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Five stages of grief: stage four – depression

Five stages of grief diagram

After losing someone close to you, it is highly likely that you will experience grief. Much more than simple sadness or longing, grief can include a huge range of intense emotions as you begin to understand what the loss means to you.

In order to explain how grief can affect a person, Dr Elizabeth Kubler-Ross developed something known as the five stages of grief. These five stages are as follows:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

It must be noted that these stages are just a guide to the most common emotions of grief – they are not intended to be a set of ‘rules’ on how to grieve. Everyone experiences grief differently. You may not go through some of the stages, you might experience them in a different order, or go back and forth between stages. Don’t be alarmed if your personal experience differs from the five stages.

What is depression?

Depression is often thought of as the ‘low point’ of the five stages. This is when reality hits, when you start to really face the prospect of life without your loved one. That reality is painful and causes a deep, indescribable sadness. You may feel completely overwhelmed by a sense of hopelessness. Other symptoms may include:

  • Crying frequently and being unable to stop crying
  • Feeling tired and weak
  • Being uninterested in socialising, fun activities or day-to-day life
  • Feeling unable to do basic chores and tasks, such as cooking, cleaning or working
  • Loss of appetite

It is essential to note at this point that Kubler-Ross’s use of the word ‘depression’ should not be confused with major depression, also known as clinical depression. Clinical depression is a serious mental health problem that may require therapy and medication. It is not the same as depression during grief, which, although terrible, is to be expected and can be overcome with time.

Why does it happen?

The first three stages of grief – denial, anger and bargaining – are all, in some way, a result of your mind being unable or unwilling to accept your loved one is gone. Depression, to put it simply, is often a result of you beginning to realise that you will have to go on living without that special person in your life.

This means that depression is an important stage in the grieving process. It shows that you are beginning to understand what has happened. That said, however, it can be one of the most difficult stages to cope with, as it often comes with an overwhelming sadness or feeling of complete emptiness. Coping day-to-day with feelings of depression can be hard and can disrupt your work and home life.

Remember that these feelings of depression are natural. As you begin to properly process the fact that your loved one is gone, is perfectly reasonable to feel intense sadness and longing. These emotions are occurring because you have lost an important part of your life, and there is nothing wrong or shameful about that.

When is it a problem?

Depression after grief is incredibly tough to cope with, but most of the time these feelings are the natural result of losing someone. However, according to statistics from the American Cancer Society, around one in five bereaved people develop clinical depression after losing someone. As mentioned, clinical depression is different from grief-related depression and should be treated by a doctor.

It can be difficult to tell clinical depression apart from grief-related depression because many of the symptoms are the same, such as crying and intense feelings of sadness. However, you should speak to your doctor if you experience any of the following:

  • Constantly feeling sad, with no moments of peace or happiness, several months after the loss of your loved one
  • Constant feelings of hopelessness and worthlessness
  • Noticeably slow speech or body movements
  • Seeing or hearing things that aren’t really there
  • Being unable to perform basic tasks such as cooking, cleaning or going to work for several weeks or more
  • Loss of appetite or sudden weight loss
  • Having thoughts of suicide or obsessively thinking about death. If you are thinking about ending your life, call Samaritans on 116 123, or see your doctor immediately.

You will be most at risk from developing clinical depression after losing a loved one if you have previously had clinical depression, you have other major life changes happening at the moment, or problems with drug and alcohol abuse. A lack of support is also a contributing factor, so be sure to contact counselling and bereavement organisations if you need to.

If you do develop clinical depression, your doctor may decide to prescribe anti-depressants. These most commonly work by increasing serotonin levels, a chemical in your brain that results in a positive mood. You doctor may also recommend counselling or therapy to help you talk through the complicated emotions you are experiencing.

How do you move past it?

Although clinical depression may be treatable, grief-related depression cannot be ‘fixed’ and, unfortunately, must be experienced in order to move past it.

The best thing you can do to help yourself cope with depression is express how you are feeling. Don’t try to ignore it or put on a brave face all the time. Try talking to a trusted friend or a counsellor, or write a journal if you don’t feel comfortable talking to someone else. Numerous scientific studies have shown that talking about how you feel causes noticeable changes in brain activity and can reduce the intensity of that emotion.

Depression can make you feel sluggish and unable to do anything, but if you can, there are some practical ways to cope with grief to help yourself cope with these emotions. These include:

  • Taking care of yourself physically. Try to eat well and frequently, and keep to a regular sleep routine.
  • Do some light exercise. This can be difficult, as depression can make you feel tired, but even a brisk walk or some gardening will boost serotonin levels in your brain.
  • Avoid drinking alcohol. Alcohol is a depressant and, though it may feel like it numbs your pain in the short-term, you will end up feeling much worse.
  • Let yourself feel what you are feeling. Try to accept that you are going through a difficult experience. Ignoring your emotions will only delay having to deal with them.

Be aware that you may experience moments of feelings of depression many years after your loss. This could happen around significant dates such as birthdays, Christmas or other special occasions.

This is perfectly normal and you do not need to feel ashamed that your loss is still having an effect on you. If the feelings of depression are constant and all-consuming so that you never have moments of peace or happiness, you may need to see a doctor, but otherwise it is to be expected that intense sadness will resurface at times.

If you are struggling to cope with feelings of depression, there is help and advice available from specialist bereavement organisations.

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