Healthy living * Mental wellbeing

Grief is not an illness, doctors say

Grief is not an illness, say doctors It should not be treated as one in most cases

Grief is not a mental illness that needs to be routinely treated with antidepressant medicines, a leading medical journal has said.

A lead editorial in today's Lancet journal warns that proposed changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) would mean that a person could be diagnosed as suffering from depression just two weeks after the death of a loved one.

The manual, published by the American Psychiatric Association, lists all mental health disorders along with the symptoms and criteria needed to make a diagnosis.

[Related story: Shy children could be classed as mentally ill]

Previous editions of the manual have highlighted the need to take into account - and usually exclude - bereavement before diagnosing someone as having a major depressive disorder, unless the symptoms are unusually severe. But the latest draft version of the manual fails to do this.

The Lancet states: "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."

"It is often not until six months, or the first anniversary of the death, that grieving can move into a less intense phase."

"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."

For many people grief may be a "necessary response to bereavement," that "should not be suppressed or eliminated," the editors wrote.

The World Health Organisation is also considering including a category on "prolonged grief disorder" in a revised edition of its International Classification of Diseases (ICD-10).

The Lancet editors argue that "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 concluded: "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. 

"Occasionally, prolonged grief disorder or depression develops, which may need treatment, but 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."

This article was published on Fri 17 February 2012



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