief reactions. They often have more anger, guilt, physical symptoms, greater depression, and a loss of meaning and purpose in life. A loss is tragic at any age, but the sense of unfairness of a life unfulfilled magnifies the anger and rage parents feel.
A longer and slower bereavement and recovery should be expected when someone loses a child. The grief may get worse with time as the parents see others going through the milestones they expected to pass with their child.
Bereaved parents especially may be helped by a grief support group. These groups may be available in the local community. You can ask your child’s cancer care team for referral to counseling or local groups.
Getting professional help
Bereavement counseling is a special type of professional help. You may be able to find it through hospice services or a referral from a health care provider. This type of counseling has been shown to reduce the level of distress that mourners go through after the death of their loved one. It can help them move through the phases of grief. Bereavement counseling can also help them adjust to their new lives without the deceased.
Helping someone who is grieving
It’s common to feel awkward when trying to comfort someone who is grieving. Many people don’t know what to say or do. Use the following tips as a guide.
What to say
- Acknowledge the situation. Example: “I heard that your_____ died.” Use the word “died.” This shows that you are more open to talk about how the person really feels.
- Express your concern. Example: “I’m sorry to hear that this happened to you.”
- Be genuine and don’t hide your feelings. Example: “I’m not sure what to say, but I want you to know I care.”
- Offer your support. Example: “Tell me what I can do for you.”
- Ask how the bereaved person feels and listen to the answer. Don’t assume you know how they will feel on any given day.
What to do
- Be there. Even if you don’t know what to say, just having someone near can be very comforting.
- Listen and give support. But don’t try to force someone if they’re not ready to talk.
- Be a good listener. Accept whatever feelings the person expresses. Even if you can’t imagine feeling like they do, never tell them how they should or shouldn’t feel.
- Give reassurance without minimizing the loss. Try to have empathy with the person without assuming you know how they feel.
- Offer to help with errands, shopping, housework, cooking, driving, or yard work. Sometimes people want help and sometimes they don’t. They may not take you up on your offer, so remember they’re not rejecting you or your friendship.
- Avoid telling the person “You’re so strong.” This puts pressure on the person to hold in feelings and keep acting “strong.”
- Continue to offer support even after the first shock wears off. Recovery takes a long time.
- It may help to check in with the bereaved on anniversaries of the death, marriage, and birthday of the deceased, since those can be especially difficult.
If the grieving person begins to abuse alcohol or drugs, neglects personal hygiene, develops physical problems, or talks about suicide, it may be a sign of complicated grief or depression. Talk to them about getting professional help.
If you believe someone is thinking about suicide, don’t leave them alone. Try to get the person to get help from their doctor or the nearest hospital emergency room right away. If that’s not possible, call 911. If you can safely do so, remove firearms and other tools for suicide.
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Boelen PA, van den Bout J. Complicated Grief, Depression, and Anxiety as Distinct Post loss Syndromes: A Confirmatory Factor Analysis Study. Am J Psychiatry. 2005;162:2175-2177.
Mental Health America. Coping with Loss: Bereavement and Grief. Accessed at www.mentalhealthamerica.net/conditions/coping-loss-bereavement-and-grief on April 29, 2016.
National Institute of Mental Health. Suicide in the America: Frequently Asked Questions (2015). Accessed at www.nimh.nih.gov/health/publications/suicide-in-america/index.shtml on April 20, 2016.
Tomarken A, Holland J, Schachter S, et al. Factors of complicated grief pre-death in caregivers of cancer patients. Psychooncology. 2008;17:105-111.
Wagner B, Knaevelsrud C, Maercker A. Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Stud. 2006;30:429-453.
Last Medical Review: 04/22/2016
Last Revised: 06/06/2016