Classifying Grief as a Form of Depression

Whether bereavement should be considered a type of depression is at the heart of a medical controversy. The dispute springs from the potential classification of grief as a form of depression by psychiatrists updating the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the guiding force in diagnosing mental illness. The D.S.M. is undergoing its first update since 1993 and is expected to be completed by end of 2012.

Under current D.S.M. guidelines, bereavement is excluded from depressive disorders. However, with eight to ten million people losing a loved one each year, the potential reclassification of bereavement as a form of depression represents a major shift in dealing with grief,  says T. Byram Karasu, M.D., professor and chair, psychiatry and behavioral sciences at Einstein and psychiatrist-in-chief at Montefiore Medical Center.

The main concern, according to Dr. Karasu, who is widely quoted by media on mental health issues, is that the natural process of overcoming grief will be needlessly masked with antidepressants prescribed by psychiatrists and interns alike.

“Bereavement is a normal process. When the bereavement becomes pathological, that’s the time that depression is diagnosed and that person should be treated. It is not either/or,” he said. Dr. Karasu says signs the bereavement may be a sign of depression include sleep disturbances and weight changes.

Dr. Karasu understands the complex work involved in the classification process, having chaired the American Psychiatric Association’s working group on major depressive disorders in adults in 1993, when the last major revision of the D.S.M. guidelines took place.

What do you think? Should bereavement be considered a form of depression or is do you consider it a natural process that people need to experience so that they can prepare for their next phase of life?  Share your experiences and thoughts in the comments below.

email
The Doctor's Tablet Editors

The Doctor's Tablet Editors

The Doctor’s Tablet is co-edited by Paul Moniz and David Flores of Albert Einstein College of Medicine’s department of communications and public affairs.

More Posts - Website

Like what you’ve read? Subscribe to The Doctor’s Tablet!
  • Nora Miller January 27, 2012, 7:48 PM

    I have personal experience with both bereavement and depression, and I would adamantly contend that they differ in critical ways. Bereavement reflects the natural disturbance of brain pathways built over time by close contact with another human. When we love someone, we make numerous and extensive neuronal connections related to our experience of them, reinforced by hormones like oxytocin. When the person dies (or leaves), our automatic pathways lead us to miss that person in proportion to the intensity of the connection. This can result in psychological and even physical pain, which we confront at first continuously, and then periodically as the pathways rebuild to fit the new world order, minus our loved one. Many of us simply pick up the pieces and move on, sometimes without assistance, sometimes with the help of a counselor to keep things in perspective. Inevitably, for a small percentage of people, sadness and bereavement get out of hand, and those few qualify for a diagnosis of depression like anyone else who had trouble handing the ups and downs of their lives. But then the diagnosis is not bereavement but depression, as it always has been. To treat loss and its natural effects as pathological makes no sense, and could open up bereavement to a needless onslaught of pharmaceuticals to “fix” what we typically fix ourselves over time without medication.