Is It Depression or the Blues, Bereavement or Grief?

Reviewed May 8, 2015


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Questions to ask:

  • Is this a repeat?
  • What has happened?
  • What can you see besides sadness?

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Anyone can think of life events that would make you sad or mad, take away your energy, and even make you question the meaning of your life. We don’t want to call every passing low mood depression because we’d be making an illness out of what might be a normal way of feeling under bad conditions. Not every sad or mad feeling is depression that needs to be checked out by a doctor or therapist. So how can we tell the difference?

Here are some general questions to think about when you’re trying to decide:

Is this a repeat? Depression is a disease that may come back. Once you’ve had it and recovered, your chance of another depression is higher than for someone who never had it. If someone has had the disease of depression in the past, new changes in mood and actions sometimes mean that it has returned.

Next, think of the lyrics to one of Gershwin’s famous songs, “How long has this been going on?” That has to be one of the biggest questions to ask when trying to spot a serious depression. If you feel sad for a day or two or even a week before getting back into the swing of things, that is likely not the disease of depression so much as a reaction to life events. The disease of depression, with few exceptions, has to be there for a couple of weeks before we can be sure that the problem is more than normal sadness.

What has happened? We each react in our own ways to the things that happen in our lives. Disappointments make us sad or upset. When high hopes for the holidays are not met, for example, a person can have the “holiday blues.” When someone is going through very hard times, it is not surprising to see him weighed down by his pain and worries.

A special situation of loss happens when a loved one leaves or dies. This special type of sadness, called grief, can last for weeks or even months. Sometimes grief becomes depression over time. But unlike depressed people, those who are grieving feel their sadness in “waves” rather than nonstop low mood. Their sadness may get suddenly worse when reminded of their loss. They most often don't have thoughts about taking their own life or losing touch with reality. But sometimes grief can make a person think about dying to rejoin her lost loved one.

Grief is about losses, while depression goes much further than sadness over a loss. Losses or disappointments that are worse and more recent affect us more strongly. Even the most awful losses move each of us differently. We always have to keep in mind that depression may be a hidden partner in lowering a person’s mood or changing his actions. 

What can you see besides sadness? The disease of depression affects many parts of a person’s behavior, not just mood. Changes in sleep, interest, appetite, energy, concentration, feelings of guilt and the will to live, fit better with depression than with simple sadness. A person who feels low and can’t be cheered up even by happy events such as time with a friend may have the disease of depression. When a person talks about taking one's own life or wishing to be dead, or when she is hearing things such as voices that others don’t hear, this means the person is dealing with depression and not just the blues.

If you ask these questions, you can likely figure out whether a person’s unhappy mood is coming from the blues or is a real disease in need of treatment.




By James M. Ellison, M.D., M.P.H. ©2012-2017 Beacon Health Options Source: Schotte K, Cooper B. Subthreshold affective disorders: a useful concept in psychiatric epidemiology? Epidemiol Psichiatr Soc. 1999 Oct-Dec;8(4):255-61; Kacel E, Gao X, et al. Understanding bereavement: what every oncology practitioner should know. J Support Oncol. 2011 Sep-Oct;9(5):172-80; Lawrence J, Davidoff DA, Kennedy JS, et al. Diagnosing depression in later life. In Ellison JM, Kyomen HH, Verma S. Mood Disorders in Later Life. Second Edition. Informa Healthcare. Informa Healthcare, 2007. pp 1-14. Reviewed by Mario Testani, M.D., Physician Advisor, ValueOptions, Inc.

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