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Depression and grief: understanding symptoms, differences, and treatment

  • Writer: Schoen Clinic UK
    Schoen Clinic UK
  • 18 hours ago
  • 6 min read

Losing someone or something important can shake the foundations of your life. Grief is a natural response to that loss, not an illness, but it can feel overwhelmingly like depression. For some people, grief and depression happen at the same time, making it hard to know what’s “normal” and when to seek help.


This article explains what we mean by depression and grief, how they overlap and differ, and what effective treatment and support can look like. It’s for anyone grieving themselves, or supporting a friend, partner or family member.


If you’re struggling with grief, low mood or thoughts of self-harm, you deserve support. This article is information only and not a diagnosis. If you’re worried about your safety, please seek urgent help via 999 or your local emergency services.


double exposure image of a man looking down while standing on train tracks, depression grief

What is depression?

Depression is more than feeling sad or “low” for a few days. Clinical depression is a recognised mental health condition, usually defined by:


  • Persistently low mood and/or loss of interest and pleasure in most activities

  • Lasting at least two weeks

  • Significant impact on day-to-day functioning (work, relationships, self-care).


People may also experience:

  • Changes in sleep (too much or too little)

  • Changes in appetite or weight

  • Fatigue and low energy

  • Poor concentration or indecisiveness

  • Feelings of worthlessness or excessive guilt

  • Thoughts that life is not worth living, or suicidal thoughts


UK guidelines (NICE NG222) describe a spectrum from less severe depression to more severe depression, and recommend different treatment options depending on severity and patient preference.


What is grief?

Grief is the emotional, physical and cognitive response to loss, most often the death of someone we love, but also relationship breakdown, serious illness, job loss or other major life changes.


Common experiences of grief include:

  • Intense sadness, yearning or longing for the person who has died

  • Waves of emotion that come and go (sometimes unexpectedly)

  • Crying, anger or irritability

  • Difficulty concentrating, forgetfulness, feeling in a “fog”

  • Physical sensations like tightness in the chest, stomach upset, fatigue or aches.


There is no “right” way to grieve. Reactions vary widely depending on personality, culture, relationship to the person who died, previous mental health and life circumstances. Many people find that over months, the raw pain becomes less constant, and they’re able to re-engage with life while still carrying feelings of loss and love.



Grief vs depression: how are they different?

Grief and depression share many features: sadness, crying, sleep problems, poor concentration, and low energy, which is why they are easy to confuse. But clinicians look for several key differences:


1. Focus of thoughts and feelings

  • In grief, thoughts are usually centred on the person who has died or what has been lost – memories, regrets, longing, and questions like “Why did this happen?”

  • In depression, thoughts are often more self-critical and pessimistic: “I’m worthless”, “Things will never get better”, “Everyone would be better off without me.”


2. Emotional pattern

  • Grief often comes in waves or “pangs” triggered by reminders (dates, photos, places). In between, people may still feel moments of relief, humour or even pleasure, especially when supported by others.

  • Depression tends to create a more persistent low mood and loss of interest, with fewer genuine breaks or positive experiences.


3. Self-esteem

  • In grief, self-esteem is usually preserved – you may feel sad, lonely or guilty about specific things, but you don’t necessarily feel fundamentally “worthless.”

  • In depression, feelings of worthlessness and excessive, global guilt are common and often central.


4. Suicidal thinking

  • Grieving people sometimes think “I wish I could be with them” without active plans to end their life.

  • Depression is more likely to involve active suicidal thoughts, plans or intentions, and may not be tied only to the person who died.


Importantly, grief and depression can co-exist. After a major loss, some people develop a full depressive episode alongside their grief. In that case, treating the depression can help them engage more fully in grief work and daily life.


Prolonged or complicated grief

For many people, grief gradually becomes less disabling over months. But a minority experience severe, persistent grief that doesn’t ease with time and significantly impairs their life.


This has been recognised in diagnostic manuals as Prolonged Grief Disorder (PGD). In the latest versions of ICD-11 and DSM-5-TR, PGD involves:

  • Intense, persistent yearning or preoccupation with the deceased

  • Lasting at least 6 months or 12 months after the loss

  • Significant impairment in social, occupational or other important areas of functioning.


People with prolonged or complicated grief may feel “stuck”, unable to imagine a future, or unable to engage in life without overwhelming guilt. It is more likely after sudden, traumatic or multiple losses, or where the relationship was very close or complicated.


When should you seek help?

Grief does not have a time limit, but it is reasonable to seek professional support if:

  • You are struggling to function at work, in education or at home

  • Your grief is not easing at all after many months, or feels like it’s getting worse

  • You avoid all reminders of the loss, or feel numb and disconnected from life

  • You’re using alcohol, drugs, gambling or other behaviours to cope and feel out of control

  • You have persistent feelings of worthlessness or hopelessness

  • You experience suicidal thoughts, plans or self-harm urges.


Seeking help is not a sign that you’re “grieving wrong” – it’s a way of looking after yourself in an extremely difficult time. Don't hesitate to reach out to the team at Schoen Clinic Chelsea if you are ready to seek support.



Evidence-based treatments for depression and grief

For depression

NICE guidelines for adults recommend a range of evidence-based treatments depending on severity and personal preference, including:


More complex or treatment-resistant depression may require specialist interventions delivered within multidisciplinary teams.


For grief and prolonged grief

Support for grief can include:

  • Bereavement counselling or grief-focused psychotherapy

  • CBT-based approaches adapted for grief

  • Meaning-centred therapies and narrative approaches

  • Group support and peer support, which many people find helpful for feeling less alone.


Research suggests that targeted, structured therapies designed specifically for prolonged grief can significantly reduce symptoms and improve functioning.


Where grief and depression overlap, clinicians will usually work out an integrated plan – for example, treating major depression alongside grief-focused work, or addressing PTSD symptoms if the loss was traumatic.


Self-help and coping strategies

While professional support can be vital, everyday strategies also make a difference:

  • Stay connected: keep in touch with people you trust, even if it’s just brief check-ins.

  • Maintain simple routines: regular meals, sleep and movement can provide a basic structure when everything else feels chaotic.

  • Express yourself: talking, journaling, creative activities or rituals (such as visiting a special place) can help process emotions.

  • Look after your body: gentle movement, balanced food and limiting alcohol or drugs can support both mood and physical health.

  • Take grief at your own pace: there is no timetable for clearing cupboards, returning to work or “moving on.”


If self-help isn’t enough or you feel stuck, that’s a sign to reach out – not a failure.


How Schoen Clinic Chelsea can support you

At Schoen Clinic Chelsea in London, our multidisciplinary team of psychiatrists, psychologists, psychotherapists and allied health professionals supports adults experiencing depression, complex grief and other mental health difficulties.


We can offer:

  • Comprehensive assessments to differentiate grief, depression and other conditions

  • Evidence-based psychological therapies adapted to your needs

  • Psychiatric input, including careful consideration of when medication may be helpful

  • Support for co-occurring issues such as anxiety, trauma or burnout

  • A compassionate, confidential space to talk about loss, meaning and rebuilding life.


If you are struggling with depression and grief and would like specialist private support, you can contact Schoen Clinic Chelsea to arrange an initial assessment or find out more about our outpatient services.


Support is also available via your GP and NHS mental health services if you prefer an NHS pathway.

You do not have to face grief or depression alone – help is available, and it is okay to ask for it.


Schoen Clinic Chelsea entrance

Written by the Schoen Clinic UK Editorial Team, drawing on expertise from our clinicians to provide accurate and up-to-date mental health information.


References


[1] NICE Clinical Knowledge Summary – Depression.https://cks.nice.org.uk/topics/depression/

[2] NICE Guideline NG222 – Depression in adults: treatment and management.https://www.nice.org.uk/guidance/ng222

[5] Zisook S, Shear K. Bereavement and depression – what psychiatrists need to know. Psychiatric Times / Dialogues Clin Neurosci. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691160/

[6] American Psychiatric Association – Major Depressive Disorder and the “Bereavement Exclusion” (DSM-5).https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Depression-Bereavement-Exclusion.pdf

[7] American Psychiatric Association – Prolonged Grief Disorder.https://www.psychiatry.org/patients-families/prolonged-grief-disorder

[8] Cruse Bereavement Support – Complicated and prolonged grief https://www.cruse.org.uk/understanding-grief/effects-of-grief/complicated-grief/

[10] Szuhany KL et al. Prolonged grief disorder: course, diagnosis, assessment and treatment. Focus (Am Psychiatr Publ), 2021.https://psychiatryonline.org/doi/full/10.1176/appi.focus.20200052

[11] NHS – Mental health services: how to get help.https://www.nhs.uk/nhs-services/mental-health-services/

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