Distinguishing Bereavement from Major Depressive Episode

Normal bereavement begins within a few months of the loss of a loved one and is accompanied by symptoms similar to those of a Major Depressive Episode (tearfulness, feelings of sadness, insomnia, poor appetite, weight loss, difficulty concentrating, irritability).  Major Depressive Episodes may accompany or follow normal bereavement and can be identified by several key symptoms including:

1. Guilt about things other than actions taken/not taken by the survivor at the time of death
2. Suicideation or thoughts of death other than passive death wish (survivor feeling better off dead or survivor feeling that he/she should have died with the deceased)
3. Morbid preoccupation with worthlessness
4. Marked psychomotor retardation
5. Prolonged and marked functional impairment (no attempt to resume activities)
6. Hallucinations or delusions (as opposed to illusions)

Symptom-duration has often been used to distinguish normal and abnormal grief, but the duration of normal bereavement may vary widely between individuals and cultures.  The diagnosis of Major Depressive Episode or complicated grief is often withheld for symptoms whose duration is less than 2 to 12 months.  6 months is a safe cutoff for USMLE.

Dr. Sidney Zisook with Medscape provides a helpful video lecture reviewing grief, when treatment is warranted, and types of treatment available.

Grief — When to Treat It [Medscape]