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Beyond depression: When grief doesn't go away

/ Source: The Associated Press

In the months after David Golebiewski’s 19-year-old daughter was killed in a car crash, grief consumed his life. He couldn’t go to the restaurant where his daughter had worked, and he spent five hours a day in Internet chat rooms with other parents who lost children.

Doctors say Golebiewski was suffering from “complicated grief” — a condition some hope will soon be recognized by the American Psychiatric Association.

They say the condition is more severe than grief and different from depression, and affects as many as 1 million people a year.

Dr. Katherine Shear, a psychiatry professor at the University of Pittsburgh School of Medicine, said that with complicated grief, the usual feelings of disbelief, loss and anguish do not go away, and eventually affect every part of a person’s life.

Links to suicide, drug and alcohol abuse

Left untreated, doctors say, complicated grief can lead to depression, suicide, drug and alcohol abuse, even heart disease.

Dr. Holly Prigerson, director of the Dana-Farber Cancer Institute’s Center for Psycho-Oncology and Palliative Care Research and an associate professor of psychiatry at Harvard Medical School, said the term “complicated grief” has been used for about 10 years.

“Unlike a lot of disorders following bereavement, including depression, it tends to persist for years and become a chronic distressed state — a sort of frame of mind,” Prigerson said.

Researchers estimate that 10 percent to 15 percent of the surviving relatives of people who die naturally experience complicated grief, Prigerson said. She said people who lose someone they were emotionally dependent on are at greatest risk.

She is working to get the disorder recognized in the American Psychiatric Association’s next edition of the Diagnostic and Statistical Manual of Mental Disorders. The next DSM-V will be published in 2012.

'There really is something different'

Dr. Michael First, a Columbia University psychiatry professor and member of a committee that will decide what goes into the DSM, said the panel will consider whether complicated grief merits its own designation.

“From what I’ve seen so far, it’s certainly not an off-the-wall suggestion,” First said. He said doctors see patients all the time, especially the elderly, who never get over the death of a loved one.

Dr. Richard Glass, a psychiatry professor at the University of Chicago and deputy editor of the Journal of the American Medical Association, said studies have shown that people suffering from complicated grief do not meet the criteria for depression or post-traumatic stress, although some of the symptoms overlap.

“The evidence so far indicates that there really is something different here,” Glass said.

The most recent study, published Tuesday in JAMA by Shear and her colleagues at the University of Pittsburgh, examined different ways to treat complicated grief.

Researchers found that 51 percent of patients treated with a therapy developed just for the symptoms of complicated grief showed improvement. So did 28 percent of complicated grief sufferers who underwent a treatment commonly used for depression.

Golebiewski, 56, of North Fayette, was given the therapy for complicated grief as part of the study. It included being tape-recorded while he talked about his daughter’s life and death, then listening to those recordings. He said after listening to the tapes repeatedly, he developed ways of dealing with those feelings.

“I was able to visualize her again in life and as happy as she was and the cheerful person that she was,” he said. “I was able to see her there in that context.”