I Lost My Older Brother… Grieving and Depression

Dear Dr. Neimeyer,

I lost my older brother just a few weeks ago. I feel so sad and depressed. Plus I have major depression and an anxiety disorder, panic disorder too. Could losing my brother make me have lapse back into a deep depression again?

-Phoebe

Dear Phoebe,

The short answer to your question is “Yes, certainly.” Good evidence exists that people who have a history of anxiety disorder and panic–particularly linked to fears of abandonment–are more susceptible to complicated and prolonged grief, just as those with a vulnerability to depression are likely to have a further episode of depression triggered by bereavement.

But depression and grief, while they may co-occur, are not the same thing, and it is important to distinguish them, as each may carry implications for treatment. Although sadness is certainly a part of both , it is also a natural, non-pathological response to bereavement, and even an adaptive one, giving us a time to retreat from the world, signal to others our need for support, and reorganize life goals in light of the loss. When it merges into a prolonged, persistent and anguished preoccupation with the death or the deceased to a point that interferes with our functioning, that’s another matter. But even this form of life-vitiating grief is distinct from depression in many respects. Rarely in grief do we become morosely focused on our own worthlessness or low self-esteem, or struggle with frequent thoughts of suicide; at most we may wish that we were reunited in an afterlife with our loved one. Depression also tends to have a relentless and pervasive character, saturating every moment of life, whereas grief tends to come in waves, with periods of relative clarity, focus and even pleasure being interrupted, often unexpectedly, by significant resurgence of longing. Depression commonly undermines our ability to complete activities of daily living, such as routine household chores, meal preparation or self-care, to a far greater degree than does grief, which typically allows us to “go through the motions” even when we don’t feel like it.

As someone having long experience with depression, you know best how it intrudes into your life–and what medical, psychological and social strategies are most effective in helping you manage it. For example, if one of the telltale signs of depression for you is agitated and disrupted sleep, appetite disturbance or lack of energy, then medication could help restore each of these function. Likewise, “behavioral activation,” pushing yourself to move into the world and tackle manageable tasks step by step, can help structure your day and reinforce your self-esteem, while availing you of the social support of others. Challenging unrealistic negative thoughts or developing strategies to resist depression, almost as if it were an opponent, can also be helpful. But whatever your approach to self-management of your depression, your sense of empowerment will grow as you make progress, and as the depression retreats, those challenges that are unique to the grief (e.g., making sense of how or why your brother died, what his death means for your life now, or how to continue a constructive sense of connection to him) will become clearer. Sometimes the grief too can be complicated, but it is more easily addressed–even by grief therapists–when the fog of depression begins to lift, and the mourner is better able to confront its unique challenges.

–Dr. Neimeyer

One comment on “I Lost My Older Brother… Grieving and Depression

  1. Dr. Neimeyer,

    First I express my condolences to Phoebe for the loss of her brother: I am sorry he is no longer with you on this earth, Phoebe. I wonder if you might share with us a little about what kind of man he was and a story about your relationship. Talking about our loss helps so much even when we are sobbing through every description.

    While I still have my brother I have lost my sister. These siblings were our playmates in our childhood and it hits us in hidden places within our hearts. It’s like a huge part of our life seems done, seems over, when they die. We face our own mortality.

    Second I wish to say thank you to Dr. Neimeyer. You are such a fine and clear writer. I think your response is most helpful for the terrible suffering that grief is and depression is. Yes, we realize there is overlap and it can often be very complex, especially when circumstances of loss occur at the same time. For example, a friend and colleague of mine lost his job and his son in the same two week period. Incredible man, he decided to go back for a Masters in Counseling. His wife and his daughter are also in the field. I think doing something meaningful for another can help us guard against falling into that pit of despair and trying then to climb out of it. I’ve suffered in that darkness myself, my psyche scorched in childhood to be reignited again when my child died. So your encouraging advice about pushing back, staying engaged in our lives and challenging negative thoughts is beneficial and constructive. A healthy dose of self-care with extra rest is also vital.

    Well, we who stop by are never disappointed with Dr. Neimeyer’s tender healing words. Thank you for helping the grieving world hurt a little bit less.

    Kindly,
    Mary Jane Hurley Brant, M.S., CGP

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