Pharmacological approach to the treatment of complicated grief Pharmacological trials of complicated grief (also formerly known as “prolonged grief disorder” or “traumatic grief“) are scarce, likely in part because attention to this condition as a potential formal diagnostic entity has only recently occurred, with different criteria sets proposed that are still the focus of ongoing debate.6 Inhibitors,research,lifescience,medical Further, the lack of inclusion of CG in the DSM as a formalized diagnosis to date has implications for FDA trials and limits pharmaceutical development targeting CG. Also, without a formalized diagnosis, few patients are assessed for CG, and clinicians do not have

CG-specific

billing codes, together limiting targeted treatment and naturalistic study Inhibitors,research,lifescience,medical of pharmacotherapy already administered to help seeking patients in practice settings. This issue is of critical importance to debates about whether CG should be included in DSM-5. Selective serotonin reuptake inhibitors One publication has reported a post-hoc comparison of paroxetine and nortriptyline for the treatment of traumatic Inhibitors,research,lifescience,medical grief (an earlier term in the literature for CG). Zygmont et al examined open paroxetine (flexible dosing, 10 mg to 50 mg/day) administered for 16 weeks to 21 individuals with traumatic grief simultaneously participating in a psychotherapy treatment development study.25 Fifteen participants completed at least 6 weeks of medication, and 13 the full course of the trial (16 weeks). In this study, measures of grief intensity Inhibitors,research,lifescience,medical (using the ICG) and measures of depression (using the HDRS rating scale) both declined by 48% and 51% respectively Inhibitors,research,lifescience,medical in the paroxetine-treated groups. This study also compared these results with

an ongoing study of bereavement related depression in which patients were treated with nortriptyline (with and without psychotherapy; n=22 for at least 6 weeks, n=18 for 16 weeks). Again, both of the antidepressant-treated chemical structure groups showed significant reductions in both grief and depressive symptoms (using the ICG and HDRS rating scales), even though depressive symptoms responded earlier in the treatment course Dipeptidyl peptidase than the improvement in grief symptoms. In another uncontrolled study, Simon et al treated and prospectively assessed four women with a primary diagnosis of CG (defined as a score of 25 or above on the ICG, at least 6 months after the death of a loved one), treated with escitalopram.26 At the end of the 10-week trial, all participants were rated as “very much improved” on the CGI-I. Both complicated grief symptoms assessed by the ICG and depressive symptoms as assessed by the HDRS were significantly decreased.