Intense Sadness Normal After Loss

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.

Second Opinion

"I think it's an important study, probably more than anything else for
consciousness-raising," Dan Blazer, MD, PhD, tells WebMD.

Blazer is the J.P. Gibbons Professor of Psychiatry and Behavioral Science at
Duke University Medical School. He wasn't involved in Wakefield's study.

Blazer says the study "does help us back off from our tendency to want
to label people and then feel like a treatment necessarily follows the way we
label them."

"I think this article says one should be a little cautious in assuming
that a person meeting criteria for a diagnosis actually may be going through
something abnormal. Their response may be totally normal at the time,"
Blazer says.

"But on the other hand, whenever somebody is going through emotional
suffering, we have to be very careful and watch it. If its extreme, it needs
to be dealt with," Blazer says.

"People generally get better over time. If they do not get better,
that's a danger sign," he says.

Study's Limits

Participants were only studied once. "We don't know what happens to
these people over time; we're just getting a snapshot," Blazer says.

He also notes that no one older than 54 was included in the data and that
the survey only asked one question about bereavement.

Still, he calls the study a "good first step" and predicts that
several other studies will probe the topic in the next few years.

The data came from the early 1990s, but that shouldn't have affected the
results, notes Wakefield. He explains that the 1990-1992 survey was the most
recent study with the data needed.

"I think in this particular case, this is timeless," Blazer agrees.
"I do not think that the fact that these data were collected in the early
'90s in any way discredits them at all."

Road to Recovery

Grief's severity and length are important, Blazer notes.

"Is that loss so severe that you're thinking life is not worth living,
that you're thinking about harming yourself? That's not normal and that is
certainly something where an individual should be seeking help," Blazer
says.

The time frame for recovery is hard to pinpoint precisely. "For most
losses, you really would expect people to begin to show some recovery in one to
two months," and clearly be doing better after six months.

"But these are ballpark figures and there's a lot of variation around
it," Blazer says.

By Miranda Hitti
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved