Short answer: no.

George Engel, a famous psychiatrist said: "grief is not a disease but it can become one." The grieving process is universal, and normal for all who lose a loved one. It occurs in every culture and has been documented throughout history. Grieving can be painful, but that does not mean that grief is an illness like major depression.

We all get "the blues" or feel "down" occasionally but it passes in a day or so and doesn't interfere with our ability work or keep up our household chores. Even though many people say "I'm feeling depressed today", mental health professions call this "little d" depression. In contrast, "BIG D" depression or major depression, is a different animal. Major depression is a state of illness, in a similar way that pneumonia is a state of illness, and it can be every bit as serious, even fatal. Lasting two weeks or more, major depression includes persistent sadness or loss of pleasure accompanied by a distinct change in bodily functioning (insomnia, decreased appetite, weight loss, trouble concentrating, guilty feelings, poor motivation to do normal activities, and in the worst case, thoughts of death or suicide). It may have started out as a state of mind, but it can become an illness of the whole person; mind and body. An additional point for the elderly: aches or pains from arthritis for example, will be magnified in intensity during depression. The good news is that major depression is highly treatable. Modern antidepressant medications are safe, effective and have far fewer side effects than ever before.

Some of the signs of grieving can look similar to major depression. Grievers often feel sad, irritable, nervous, worried, angry, guilty, and they can have trouble sleeping and keeping up with work and their other usual activities. How can depression and grief be distinguished? Should they be handled differently?

The grieving process is the emotional digestion of the role or roles the deceased played in the life of the griever. Legacies, children, years of shared life experiences, and memories (good and bad) often need to be reviewed and re-filed in memory in a safe location that allows the griever to move on to a new life without the deceased. Even one's concept of identity can be shaken up by the death of someone important. In short, grieving is work. It requires energy, a safe place to express it and enough time to work it through.

The time course is important to note in distinguishing grief and depression. Grieving is most intense right after the death and over the ensuing weeks and months it lessens in intensity. The process of working through the loss takes time and it can be painful as well as joyful or anger provoking. During the grieving process it is common to neglect some duties, feel preoccupied, feel sad, and feel like searching for or hanging on to mementos or reminders of the deceased person. The work of grieving can go on for a lifetime but usually at far lower levels of intensity and it becomes more intermittent than constant over time.

Supportive friends or family can help the grieving process along by encouraging the grieving person to talk. Any of the above should be fair game for discussion. Most grievers don't know what to expect and have never felt like this before. For some, the comforting support of others who have experienced grief can be immensely helpful. Organizations like the Good Grief Center (412-224-4700) can provide a listening ear, validation, educational resources, and if necessary, referrals to other sources of help. Sometimes, professional help is indicated.

Now let's consider depression and grieving together. If you take a snapshot of a griever on any given day, they might appear to look depressed but this might just be their "grief work" going on. Can grief turn into major depression? You bet it can. This is what was meant when George Engle said "grief is not a disease but it can become one". Research has shown that up to 50% of grievers can enter a state of major depression at some point in their grieving. Those who endured prior episodes of major depression are at higher risk. Professional help should be obtained if a change from grief to major depression is suspected.

There are many helpful places to turn for help with grief and depression concerns. No one need suffer alone; no one need go without assistance or guidance.