Depression or Bereavement?

Have you ever lost your loved ones? 

Are you still stuck in those memories? 

Are you confused about your condition that whether you're in Grief or in Depression?

This blog will help you out to know your mental status, let's dive in to the topic.. 

 

Bereavement is a state of grief related to Death of a loved ones.

 In DSM-5 Bereavement is not a mental disorder, however Uncomplicated bereavement is a condition that may be a focus of Clinical Attention. 

Clinical Presentations

Mild

1) Feeling of Sadness. 

2) Insomnia 

3) Diminished Appetite 

4) Weight loss

5) Aloofness 

6) Not indulged in even their favorite activities. 

 Moderate & Severe 

1) Intense Guilt related to issues beyond those surrounding the death of a loved ones. 

2) Thought about being dead inorder to be with the deceased person. 

3) Feeling Worthlessness. 

4) Marked Psychomotor Retardation 

5) Prolonged Severe functional Impairments 

6) Hallucinations other than the transient perceptions of the voice of the deceased Person. 

Course & Prognosis 

The course and prognosis depend on the Severity of Illness, Rapidity of Interventions and the degree of Response to the Interventions.

The Age of onset, Episode Severity and The presence of Co-morbidity also influence course and prognosis.

"The Younger the age of Onset, the higher the recurrence of multiple episodes."

 In general 90% recover from a first episode of Moderate to Major bereavement within 1 to 2 years.

The mean length of an Untreated episode of major Bereavement is 8 to 12 months.

The cumulative probability of recurrence is 20 to 60% within 2 years and 70% by 5 years. 

The Most significant risk for relapse is in the 6 months to 1 year after Discontinuing treatment.

Children in Grief who live in families with high levels of chronic conflicts are more likely to have Relapses. 

How to Diagnose??

Children's Depression Rating Scale-Revised (CDRS-R)  is a 17-item instruments administred by Clinicians separately to the Parents and Child or Adolscent. 

The Clinicians scores a rating for each item using the information from both the Parent and the Child. The scale assesses Affective, Somatic, Cognitive, and Psychomotor symptoms. A cumulative score of 40 is a marker for Moderate Depression and a score of 45 or higher for Significant depression. 

Evidence- based Treatment Studies

The adolescent who were drifted to depression from prolonged bereavement were chosen for the study.  The Treatment for Adolescents with Depression Study (TADS)  divided 439 Adolescents between 12 and 17 years of age into Three treatment group of 12 weeks. 

The first group composed of either Fluoxetine alone (10 to 40 mg/day).

The second group composed of Fluoxetine with same dose range in combination with CBT (Cognitive behavioral therapy).

The third group was on CBT alone.

Based on rating of the Children's Depression Rating Scale-Revised (CDRS-R), combination treatment had significantly superior response rates compared with either treatment alone. Based on CGI scores at 12 weeks, rates of much or very much improved were 71% for the combined treatment, 60.6% for the Fluoxetine group, 43.2% for the CBT alone group,  and 34.4% for the Placebo group. By the end of 9 months of treatment, however, response rates for each group had converged, so that response for the combination group was 86%, Fluoxetine group response was about 81%  and CBT alone group response was about 81%. 

Psychosocial Interventions 

1) Cognitive Behavioral Therapy- It is an efficacious intervention for the treatment of moderately severe depression in children and adolescents. CBT aim to challenge Maladaptive beliefs and enhance problem-solving abilities and social competence. 

2) Relaxation techniques- 

• Deep breathing. Deep, slow breathing can help you release anxiety and relax from head to toe. Try it at set times throughout the day or whenever you feel stress building. Combine deep breathing with meditation for even greater relaxation, stress relief, and focus.
• Exercise. This is a great relaxation technique, says Payne, and it offers great physical health benefits, too. Yoga is a particularly beneficial therapy because it focuses on meditation, balance, deep breathing, and relaxation all at the same time.
• Surround yourself with scents. Some people find certain pleasant aromas very relaxing. Known as aromatherapy, this technique can be as simple as lighting a candle scented with a favorite fragrance.
• Take a vacation in your mind. Called visual or guided imagery, this relaxation technique uses your imagination to carry yourself away from daily stress. Picture yourself in a serene, peaceful place that makes you happy. Take time to experience all the sensations in your mind.
• Warm up. Treat yourself to a long, luxurious soak in a bubble bath or lose yourself in the steam of a hot shower. Even sipping on a mug of hot coffee, tea, or cocoa can be soothing.
• Scribble out your stress. If something's bothering you and you just need to get it off your chest, a diary or journal can be your best friend. Take a few moments each day — or any time you feel down or stressed — to write about your fears, concerns, or frustrations.

3) Interpersonal Psychotherapy (IPT)-

IPT focuses on improving depression through focus on ways in which depression interferes with interpersonal relationships and overcoming these challenges. The four main area of focus with interpersonal psychotherapy include Loss, Interpersonal disputes,Role transition, and Interpersonal Deficits.

4) Interpersonal Psychotherapy for Adolscent (IPT- A)- 

A modification of Interpersonal therapy to more specifically address depression for adolescents (IPT-A) include a focus on separation from Parents, Authority figures, Peer Pressure and Dyadic relationship. A 12 week study of 48 adolescents with major depression randomly assigned to IPT-A or clinical monitoring found the group receiving IPT-A showed Decreased depressive symptoms, Increased Social functioning, and Improved problem solving compared to the other group. 

5) Developmental Education and Parenting Interventions -

The team developed a Psychoeducation control condition, Developmental Education and Parenting Interventions for parents using small group sessions. The DEPI condition was designed to educate parents about child development and emphasized Emotional and Social development without individual coaching or practice with behavioral techniques.

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