Grief and Depression

Dear Dr. Neimeyer,

Following the death of my 22 year old daughter of a drug overdose two years ago, I of course have struggled with my grief, but also had two very distinct periods of depression, each approximately 6 months long, filled with classic symptoms of lack of energy to do anything, loss of interest in food, sex or social life, general self-neglect of my self care and appearance, and a sense of cutting off from my husband.  The symptoms seemed to come on suddenly, and then turn off just as suddenly.  For example, this last time they came on in the midst of an otherwise enjoyable vacation in the late summer, and persisted until the middle of last month, when they lifted in just a day or two.  Of course I am still very sad and miss my daughter, but more or less returned to full functioning.  In part this might be a result of my taking Prozac that my doctor starting prescribing to me three months ago.

What is even harder for me to understand is that this last time I seemed to pop up into what might almost be called a super-normal mood:  I have been filled with energy, have started a lot of new projects at home and at work, don’t need as much sleep (even compared to my life before my daughter’s death), have started to play a musical instrument and take lessons for the first time,and  am making more friends.  On the down side, I confess that I tend to get irritated at people who can’t seem to keep up with me, and my husband says I talk too much and too fast.  He thinks I seem manic.  I don’t have a history of bipolar disorder, but I guess I have always been kind of an “on or off” person, with not much in between.  Now, though, it seems more extreme.

So my question is, could this be a result of the grief, or what?  I’m kind of liking all the energy I have now–it sure beats the depression–but I don’t want to drive people away or burn myself out.

Sandy

Dear Sandy,

Your rich description of the months of darkness does indeed seem to point to a textbook case of depression, even if the clarity of the entrance into and exit from each of the two episodes is sharper for you than it would be for many people.  I also appreciate the way in which you yourself can distinguish between the grief over separation from your daughter and the symptoms of your mood disorder, which seems to have a seasonal affective disorder (SAD) quality in its onset and offset.  Because SAD can carry some important treatment implications, it is something worth evaluating with your physician as a factor that can further complicate your bereavement.

As to the mystery of your current “super-normal” mood, again the feelings and behaviors you describe do suggest a hypomanic upswing in mood rather than simply a return to your emotional baseline.  A serious loss like that of your daughter under tragic circumstances can indeed trigger both mood disorders (like a collapse into depression) and susceptibility to bipolar disorder if the mourner has a propensity for that (as your description of your usual “on-or-off” personality style might suggest).  Again, this is something that deserves closer consideration by your physician, and could be clarified by a family history (that is, a discussion of whether other blood relatives, and especially parents, grandparents or siblings, displayed signs of mania or bipolar disorder, whether or not this was diagnosed or treated).  However, another strong possibility is that the antidepressant medication you were given might require adjustment in type or dosage, or the addition of another medication such as Lithium or Lamictal to help stabilize your mood or reduce the risk of future episodes of cycling through extremes of high and low.  So a conservative recommendation would be to begin by consulting your physician about your current symptoms, and whether they could be linked to your medication regimen.

Finally, as important as medication may be in your case in treating your depression and moderating your current tendency to cycle too far in the opposite direction, remember that your own self-awareness and the observations and support of people who care about you also play a crucial role in restoring emotional balance in the aftermath of trauma and turbulence.  Having an open dialogue with your husband about your concerns and his, and perhaps even bringing him into consultations with your doctor, can add helpful perspectives on what you need, as well as de-mystify for your husband some of what you are going through.  Each of you has suffered a greater loss than any parent should have to bear, and experiencing greater tension or distance from one another can only compound this tragedy.

–Dr. Neimeyer