Research published on June 8 in JAMA Psychiatry shows that a structured psychotherapy developed by Dr. M. Katherine Shear of Columbia University is the most effective way to treat those who are suffering from the debilitating condition known as complicated grief. Research results also showed antidepressant medication makes a difference only for relief of co-occurring symptoms of depression.

Complicated grief occurs in about 7 percent of the bereaved which means about 10 million people develop this condition each year in the United States. Untreated, complicated grief is associated with negative health outcomes, including increased suicidality. Typical symptoms of complicated grief include:

  • prolonged acute grief with intense yearning, longing and sorrow
  • frequent troubling thoughts about the death
  • excessive avoidance of reminders of the loss

Co-occurring depressive symptoms are also prevalent.

Dr. Shear, the Marion E. Kenworthy Professor of Psychiatry at Columbia University’s School of Social Work and Columbia College of Physicians and Surgeons, has developed a 16-session complicated grief treatment (CGT) to help those suffering from complicated grief accept the finality of their loss and rebuild their lives. In two previous clinical trials, CGT has been found to have a better outcome than grief-focused interpersonal therapy. This four-center national study, led by Dr. Shear in collaboration with researchers Drs. Charles Reynolds, Naomi Simon and Sidney Zisook, was the first to study anti-depressant medication for complicated grief.

Patients who met the criteria for complicated grief were recruited at academic medical centers in New York, Boston, Pittsburgh, and San Diego. All participants received an antidepressant or a pill placebo along with psycho-education, grief monitoring and encouragement to engage in activities. Half of the participants also received CGT.

This study showed a very strong effect of CGT, with a response rate of 83 percent. Study findings did not show a difference between antidepressant and placebo when administered with or without CGT. However, when citalopram was added to CGT co-occurring depressive symptoms did decrease more than with placebo.

“Physicians and other direct care professionals can improve the care of patients with complicated grief if they know how to recognize this condition and how it is different from depression. Complicated grief is a serious, prevalent, and frequently chronic and debilitating condition that needs to be recognized and treated,” Dr. Shear said. “Complicated grief can be clearly differentiated from major depression both in symptoms and response to treatment.”

Columbia University served as the coordinating Center for the study. The randomized clinical trial was conducted by researchers at the University of Pittsburgh School of Medicine, Massachusetts General Hospital/Harvard Medical School, and the University of California, San Diego, San Diego VA Healthcare System, and was funded by four separate grants from the National Institute of Mental Health.

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The following researchers are available for press interviews to explain these findings:
1) Dr. M. Katherine Shear, Columbia University, School of Social Work (contact Mary-Lea Cox Awanohara: 212/851-2327)
2) Dr. Charles Reynolds, University of Pittsburgh, Department of Psychiatry (contact Ashley Trentrock)
3) Dr. Naomi Simons, Massachusetts General Hospital and Harvard Medical School, Department of Psychiatry (contact Noah Brown: 617/643-3907)
4) Dr. Sidney Zisook, University of California-San Diego, Department of Psychiatry

Photo credit: Counselling and Support, by Joe Houghton of www.houghtonphotography.com.

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