February 16, 2012

Treat Grief With Love Not Drugs

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Joseph V. Madia, MD By:

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Antidepressants should be prescribed to prevent illness and not emotions

(dailyRx News) One of the world’s leading general medical journals just expressed its concerns about changes in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

The lead editorial in this week’s edition of The Lancet states that grief—the unhappy and painful emotion typically felt after loss—is not an illness and thus should not be medically managed with pharmaceuticals in everyday healthcare.

"Talk to a therapist if suffering with grief or depression."

People become depressed for a variety of reasons, but this editorial recognizes that the grief felt with loss is very different from the average depression case. However, the new revision of the DSM excluded a previous sidebar in the diagnosis of major depressive disorder (MDD) that instructed mental health practitioners to first check and treat for bereavement before treating for major depression.

"In the draft version of DSM-5…there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than two weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction,” the editorial authors explain.

The report suggests that current evidence for antidepressant therapy on grief is lacking and medically treating the sadness felt after loss is both flawed and dangerously simple.

Authors note, “Bereavement is associated with adverse health outcomes, both physical and mental, but interventions are best targeted at those at highest risk of developing a disorder or those who develop complicated grief or depression, rather than for all."

The National Institute of Health recommends first treating grief at home. Emotional support can be found from family members and friends as well as within the community at churches, within self-help groups, amongst mental health professionals, and from social workers at local organizations.

Many people who lose a spouse or child find comfort in support groups, sharing common experiences, memories, and struggles. The NIH suggests it could take a year or longer to overcome the emotional turmoil felt by a loss, and finding outlets for emotional support provides the best therapy.

This U.S. medical health source does not believe people should try to prevent grief. The NIH's A.D.A.M. Medical Encyclopedia notes, “Grief should not be prevented because it is a healthy response to loss. Instead, it should be respected. Those who are grieving should have support to help them through the process.”

dailyRx consulted contributing expert Nicole Meise, Ph.D., a psychotherapist in a private practice, on how one may distinguish between healthy and unhealthy grief.  "It's difficult, because symptoms of grief can look a lot like, and eventually manifest into depression, but that doesn't mean they are one in the same," says Meise.  

"A critical distinction between bereavement and depression stems from the fact that one implies an emotional state of mind which results from a specific event or loss, and the other a more chronic condition which may or may not be linked to situational factors."

In terms of what the DSM-V changes might mean, Meise explains, "Treatment approaches for depression and bereavement vary. Although there is some overlap, the recovery process is likely to be different; putting the two in the same category may result in confusion regarding the standard of care."  

  

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
February 16, 2012

Last Updated:
February 16, 2012