3 Things Pharmacists Should Know About Complicated Grief

Complicated grief is a severely under-recognized public health problem.

About 7% of individuals in bereavement develop complicated grief, a serious, prevalent, and frequently chronic and debilitating condition that requires recognition and treatment.

Clinical depression, on the other hand, is a fairly common illness, with a lifetime prevalence of 25% in women and 12% in men. Unfortunately, only about one-third of those with clinical depression seek medical treatment, and far fewer patients with complicated grief pursue it.

The US Preventive Services Task Force recently updated its recommendations for depression screening in adults. Although it didn’t endorse a specific screening method, evidence from previous research suggests that pharmacists, as members of a collaborative care team, can play an important role in depression screening services.

Pharmacists’ frequent contact with patients may also prove useful in detecting and addressing complicated grief.

For example, pharmacists can play a role in preventing potential suicide attempts, which some patients with complicated grief idealize. And, given that poisoning is one of the most common methods of suicide, pharmacists can play a role in preventing patients from obtaining the means to overdose on prescription medications.

Here are some other must-know facts about complicated grief:

1. Complicated grief often prevents patients from healing while they’re in mourning.

Because the condition is most common following the death of a loved one, it’s important to recognize when a patient has complicated grief as early as possible, so that the healing process can begin.

Signs and symptoms may include:

· Intense sorrow and pain at the thought of a deceased loved one

· Hyper-focus on the loved one’s death

· Numbness or detachment

· Irritability or agitation

· Inability to enjoy life or remember past positive experiences

Pharmacists who identify patients with complicated grief can counsel them about the benefits of seeking treatment in the form of interpersonal therapy, motivational interviewing, positive psychology, and cognitive behavioral therapy.

2. Complicated grief isn’t only caused by a loved one’s death.

Although complicated grief is most commonly associated with the death of a loved one, the events that can cause it are more varied.

According to the Mayo Clinic, other factors that may increase the risk of complicated grief development include:

· Lack of a support system or friendships

· Past history of depression or other mental health

· Traumatic childhood experiences, such as abuse or neglect

· Other major life stressors

The major difference between complicated grief and depression is patients’ persistant inability to adapt to their new reality.

3. Treating complicated grief with antidepressants isn’t always appropriate.

Co-occurring depressive symptoms are common, but complicated grief is clearly differentiated from major depression.

Off-label antidepressant prescribing is pervasive, so pharmacists should be stay on the lookout for any inappropriate prescriptions.

Although many health care providers acknowledge that off-label drug use can be appropriate in certain circumstances, it’s still important for pharmacists to let patients know that the risk for adverse events is higher when a medication is taken for an unapproved purpose. In fact, one study found that patients prescribed drugs for indications that the FDA hasn’t approved face a 44% greater risk for adverse drug events.

Of note for pharmacists, the current study findings “indicate that the mere presence of an antidepressant prescription is a poor proxy for depression treatment,” the researchers concluded.

As medication experts, pharmacists should take the time to counsel patients about their condition and optimal treatment options.

A recent investigation published in the Journal of the American Medical Association found that psychotherapy with complicated grief treatment appeared to be effective, but the addition of the antidepressant citalopram didn’t significantly improve outcomes among patients with complicated grief.

“Our results support the use of antidepressants in conjunction with CGT [complicated grief treatment] for relief of co-occurring depressive symptoms,” the study authors concluded. “When CGT is unavailable, CGT-informed supportive clinical management with or without antidepressants may be a helpful approach.”