BOSTON?It's normal for to the death of a close friend or family member to bring sadness, mood changes, or trouble sleeping and eating. For some people, though, grief and bereavement can evolve into clinical depression, according to Coping with Grief & Loss: A guide to healing, a newly updated report from Harvard Health Publications.

While most people pass through grief or bereavement without professional help, it's important to seek a helping hand if troubling or long-lasting symptoms of depression begin to interfere with daily life. Talk with your doctor or a mental health professional if you have suicidal thoughts or experience any of these other symptoms of bereavement-related depression:

  • persistent feelings of worthlessness, which is generally felt with depression but not with healthy grief
  • ongoing guilt
  • marked mental and physical sluggishness
  • persistent trouble functioning
  • hallucinations, other than occasionally thinking you hear or see the deceased.

Small studies suggest that psychotherapy, antidepressant medication, or both may ease symptoms of depression associated with grief.

Sometimes people feel so mired in grief that months or even years go by with little or no let-up. This may be a sign of complicated grief, a term mental health professionals use when grieving proves especially difficult. Complicated grief combines features of depression with those of post-traumatic stress disorder. Among adults who suffer a significant loss, about one in 11 experiences complicated grief. Symptoms include

  • intrusive, upsetting memories, thoughts, and images of the deceased
  • constant, painful yearning for the deceased
  • an inability to accept the reality of the death
  • frequent nightmares
  • detachment from others
  • desperate loneliness and helplessness, anger, and bitterness
  • thoughts of suicide and wanting to die.

Other reasons to seek professional help include drug abuse, increased use of tobacco or alcohol, gaining or losing a significant amount of weight, experiencing uncontrollable anxiety, and failing to feel somewhat better after a year has passed. Talk to your doctor or a mental health professional if you think you may have complicated grief or depression related to grief or bereavement.

This updated Special Health Report also covers these topics:

  • The health effects of grief
  • A guide to grieving at different stages in life
  • Practical coping strategies

Coping with Grief & Loss is available for $18 from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School. Order it online at www.health.harvard.edu/GLor by calling 877-649-9457 (toll-free).

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