Delineating depression and grief: the key to treatment


According to a speaker at the Annual 2022 Psychiatric timeMT CME World Conference, being held in San Diego this week.

Dr. Katherine Shear, MD, who is a professor of psychiatry at the Columbia School of Social Work, discussed bereavement, grief and depression in a special report on MDD given during the meeting.

She noted that it’s important to note that “MDD and bereavement are not the same thing,” and that a thorough initial assessment and differential diagnosis are both essential to best treat your patients.

Shear provided a framework for rating the severity of grief to help distinguish grief from depression, noting that the Complicated Grief Inventory includes 19 items on a 5-point scale, which assesses emotional, cognitive, or behavioral symptoms. . A score above 30 is considered a “clinically significant” grief symptom. Similarly, the Occupational and Social Adjustment Scale details 5 items to help identify bereavement, and a score of 10 or greater can be considered clinically significant impairment due to bereavement.

Commonly reported grief-related symptoms include: longing for the deceased, disbelief, pangs of intense emotions, avoidance or reminders of loss, feeling confused, feeling disconnected, self-criticism and difficulty dealing with strong emotions, Shear explained. . Patients who report that they feel longing and are preoccupied with the loss, and who also report three or more of the mentioned grief symptoms for more than a year since the loss, may be experiencing a prolonged mourning.

“When these symptoms are persistent and they don’t come and go, and they stay in a way that interferes with their lives, that’s when we have protracted grief disorder,” Shear said.

There are key distinguishing factors between grief and depression, Shear said, noting that patients who experience grief often have happy, pleasant memories interspersed with emotional pain, loss of interest, guilt and self-esteem. -accusation related and centered on the desire of the deceased. . Similarly, in grieving patients, the suicidal tendency is linked to the desire for reunion and/or the refusal to live without the deceased. In contrast, in patients with depression, emotional pain is often pervasive, as is loss of interest and pleasure. to feelings of despair.

With these differences in mind, Shear noted, it is essential to tailor the therapeutic approach to each patient using evidence-based treatment.

“We have good treatments for extended therapy for grief disorders,” she said, with new treatments emerging frequently. Grief-specific cognitive behavioral therapy, interpersonal psychotherapy, and treatment of complicated grief are all options that have been explored by patients, many of whom have had good results.

Shear encouraged the psychiatric professionals present at the meeting to help the patient cope with the loss by helping them understand and accept their grief, manage their emotions, strengthen their relationships and connect with their memories. of the deceased, while seeing a bright future for themselves.

Addressing barriers, including disbelief, protest, counterfactual thinking, caregiver self-blame, and avoidance of situations that remind them of the deceased person, in addition to avoiding closeness with others, can all help the patient reach healing milestones.

Shear encouraged health care providers seeking more information about grief to visit

Learn more about Dr. Shear here.


Shear KM. Mourning and depression. Presented at: Annual 2022 Psychiatric timeMT CME World Conference. August 11-13, 2022. San Diego.

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