General News — 09 April 2013

A Sydney psychiatrist has questioned expected changes in the DSM-5 which will allow psychiatrists to diagnose major depression in grieving patients only two weeks after their bereavement.

Speaking to Psychiatry Update Professor Gordon Parker of the University of New South Wales said grief was a normal phenomenon that generally did not require medical treatment, whereas clinical depression was a diagnosable mental disorder which responded to various forms of treatment, including drugs.

“By pathologising and medicalising grief and indirectly encouraging doctors to prescribe antidepressants for it, psychiatrists run the risk of losing a lot of our credibility,” he said.

Previous DSM criteria for a major depressive episode had specifically excluded grief states unless symptoms persisted for more than two months or were particularly severe.

In a discu ssion paper published this month in Acta Psychiatrica  Scandinavia, Professor Parker argued that there are major differences between grief and clinical depression.

Grieving people did not have the same problems of self-esteem as the depressed, he noted, and the recurrence rate of major depression in the bereaved was no greater than in the general population.

The bereaved were also less likely to have impaired role functioning or comorbid disorders, he said.

Another distinction was that clinical depression lacked the stages – from initial shock and numbness through to yearning,  anger, guilt and eventual resolution – which were integral to grief.

There were also huge differences in treatment response, he said.

Rather than try to shoehorn grief into the domain of clinical depression, it might be better to go the other way and consider whether many reactive depressive conditions would fit more comfortably within a grief paradigm, Professor Parker suggested.

As first appeared in Psychiatry Update, 4 April 2013

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(3) Readers Comments

  1. I would agree that grief and clinical depression have major differences, and this water should be tread carefully. Grief is a normal part of all of our lives, and we all deal with it. A recent
    blog post about grief was particularly enlightening, reminding us how we all interact with grieving people on a daily basis and must be supportive as well as we’re able. However, diagnosing people’s grief as depression is another step.

  2. Grief is actually the body’s healing process to loss. It is quite different than Depression. As a grief specialist it is necessary to go right through grief to release the attachment, to let go of the future dreams and hopes, to honor the relationship. The problem comes from when people are not grieving or have what is called “complicated grief” with no insight. We need to help people understand the process and clear away guilt and other issues that get in the way of people being able to honor the loss. When that happens people heal… Instead of pathologicallizing it, we need to do the opposite. In my humble, professional opinion…

  3. If grief is severely impairing ones ability to function in key roles or if a person is having persistent suicidal thoughts, it is essential to seek professional help from someone trained in the treatment of loss to decide whether medication — along with therapy — might be helpful. Dr Katherine Shear, the director of the Center For Complicated Grief at Columbia University School of Social Work has developed a focused 16 week therapy, complicated grief therapy that has been proven efficacious in clinical trial to help those with complicated grief. People with Complicated Grief often say that they feel “stuck”, grief dominates their lives with no respite in sight. Dr Shear’s 16 week treatment guides people in resolving grief complications and revitalizes the natural healing process.

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