The feeling states of sadness, grief, and loss are closely related to one another and often fall underneath the umbrella of depression. Sadness refers to a feeling of unhappiness, while grief consists of distress related to the process of mourning a loss of some sort. Depression can be a feeling but is also a mood—a more enduring emotional condition that exists on a continuum. The most severe form of depression is a diagnosable disorder marked by a variety of symptoms that can include:

• Sadness.
• Difficulty sleeping or sleeping too much.
• Increased or decreased appetite.
• Weight loss or gain.
• Loss of interest and enthusiasm.
• Feelings of helplessness, hopelessness, and/or worthlessness.
• Decreased self-esteem.
• Fatigue or loss of energy.
• Poor concentration or indecision.
• Suicidal thoughts, thoughts of death, or suicide attempts.

Symptoms of depression frequently accompany chronic pain. When pain becomes a constant companion, you begin to suffer significant losses, including the ability to work and physically function as before, the ability to participate in previously enjoyed recreational and family activities, financial losses, and hopes and dreams for the future. Going through multiple medical procedures or treatments without noticeable benefit can add to feelings of depression. These losses characteristically lead to feelings of hopelessness, helplessness, and worthlessness. Depression is sometimes described as anger turned inward against oneself. If drug dependence or addiction to pain medication is added to the picture, the severity of these losses and the feelings that go with them typically increase, creating further emotional imbalances. Unresolved grief can contribute to both pain and drug use. Grief is a natural state attached to loss. Loss occurs when someone or something is no longer available to us due to death, injury/illness or other health reasons, the end of a relationship, etc. The more emotionally important the loss, the greater the grief associated with it. Healing from grief involves mourning the loss and eventually accepting it. Mourning is a process of saying good-bye to and letting go of what you have lost. You may grieve the loss of your mobility, functioning, and old lifestyle because of your chronic pain. You may even grieve the loss of pain medications, which may have come to seem like your best friend, lover, and reliable confidant. Acceptance of a significant loss does not mean that there is no longer any distress related to it. Losses that are fully accepted can still be painful, but they no longer create serious emotional imbalances which hinder health and healing. Much like a physical injury that has healed, there may always be a scar. Mourning and healing from grief is a process of regaining balance that takes time (months to years, generally) and is different for each individual. This healing process requires allowing yourself to fully feel all the uncomfortable, painful emotions that are part and parcel of saying good-bye to and letting go of people and things that were important in your life. Mood-altering medications themselves actually cause depression, though they seem to relieve it (only temporarily).

Depression and Grief:

Identify any symptoms of depression you have experienced. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe two things you can do to help you through these symptoms of depression. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Identify your most significant losses, including losses due to chronic pain, and describe how you grieved each one. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe your understanding of what you need to do in order to more fully grieve and accept these losses and to heal and regain balance. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).