When people deal with loss, I am often asked, what is the difference between sorrow and clinical depression?  The difference matters because it has implications for our emotional, spiritual and physical health.  Nearly 2.5 million Americans die each year. Many people are left behind grieving their losses.

How we grieve is important. The response to loss can either move us forward or keep us stuck and trigger mental health disorders. Grief can be a trigger for clinical depression, or if someone is experiencing depression, grief can exacerbate the disorder.

The boundary between sorrow and grief can be distinguished in several ways. Expressing grief or sorrow allows us to stay intimately connected with others, while depression tends to isolate us. With sorrow, we sense that someday the feelings will end as scripture reminds us, “Weeping may last for the night, but joy returns in the morning.” Depression has a different feel. It feels as if it will last forever.

With depression, we feel  low-self-esteem or worthlessness. In normal grief, self-esteem remains. Emotional pain is usually accompanied by positive emotions and fond recollections of the deceased; with clinical depression, you see misery and unhappiness.

Another important distinction highlighted by Dr. Kay R. Jamison in her book, Nothing Was the Same, is that the normally grieving person is “consolable” by friends, family. They allow others in and are helped by their presence.  The person with clinical depression is not helped by those around him or her and may fantasize being with the deceased to the point that this fantasy becomes persistent. In some cases, the person feels suicidal without the deceased. There is a severe feeling of hopelessness.

Furthermore, when a person can’t  carry out the activities of day to day living, they become stuck in the sadness and immobilized. While this is an initial grief reaction, it doesn’t linger for months on end like in the case of clinical depression.

Normal grief is triggered by situations like the anniversary of the person’s death, a birthday or special event like a wedding. Major depression is more constant and there is little relief  regardless of the day.

if you are unsure if you are clinically depression in the few weeks that follow a grief event, do what is called, “watchful waiting” to see how your grief progresses.  Certainly, any signs of suicidal thinking or behavior are of concern. But if your depression seems to improve as the days go by, it is probably normal grief.  If not, and your sense of grief lingers and feels like it won’t ever go away, clinical depression could be in play and you may need additional help.