Is It Grief or Depression? Thoughts on “A Glut of Antidepressants”

This week, The New York Times Health and Science section ran an article by Roni Caryn Rabin titled, “A Glut of Antidepressants,” in which she explored the skyrocketing use of antidepressant medications in the United States. In the article, a study from the April issue of the Journal of Psychotherapy and Psychosomatics was cited showing that, “nearly two-thirds of a sample of more than 5,000 patients who had been given a diagnosis of depression within the previous 12 months did not meet the criteria for major depressive episode as described by the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (or D.S.M.).”

Even more disturbing was what followed that initial finding. The article went on to read, “Elderly patients were most likely to be misdiagnosed, the latest study found. Six out of seven patients age 65 and older who had been given a diagnosis of depression did not fit the criteria. More educated patients… were less likely to receive an inaccurate diagnosis.”

As people age, it is natural to observe some signs of emotional change. There are many stressful situations that arise as life marches on that can trigger feelings of grief or depression. From chronic illness to loneliness, fear of death or the death of a loved one or peer, seniors are more prone to deep feelings of sadness than the rest of the population.

It is also important to recognize the difference between grief and depression, and know when it is time to reach out for help. In Rabin’s article, she cites the loss of a family member or loved one as one of the most common situations in which antidepressants are prescribed incorrectly. While there are many life events that can certainly trigger major depression, bereavement is the only one excluded from the diagnosis because grief is considered a natural process. Here are a few key differentiators between grief and major depression as defined by D.S.M.:

– In grief, painful feelings come in waves, often intermixed with positive memories. In depression, mood and ideation are almost constantly negative.

– Self-esteem is usual preserved in grief. Corrosive feelings of worthlessness are common in depression.

If you notice yourself or your loved one experiencing symptoms of grief, start by connecting with others. Whether it be a friend, support group or caretaker, many times these support systems are critical for overcoming these feelings. If you are concerned that a major depressive episode is beginning to take shape, be sure to seek an accurate diagnosis. Visit a mental health professional, ask questions, and see if you can find a solution that doesn’t involve medication unless absolutely necessary.