Intense Sadness Can Be Normal

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, Ph.D., D.S.W., 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.

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 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, M.D., Ph.D., 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."

Study's Limits

Participants were studied only 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."

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, M.D.
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