Should grief be treated with antidepressants?
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Should grief be treated with antidepressants?
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Changes to the DSM criteria mean that grief will no longer be a reason for excluding a diagnosis of depression. A good opinion piece in the NEJM today which is open access says this is not a good idea
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Forums » Open clinical » Psychiatry » Should grief be treated with antidepressants?
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Should grief be treated with antidepressants?
posted at 17/5/2012 8:20 AM BST
on bmj.com
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Posts: 696
First: 17/11/2008 Last: 19/6/2013 |
Changes to the DSM criteria mean that grief will no longer be a reason for excluding a diagnosis of depression. A good opinion piece in the NEJM today which is open access says this is not a good idea because grief usually resolves within two to six months and most patients present with tearfulness, sadness and insomnia but with symptoms that are cognitiviely different from depression. The author of the piece says, "Grief-stricken patients frequently report symptoms that are also typical of major depression, such as sadness, tearfulness, insomnia, and decreased appetite. But, as numerous researchers have noted, grief rarely produces the cognitive symptoms of depression, such as low self-esteem or feelings of worthlessness. " The changes to DSM 5 woulld mean a person could be diagnosed after two weeks of losing someone. The author points out that up to 20% of people do develop depression after grieving but still- most people do not, I fear that such a change will medicalise grief and that giving a person who is grieving antidpressants is not as helpful as letting grief take its natural course- however painful that is for a while. http://www.nejm.org/doi/full/10.1056/NEJMp1201794?query=TOC |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 9:52 AM BST
on bmj.com
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Posts: 1343
First: 13/4/2010 Last: 19/6/2013 |
I agree with you in essence Luisad - grief is a traumatic but normal process for most people and should be allowed to run its natural course and not be medicalised. Using antidepressants in the first few months will almost certainly have little or no impact but the only way to find out for sure would be to do some kind of RDBC trial - awkward and difficult to do but by no means impossible. Unless and until such studies are done I will continue to offer help and support but avoid using anti-depressants for the vast majority of grieving people. However, I must pick on one point from the NEJM article. Speaking from very personal experince a loss of self-esteem was, for me, the most prominent feature of my grief and the feature which I most recall 7 years later. |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 10:31 AM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
It appears a better decision to treat patients with grief with antidepressants, may be with a minimal possible duration because although grief usually appear to resolve within two to six months and most patients present with tearfulness, sadness and insomnia eventually stabilize themselves in the natural course, with 'time' as a remedy, these patients tend to suffer with depression in future, & become susceptible to suffer form psychiatric illnesses. So, I think the changes in the DSM 5 criterion are worth justification. |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 2:11 PM BST
on bmj.com
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Posts: 1012
First: 15/7/2011 Last: 15/6/2013 |
In Response to Re: Should grief be treated with antidepressants?: It appears a better decision to treat patients with grief with antidepressants, may be with a minimal possible duration because although grief usually appear to resolve within two to six months and most patients present with tearfulness, sadness and insomnia eventually stabilize themselves in the natural course, with 'time' as a remedy, these patients tend to suffer with depression in future, & become susceptible to suffer form psychiatric illnesses. So, I think the changes in the DSM 5 criterion are worth justification. Posted by Dr. K. Ashutosh Dr Ahutosh I wasn't altogether clear with what you advocated above. My laymans interpretation was that your saying people who suffer grief 'tend to suffer with depression in the future' etc and ' become susceptible to suffer from psychiatric illness'. Surely that suggests that everyone who is bereaved (all of us at some time) become depressed later. That cannot be the case surely? Have I misunderstood? |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 2:33 PM BST
on bmj.com
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Posts: 35
First: 11/1/2012 Last: 19/2/2013 |
Usually not - but if it is pathological grief, merging into depression, surely at some point it actually IS depression and not "just" bereavement, and therefore should be treated as depression? |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 3:28 PM BST
on bmj.com
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Posts: 233
First: 15/5/2012 Last: 11/6/2013 |
In Response to Re: Should grief be treated with antidepressants?: It appears a better decision to treat patients with grief with antidepressants, may be with a minimal possible duration because although grief usually appear to resolve within two to six months and most patients present with tearfulness, sadness and insomnia eventually stabilize themselves in the natural course, with 'time' as a remedy, these patients tend to suffer with depression in future, & become susceptible to suffer form psychiatric illnesses. So, I think the changes in the DSM 5 criterion are worth justification. Posted by Dr. K. Ashutosh Dr Ashutosh: I have to strongly disagree with you. Grief is a physiological/psychological reaction to an acute stressor or loss. Supportive Psychotherapy does very well in the short term. Longer term one might consider CBT. There is no to minimal evidence of grief leading to a psychiatric illness. On the contrary, there is significant concern about DSM 5's classification about grief. I really do hope that you do not prescribe an SSRI to a patient who just lost his family member. Cheers |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 5:30 PM BST
on bmj.com
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Posts: 1302
First: 9/12/2011 Last: 12/6/2013 |
No, But if Grief turns into Pathological Depression, with a clear definition of clinical depression. But as with all things Psychiatric, balancing the drugs seems to be tricky. Counseling would be better of possible. DuaneF |
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 6:58 PM BST
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
All depends how a person functions. When grief causes a person functional impairment, one needs to take action. Psychotherapy does not always help. Let me tell you a story. A strong willed person who lost his father was "holding up"well till he started feeling a constant lump and feeling of fullness of the stomach. In a short time it grew into reccurrent episodes of all body tingling, then heat, then cold sweat with nausea and the end of such "episode" was being sleepy. Later on came reccurrent episodes of sudden feeling of "falling", very bad feeling, nausea, a vasovagal crisis and then sleepiness. The symptoms grew worse once they started appearing after each meal and caused almost anorexia. All investigations were negative. So, would you leave such a patient untreated? And remember. all started with grief and in a short time came to this,Well after starting SSRI's the person recovered dramatically. P.S. This is a very extreme case. But, don't you think a person who can't sleep for more than a week and feels sad and tearful may need some short termed medical treatment to help alleviate the crisis of grief? Or is it OK to suffer because some of you think we are obliged to suffer during grief??
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Re: Should grief be treated with antidepressants?
posted at 17/5/2012 7:52 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
In Response to Re: Should grief be treated with antidepressants?: In Response to Re: Should grief be treated with antidepressants? : Dr Ahutosh I wasn't altogether clear with what you advocated above. My laymans interpretation was that your saying people who suffer grief 'tend to suffer with depression in the future' etc and ' become susceptible to suffer from psychiatric illness'. Surely that suggests that everyone who is bereaved (all of us at some time) become depressed later. That cannot be the case surely? Have I misunderstood? Posted by kirked Respected Mr. Kirked, what I mean to say is the 'anticipatory treatment', to just provide an instant relief to the sufferers, & have further cleared it to be just a possibility for the future degradation in the psychosocial health. Prevention is always good! |
Forums » Open clinical » Psychiatry » Should grief be treated with antidepressants?
