Sadness, Grief or Depression: How to Tell What You Are Feeling

How is ordinary sadness different from depression?

Everyone feels sad or low sometimes, and these feelings usually pass. Feeling down in response to a disappointment, a loss or a hard week is part of being human, not a sign that something is wrong with you.

Depression is also called major depression or clinical depression, and it is a serious mental health disorder. It can cause severe symptoms that affect how a person feels, thinks and handles daily activities such as sleeping, eating or working.

What are the signs of depression?

Not everyone with depression has every symptom. Some people have only a few, and some have many. Common signs include:

• A persistent sad, anxious or empty mood
• Loss of interest or pleasure in hobbies and activities
• Feeling hopeless, guilty, worthless or helpless
• Irritability, frustration or restlessness
• Fatigue, low energy or feeling slowed down
• Trouble concentrating, remembering or making decisions
• Sleeping too little, waking too early or oversleeping
• Changes in appetite or unplanned weight changes
• Aches, headaches or digestive problems with no clear physical cause
• Thoughts of death or suicide

What does the two-week marker mean?

To be diagnosed with depression, a person must have symptoms most of the day, nearly every day, for at least 2 weeks, and one of them must be a depressed mood or a loss of interest or pleasure in most activities. A bad few days, even a very bad few days, is not the same pattern.

This is a guide for clinicians, not a rule that you must wait out. The National Institute of Mental Health notes that people with only a few symptoms may also benefit from treatment. Any thoughts of suicide need attention right away, no matter how long you have felt this way.

How is grief different from depression?

Grief is a normal reaction to a loss, and it can be mental, physical, social and emotional. It can bring anger, guilt, anxiety, sadness, sleep problems and changes in appetite. People who are grieving may call themselves depressed, and the two do share features, including intense sadness and pulling back from usual activities. The American Psychiatric Association describes some important differences:

Can grief and depression happen together?

Yes. When they occur together, grief is more severe and lasts longer than grief without depression. There is no set timetable for grieving, and how long it lasts can depend on how close you were to the person, whether the death was expected, and other factors.

Asking for help does not mean you are grieving the wrong way. Grief counseling or grief therapy helps some people, and an evaluation can show whether depression is part of what you are carrying. Any thought of ending your life deserves urgent attention, even during grief.

Are there different types of depression?

Yes. They differ in their pattern and in how long they last. Types include:

• Major depression: the pattern described above.
• Persistent depressive disorder: less severe symptoms that last much longer, usually for at least 2 years. Because it becomes part of daily life, some people assume they have always been this way.
• Seasonal affective disorder: symptoms that typically start in late fall and early winter and go away in spring and summer.
• Perinatal depression: depression during pregnancy or after childbirth, which is more than the baby blues.
• Bipolar disorder: depressive episodes along with manic or hypomanic episodes. Our guide on mood swings and bipolar disorder explains the difference.

When should I ask for help, and what can I do in the meantime?

Talk to a health care provider if symptoms persist or do not go away, or if they are getting in the way of work, school or the people you love. A primary care provider is a fine place to begin. Certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms, so a physical exam and lab tests may be part of ruling those out.

While you arrange care, the National Institute of Mental Health suggests small things that may help: trying to do things you used to enjoy even if you do not feel like it, keeping regular sleep and meal times, doing what you can as you can, talking to people you trust, avoiding alcohol and drugs, and delaying important life decisions until you feel better.

What does treatment look like here?

Depression treatment typically involves psychotherapy, medication, or both. Finding the right plan may take trial and error, and most people with depression benefit from treatment. At DanShalom Behavioral Clinic, Victor Onodjacha, MSN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner, starts with a psychiatric evaluation of about 60 minutes, in Sugar Land or by secure video if you are physically in Texas, Idaho, Arizona or Maryland. Follow-ups are about 30 minutes. See our page on depression treatment for more.

If medication is an option, we decide together after the evaluation. Not every medication can be prescribed at every kind of visit, some may need an in-person appointment, and we explain what applies to you. Read about medication management, and please talk with your prescriber before you start, stop or change anything.

DanShalom Behavioral Clinic is not an emergency service. If you or someone you love is in crisis or having thoughts of suicide, call or text 988 now, or call 911 in a life-threatening situation. Our crisis resources page lists more places to turn.