I Lost My Older Brother… Grieving and Depression

Dear Dr. Neimeyer,

I lost my older brother just a few weeks ago. I feel so sad and depressed. Plus I have major depression and an anxiety disorder, panic disorder too. Could losing my brother make me have lapse back into a deep depression again?

-Phoebe

Dear Phoebe,

The short answer to your question is “Yes, certainly.” Good evidence exists that people who have a history of anxiety disorder and panic–particularly linked to fears of abandonment–are more susceptible to complicated and prolonged grief, just as those with a vulnerability to depression are likely to have a further episode of depression triggered by bereavement.

But depression and grief, while they may co-occur, are not the same thing, and it is important to distinguish them, as each may carry implications for treatment. Although sadness is certainly a part of both , it is also a natural, non-pathological response to bereavement, and even an adaptive one, giving us a time to retreat from the world, signal to others our need for support, and reorganize life goals in light of the loss. When it merges into a prolonged, persistent and anguished preoccupation with the death or the deceased to a point that interferes with our functioning, that’s another matter. But even this form of life-vitiating grief is distinct from depression in many respects. Rarely in grief do we become morosely focused on our own worthlessness or low self-esteem, or struggle with frequent thoughts of suicide; at most we may wish that we were reunited in an afterlife with our loved one. Depression also tends to have a relentless and pervasive character, saturating every moment of life, whereas grief tends to come in waves, with periods of relative clarity, focus and even pleasure being interrupted, often unexpectedly, by significant resurgence of longing. Depression commonly undermines our ability to complete activities of daily living, such as routine household chores, meal preparation or self-care, to a far greater degree than does grief, which typically allows us to “go through the motions” even when we don’t feel like it.

As someone having long experience with depression, you know best how it intrudes into your life–and what medical, psychological and social strategies are most effective in helping you manage it. For example, if one of the telltale signs of depression for you is agitated and disrupted sleep, appetite disturbance or lack of energy, then medication could help restore each of these function. Likewise, “behavioral activation,” pushing yourself to move into the world and tackle manageable tasks step by step, can help structure your day and reinforce your self-esteem, while availing you of the social support of others. Challenging unrealistic negative thoughts or developing strategies to resist depression, almost as if it were an opponent, can also be helpful. But whatever your approach to self-management of your depression, your sense of empowerment will grow as you make progress, and as the depression retreats, those challenges that are unique to the grief (e.g., making sense of how or why your brother died, what his death means for your life now, or how to continue a constructive sense of connection to him) will become clearer. Sometimes the grief too can be complicated, but it is more easily addressed–even by grief therapists–when the fog of depression begins to lift, and the mourner is better able to confront its unique challenges.

–Dr. Neimeyer