The Use Of Anti-depressants In Grieving?

[Padre]

About 4 weeks ago I came off an antidepressant which allowed the unresolved grief issues over my sister's death to surface. I belive that the anti-depressant kept me from fully grieving her loss which I am in the process of doing now.

A collegue, therapist, and good friend who has known me over the years knows exactly where I am at and says perhaps just a small dosage of an anti-depressant (not the one that I was on) could be beneficial until resolution and integration is accompliushed.

I see my MD on Monday to explain what has been going on, and to get a med check (I am also on a synthroid med.) I seem to be doing well and don't really want to take any more meds. I would appreciate any advice in this respect.

[MartyT]

Dear Friend,

Since your physician knows your personal health history, he or she is in a better position to evaluate your need for medication, but I think you are wise to arm yourself with some useful information before meeting with your doctor on Monday. Keep in mind, too, that while MDs are qualified to prescribe medications, not all physicians are knowledgeable about grief and the normal mourning process.

In his classic text, Grief Counseling and Grief Therapy, grief expert J. William Worden notes,

"There has been much discussion among mental health professionals about the use of medication in the management of acute, normal grief. The consensus is that medication ought to be used sparingly and focused on giving relief from anxiety or from insomnia as opposed to providing relief from depressive symptoms . . . It is usually inadvisable to give antidepressant medications to people undergoing an acute grief reaction. These anitdepressants take a long time to work, they rarely relieve normal grief symptoms, and they could pave the way for an abnormal grief response, though this has yet to be proved through controlled studies. The exception would be in cases of major depressive episodes. Psychiatrist Beverly Raphael (2001) affirmed that, although our psychological understandings of bereavement have increased, there is not yet a good basis for biological intervention. Pharmacological approaches should, for the most part, only be provided where there is an established disorder for which they are indicated. I would concur with this.” [pp. 70-71].

In 1989, an Institute of Medicine Committee for the Study of Health Consequences of the Stress of Bereavement stated that it did not recommend the use of anti-depressants "for individuals whose grief remains within the ‘normal bounds' of intensity and duration."

Notice that both these references speak about “normal grief” or grief “within the ‘normal bounds’ of intensity and duration.” Normal grief is neither an illness nor a pathological condition; it is a normal response to losing a loved one – but since we all are unique human beings with our own individual backgrounds and experiences, what is “normal” can vary considerably from one griever to the next, and how our grief is expressed will vary as well. Everyone grieves differently according to their age, gender, personality, culture, value system, past experiences with loss, and available support. How you react to your sister’s death depends on how you’ve reacted to other crises in your life; on what was lost when this death happened (e.g., who you were in your relationship with your sister); on who died (i.e., what your sister meant to you and the role she played in your life); on when her death occurred (at what point in your life cycle as well as hers); and on how (the circumstances surrounding her death, and how her death occurred).

As you probably already know, whether a person is grieving or not, using medications for sleeplessness, depression and/or anxiety involves certain risks, such as impaired motor coordination and mental acuity. Drug dependence, especially when drugs are taken in combination with alcohol, is also a risk. Be sure to ask your doctor about any potential side effects and/or drug interactions, to avoid aggravating existing problems or creating new ones.

Whether you decide with your doctor to continue taking medication or not, I encourage you to educate yourself about the grief process, because your grief journey will feel so much safer and more predictable, you’ll understand yourself better, and you’ll feel less “crazy” and afraid. Visit my Grief Healing Web site and some of the links listed on my Death of A Sibling page. Read and learn about bereavement through books, articles, audiotapes, seminars, workshops, classes and support groups, including this online forum -- which functions as a virtual support group. Visit sites specifically aimed at adults whose siblings have died, such as Adult Sibling Grief. Such activities expose you to models of survival and growth, and can give you hope that you can make it, too.

I hope this information proves useful to you, my friend, and for the loss of your beloved sister, you have my deepest sympathy.

Wishing you peace and healing,

Marty T