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Warning over treating grief as an illness

Adrian O'Dowd

Monday, 20 February 2012

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GPs have been advised they should not routinely treat grief with antidepressants because it is not an illness, according to a new editorial published in The Lancet.

The journal’s lead editorial warns that it is dangerously simplistic and wrong to medicalise grief by routinely treating it with antidepressants.

The editorial expresses concerns about the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association.

Although previous editions of DSM have  highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder, the current draft of this fifth edition fails to do that, said The Lancet editorial.

It says: “In the draft version of DSM-5, however, 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 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.

“Medicalising grief, so that treatment is legitimised routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed. The evidence base for treating recently bereaved people with standard antidepressant regimens is absent.”

The editorial also highlights concerns it has over the World Health Organization’s International Classification of Diseases, currently under revision as ICD-11. The team behind this revision is debating a proposal to include a category on “prolonged grief disorder”.

The editorial says: “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.”

It concludes: “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. Putting a timeframe on grief is inappropriate—DSM-5 and ICD-11 please take note.”

Sometimes, there are cases of prolonged grief disorder or depression that needed treatment, but the editorial adds: “Most people who experience the death of someone they love do not need treatment by a psychiatrist or indeed by any doctor. For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills.”

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