Grief or Depression? How to Tell When Grieving Goes Too Far. Part 3

by on Sep.09, 2011, under Grief & Coping

First, the experience of bereavement is not only virtually universal, but often repeated a number of times during the lifetime of an individual. There are not enough doctors, psychiatrists or psychotherapists to evaluate everyone undergoing a grief reaction as to whether or not this bereaved person has entered the realm of clinical depression.

Second, there remains a stigma attached to mere psychiatric evaluation, let alone treatment. People undergoing bereavement may feel rightly offended at the suggestion of seeing a psychiatrist.

Third, the mere absence of Major Depression will not always lead the psychiatrist to refrain from prescribing medications or the therapist from embarking on psychotherapy, even if there is no well-established need or effectiveness for these treatments in the specific situation.

Although this precaution may sound alarmingly libelous against my own profession, it need not represent mere quackery or self-interest on the part of unethical clinicians looking for more business. There are realms of reasonable disagreement, even among quite responsible clinicians and prominent researchers, as to the proper boundaries for the usefulness of psychiatric and psychological treatments outside the realm of “classical” diagnoses like Major Depression.

There is, for an example, a diagnostic entity called “Dysthymic Disorder,” a diagnosis which can be made on the basis of fewer, less constant, and/or less severe symptoms depression, persisting over a longer period of time-in this case, at least two years. Good, scientific evidence does exist for the usefulness of antidepressants and psychotherapy with this type of depression, sometimes labeled “minor.”

Another legitimate perspective holds that drugs such as antidepressants bear a relationship to depressed mood and associated symptoms of depression, which more closely resembles the relationship of aspirin to pain, than of penicillin to pneumonia. In other words, antidepressants may have beneficial effects regardless of the cause of depression, whether due to presumably hereditary biochemical abnormalities in the brain, to bereavement, or to physical factors, like viral illnesses or high blood pressure medication.

Similarly, aspirin may alleviate pain whether it is due to a stress-related tension headache, sunburn, a sprain, arthritis, or even a brain tumor!

Yet another viewpoint holds that many psychiatric symptoms, even in the absence of overt depression, represent disorders in some way biologically based in the similar disturbances of brain biochemistry as depression, and therefore respond to the same drugs. These might include eating disorders, such as bulimia, obsessive-compulsive disorder, or compulsive stealing (kleptomania), to mention just a few.

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