Grief vs. Depression: Where to Draw the Line
Depression is often triggered by a negative event, such as divorce, illness, or the loss of a loved one. Grief and depression present very similar symptoms: dysphoric mood, feelings of guilt, cognitive slowness, fatigue, appetite changes, and recurrent thoughts of death. Whether a grieving person should be diagnosed with Major Depressive Disorder (MDD) is a matter of significant controversy among healthcare professionals.
In previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), clinicians were advised to wait two months before diagnosing those who had just lost a loved one with MDD. This bereavement exclusion criterion was removed in the latest edition of the DSM and replaced with diagnostic criteria to help clinicians differentiate between normal grief and MDD. Mental health professionals that support the bereavement exclusion argue that grief is a natural part of life and that the diagnosis and treatment of MDD is unnecessary and harmful in some cases. Those that support the removal of the bereavement exclusion maintain that early diagnosis and treatment will reduce suffering and the risk of suicide. It is also an arbitrary time frame and implies that other kinds of losses aren’t as significant or likely to lead to depression, which is not true. Both sides of the argument offer valid points, but epidemiological data supports the removal of the bereavement exclusion.
Bereavement Exclusion is a Valid Criterion
The removal of the bereavement exclusion may result in over-diagnosis of MDD and many mental health professionals fear the negative repercussions. According to Doctor Allen Frances, in a New York Times op-ed article, grief is a normal part of life....
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...prevent a suicide.
When weighing the risks of maintaining bereavement as an exclusionary criterion against the risks of removing the bereavement exclusion, it is clear that the danger involved in maintaining it is far more significant. The possibility of missing a diagnosis of depression and delaying necessary treatment for two months is a risk that should not be tolerated. The removal of the bereavement exclusion is an issue that many mental health professionals debated about before the publication of the DSM-5. Although the decision is still controversial, I believe that the DSM-5 task force made the right decision to remove it. Although I can understand some clinicians’ concerns about an increase in false positives, epidemiological data and logic do not support keeping recent bereavement as an exclusionary criterion for the diagnosis of depression.