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Intense Sadness Normal After Loss

Study Questions Criteria for Depression Diagnosis After Loss
By
WebMD Health News
Reviewed by Louise Chang, MD

April 6, 2007 -- After a major setback, such as divorce or job loss, intense sadness may be normal and not warrant a depression diagnosis, researchers report.

They include Jerome C. Wakefield, PhD, DSW, University Professor and professor of social work at New York University.

"Normal grief ... is a reaction to a lot more things than just the death of a loved one, and the diagnostic criteria [for depression] have never confronted that issue," Wakefield tells WebMD.

He explains that depression diagnosis is based on having a certain number of depression symptoms such as sadness, fatigue, sleep problems, lack of appetite, lack of pleasure in usual activities, and low self-esteem for at least two weeks.

An exception is made for people grieving a loved one's recent death. That exception should be broadened to include people recovering from other major losses, Wakefield's team argues.

Depression and Loss

Wakefield and colleagues studied data on more than 8,000 U.S. residents aged 15-54 who completed a national health survey between 1990 and 1992.

A total of 157 participants had depression symptoms triggered by bereavement. An additional 710 participants had depression symptoms triggered by other losses, which weren't detailed in the study.

Such losses "can throw us into as much doubt about the meaning of our lives, what we should be doing, and how we should go on, as the death of a loved one, sometimes," Wakefield says.

"The study suggests that indeed we have the same kinds of deep sadness responses to all these kinds of losses and they look normal," compared with people with an abnormal grieving, Wakefield says.

Normal Grief or Depression?

"Obviously, depression is a very serious and widespread problem," Wakefield says.

He notes that sometimes, normal sadness after loss can turn into clinical depression. "We need to pay attention to the context of our lives to tell the difference," he says.

"If you have any doubt, go see somebody and talk it over. Assess it with the professional and say, 'Does this seem like a clinical situation or I'm having a normal response?' That's the safest thing," Wakefield says.

"But for some individuals ... if they're not having particularly severe or dangerous symptoms such as suicidal thoughts or total lack of functioning ... it may be prudent to simply observe and wait and see if the symptoms start going away of their own accord," he says.

There's nothing wrong with seeking support after loss, Wakefield notes.

"Even people who are feeling like they are proportionally and reasonably responding to some horrible life losses may want to take medication or at least get some other kind of supportive treatment or psychotherapeutic treatment in order to help them deal with their feelings and suffer less and prevent it from developing, which it sometimes does, into a genuine clinical depression," Wakefield says.

He points out that there are many treatments for depression. The study doesn't make treatment recommendations.

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