Is Heartbreak-Related Depression A Real Thing?
A bad breakup leaves you depressed and anxious. So what's normal sadness and what's real depression?
getty In 2009, Billy Joel and Christie Brinkley's daughter, Alexa Ray Joel, was rushed to the hospital after swallowing a handful of homeopathic pain pills. But just as curious as Joel's behavior was the explanation she gave for it: a bad case of "heartbreak-related depression."
When she took the pills, she had been upset over her breakup with her "first love," musician and former bandmate Jimmy Riot. But she's not the only one to suffer from depression after a breakup.
Almost everyone has suffered the pain of a bad breakup, to the point that it has become a cliché in American pop culture: first you cry your heart out, then you watch a bad movie on Lifetime or TBS while digging into a pint of Ben & Jerry's, followed by a little drunk dialing or, nowadays, Facebook-stalking.
Not everyone who breaks up experiences actual depression, a clinical disorder affecting an estimated 18.8 million adult Americans during any one-year period, according to the National Institute of Mental Health. And "heartbreak-related depression" does not currently exist as a clinically diagnosable form of depression.
So what was Joel suffering from? Heartbreak, depression or a hybrid of the two?
"I would not call it 'heartbreak-related depression,'" says California-based psychotherapist Tina Tessina. "I'd call it grief, complicated by low-self esteem and suicidal ideation. The appropriate reaction to a breakup is grief about the loss and anger at the ex. Attempting suicide in the aftermath indicates a much worse problem than heartbreak."
While many have speculated that taking a handful of homeopathic pain pills was more of a cry for help than a true suicide attempt, Tessina says she would guess that Alexa has a self-esteem problem, and that the relationship probably eroded her confidence even further. Then, the breakup was a trigger for her to punish herself.
"Suicide and depression are two different things. Depression is emotional exhaustion, and the sufferer is usually too debilitated to do much of anything. Suicide attempts are both a cry for help and anger turned inward, at the self," says Tessina.
Regardless of exactly what led Alexa to take those pills, women and men who have experienced depression after a breakup are praising the singer for opening up about her experience. Alexa's Facebook page is flooded with shout-outs commending her for going public with her condition.
"I absolutely think heartbreak-related depression exists, as anyone who's experienced it can tell you," says Susan Piver, the Boston-based author of the just-released memoir The Wisdom of a Broken Heart: An Uncommon Guide to Healing, Insight and Love and a commenter on Alexa's page.
"Remorse, grief and shock are common in any heartbreak in life, but when it's over a relationship there are other qualities: incredible shame, ridiculously low self-esteem, mood swings absolutely beyond your control. But the biggest one is obsessive thinking, whether you're awake or asleep. You're thinking what if I dyed my hair? What if I wore boots instead of heels, would things have turned out differently? It's incredible how your own mind turns against you."
Helen Fisher, a biological anthropologist at Rutgers University who studies romance and the brain, recently used a scanner to study the brains of 15 people who were rejected in love. The activity in certain areas of the brain "explains a lot about heartbreak-related depression that psychology cannot," she says.
"The heartbroken person has a very bad combination in the brain of intense love they can't get [reciprocated], intense craving, and real feelings of physiological distress," Fisher said, adding that this can lead to depression as well as "doing stupid, dangerous things to win the person."
According to the American Psychological Association's fact sheet, depression occurs when "feelings of extreme sadness or despair last for at least two weeks or longer and when they interfere with activities of daily living such as working or even eating and sleeping. Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. Some may have thoughts of death or suicide."
While the APA's fact sheet doesn't specifically name "heartbreak" as a cause of depression, it does say that "significant transitions and major life stressors such as the death of a loved one or the loss of a job can help bring about depression. Other more subtle factors that lead to a loss of identity or self-esteem may also contribute."
Carl Hindy, a New Hampshire psychologist who specializes in depression and relationships, says a bad breakup could certainly lead to a loss of identity or self-esteem, especially among young people. "There is extra risk for young people. How deeply wounded someone is is tied to how much of their sense of self is rooted in the person that they're with. If a person's good feelings about herself and her identity are interwoven with the other person, then they're really submerged."
Hindy also says the loss of a first love, as in Alexa's case, can be especially painful. "First love, the earliest love, has a special importance. You're less experienced, more insecure and more vulnerable. Certainly first love makes for greater intensity and greater loss."
But this doesn't mean that every young heartbreak leads to depression. While a patient complaining of heartbreak-related depression could be suffering from a major depressive disorder, he said she is more likely to have an "adjustment disorder," one of the most common reasons people seek professional help.
In an adjustment disorder, "the patient is dealing with some hurtful, stressful experience or life event, such as losing somebody or losing a job," says Hindy. "This can cause symptoms of anxiety and depression that are usually transient." If the severity of the symptoms is extreme, it is more likely to be a major depressive disorder, Hindy added.
On Facebook, Joel is leading the charge to bring attention to heartbreak-related depression. "Let's all help to shed the light on [this]; it is a REAL & SERIOUS condition that affects millions, and it SHOULD get TREATED!!!" she wrote last week.
But seeing as the condition does not technically exist, how is it treated? "If it's a result of a breakup, then I'd guide them through grief by writing, talking, and creating a ritual," says Tessina. "I do a lot of listening, because grief needs a witness."
Tessina also helps her patients to sort out their feelings about the split. "I help them figure out what they're angry about, what they're sad about, and to help them see the relationship more realistically, recognize its flaws, and why it ended. After getting through the initial stages of the grief, we'd talk about what went wrong, and what the client can learn from the experience to improve future relationships." In certain cases, Tessina would treat the patient for depression.
Hindy agreed that in addition to treating a heartbroken person's depression, he would also "explore the grief that's related to this particular loss and find out what happened in the relationship."
And while "heartbreak-related depression" may not technically exist, Hindy thinks Alexa has "coined a term." So does Piver. "I think it's a genius phrase—anybody who has ever been through it knows exactly what it means," she said.
Jennifer D'Angelo Friedman is a freelance writer and editor living in New York City. She was previously the features editor of FOXNews.com, and has contributed to the New York Post and AOL.com.