After a death, many people ask some version of the same question: is this grief, or is something else going on? From the outside the two can look alike. Both can bring deep sadness, poor sleep, a lost appetite and little interest in things you used to enjoy.
This article explains how clinicians tell them apart, why both can be present at once, and what changed in the diagnostic manual in 2013. It cannot tell you which one you have. That takes a conversation with a clinician who can hear your whole story. If you are still working out what grief itself is like, start with what grief feels like.
Why are grief and depression so easy to confuse?
They share many of the same signs. The National Cancer Institute (NCI) lists sadness, despair, insomnia, loss of appetite, fatigue, guilt, loss of interest and a disorganized daily routine among the reactions people can have in ordinary grief. The National Institute on Aging adds problems with concentration and a hard time making decisions. Read as a list, that could describe a depressive episode.
The difference lies less in which symptoms appear than in their shape: how they come and go, what they attach to, and how you feel about yourself while they are happening.
What do clinicians look for?
DSM-5 is the manual American clinicians use to diagnose mental health conditions. The NCI summarizes four ways it separates grief from a major depressive episode, the clinical name for depression that meets full diagnostic criteria.
- Waves or a constant low. In grief, painful feelings come in waves, lessen in intensity and frequency over time, and are often mixed with positive memories of the person who died. In depression, mood and thinking are constantly negative.
- Emptiness or sustained depressed mood. In grief, the prevailing feeling is emptiness. In major depression, it is a long, sustained depressed mood and an inability to expect pleasure or happiness.
- Self-esteem. In grief, self-esteem is usually preserved. In major depression, feelings of worthlessness and self-loathing are common.
- Thoughts of death. Thoughts of suicide can occur in grief, and they are generally focused on the person who died, such as a wish to join them in death. In major depression, such thoughts are more likely to be directed at oneself only.
These are tendencies, and real people do not sort neatly into two columns. Any thought of suicide deserves attention, whatever lies behind it. If you are having thoughts of ending your life, call or text 988, or call 911 in an emergency.
Can you be grieving and depressed at the same time?
Yes. A 2014 commentary in the journal Innovations in Clinical Neuroscience put it plainly: bereavement does not "immunize" a person against a major depressive episode, and is in fact a common precipitant of clinical depression. Someone can be mourning a person they loved and also be depressed, and each deserves attention in its own right.
Grief can also become persistent in a way that is different from depression. Prolonged grief disorder is a separate diagnosis that centers on yearning for, and preoccupation with, the person who died. In the research that tested the current criteria, it was distinct from major depressive disorder. The two often occur together, though. A 2021 meta-analysis of 23 studies estimated that 63% of adults with prolonged grief symptoms also had symptoms of depression. The authors called their results preliminary because the included studies carried a high risk of bias. For how that diagnosis is defined, see prolonged grief disorder.
What changed in DSM-5 in 2013?
The previous edition of the manual advised clinicians to refrain from diagnosing major depression within the first 2 months after the death of a loved one. This was known as the bereavement exclusion. DSM-5, published in 2013, removed it. According to the NCI, the change recognized that in vulnerable individuals grief can precipitate major depression within a short time, and that this can be potentially lethal.
The change is often misread. It does not mean grief becomes depression after a set number of weeks, and it does not turn ordinary grief into a disorder. In the NCI's words, DSM-5 emphasizes that "although depression is a normal consequence of bereavement, major depression should not be diagnosed in the context of a normal grieving process." It also emphasizes that major depression can and should be diagnosed when symptoms and features of depression are present and clearly distinguishable from a normal grieving process.
Some critics worried that removing the exclusion could "medicalize" ordinary grief. The 2014 commentary notes that criticism. It also says that recognizing major depression in the context of recent bereavement takes careful clinical judgment, and by no means implies that antidepressant treatment is warranted.
Why does the difference matter?
Because the help that fits one may not fit the other. In a 2014 randomized trial of 151 adults aged 50 or older with complicated grief (the older research term for prolonged grief disorder), a therapy designed for grief was compared with interpersonal psychotherapy, an established treatment for depression. Both groups improved, but 70.5% responded to the grief therapy and 32.0% to the depression therapy. The authors concluded that health care providers need to distinguish complicated grief from depression.
Medication follows a similar pattern. The American Psychiatric Association says there are currently no medications to treat specific symptoms of grief. The NCI says antidepressants alone have a limited impact on grief intensity but are critical for reducing depressive symptoms. Whether medication makes sense for you is a decision to make with a prescriber. The different talking therapies are compared in types of grief therapy.
When is it worth getting assessed?
You do not have to know which it is before you ask. Going by the distinctions above, a clinician is likely to look more closely when low mood has become constant instead of arriving in waves, when a person feels worthless or full of self-loathing, or when they can no longer expect pleasure in anything. The National Institute on Aging offers a simpler guide: if sadness is making it difficult to carry on in your day-to-day life, help is available.
A licensed mental health clinician can assess what is happening and talk through options with you. Dr. Rabin works with people in grief and loss and with depression and mood difficulties, in person in Brookline and by secure telehealth across Massachusetts. She offers a free initial consultation of about 15 minutes by phone, which you can request through the contact page.
Keep reading
Sources
- National Cancer Institute, Grief, Bereavement, and Coping With Loss (PDQ), Health Professional Version (2024)
- National Cancer Institute, Grief, Bereavement, and Loss (PDQ), Patient Version (2025)
- Pies, The Bereavement Exclusion and DSM-5: An Update and Commentary, Innovations in Clinical Neuroscience (2014)
- Prigerson, Boelen, Xu, Smith and Maciejewski, Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale, World Psychiatry (2021)
- Komischke-Konnerup, Zachariae, Johannsen, Nielsen and O'Connor, Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis, Journal of Affective Disorders Reports (2021)
- Shear et al., Treatment of complicated grief in elderly persons: a randomized clinical trial, JAMA Psychiatry (2014)
- American Psychiatric Association, Prolonged Grief Disorder (2025)
- National Institute on Aging, Coping With Grief and Loss (2024)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.
