DSM-5: Bereavement and Depression

by Victoria Brewster, MSW

Thanks to LinkedIn, I came across an article on Grief/Bereavement and Depression in the NY Times. As a professional with an MSW, this article causes me to pause and to express concern. Grief/Bereavement is normal after the death of a loved one. As one who works with older adults, I have experienced the reality for many older adults, after a certain age it is more likely, that one is faced with death on a regular basis.

Depression has been underdiagnosed in older adults. When one’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? The DSM-IV clearly distinguishes between normal and expected grief after loss from the more persistent and severe symptoms of clinical depression.

Grief usually runs its course within 2-6 months and typically does not require treatment with medications. Those suffering from grief report symptoms that are also symptoms of major depression; sadness, tearfulness, insomnia and decreased appetite. But, researchers have noted, grief rarely produces the symptoms of depression, such as low self-esteem or feelings of worthlessness.

“Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.” – Eric Widera, Geriatrician

The 5th edition of the DSM , which is due out this year, would characterize bereavement as a depressive disorder.

In removing the ‘bereavement exclusion’, the DSM-5 encourages clinicians to diagnose major depression in persons with normal symptoms of bereavement after only 2 weeks of mild depressive symptoms.

This gives me the feeling that depression may become overdiagnosed and anti-depressants overprescribed for what should be ‘normal’ grief. What are your thoughts on this?

*First posted at: http://www.socialjusticesolutions.org/2013/01/25/dsm-v-bereavement-and-depression/