A few years ago, a student complained to me that her mother was prescribed medication to help cope with the death of her husband. She was outraged, stating that her mother should not and could not hide from her grief by taking medication. Expecting that I would readily agree with her, she asked my opinion, only to find that my thoughts on the matter were more nuanced.
Whether persons experiencing grief should take medication as a result of the loss can be a contentious issue. It was heatedly debated when psychiatrists recently revised the Diagnostic and Statistical Manual—the book therapists consult to diagnose and treat mental health issues. In the manual’s newest edition, psychiatrists identified a new disorder, prolonged grief disorder (PGD), establishing a complication of grief that warrants therapeutic, psychiatric intervention. Simply defined, PGD is an intense form of grief that inhibits a person’s ability to return to previous levels of functioning following loss, whether at work, school, home, or within society. It is generally not diagnosable until 12 months after a loss. Many therapists embraced this change to the diagnostic manual because it recognized that grief may lead to significant complications and impairment needing clinical intervention. Others feared the addition of PGD would lead to the pathologizing of “normal” grief and lead to an increase in the use of unnecessary medications prescribed by clinicians who are not experts in grief.
As with many arguments, there is truth on both sides. Generally, grief is a normal transition, a response to a significant loss, that most people will experience many times in life. It is painful. Yet, it is necessary. In most cases, the grieving process helps individuals come to terms with the loss, in part, by dealing with the painful emotions and residues of that loss. Sometimes as individuals experience grief, they not only learn to cope with loss but also grow—recognizing new strengths, acknowledging unexpected support, gaining new insights, appreciations, and skills.
Most bereaved people will not need medication, and medication may delay the natural journey with grief. In fact, to date, medication has not been found to help people with PGD although more trials are ongoing. On the other hand, specific protocols involving cognitive behavior therapy developed for PGD have been found to help.
We do know that there are people grieving a loss who also have pre-existing mental health conditions, and they may benefit from pharmaceutical intervention. For example, those with a history of anxiety, depression, or post-traumatic stress disorder may benefit from medication when they are grieving. Sometimes those other conditions, such as depression, existed but were never diagnosed until a loss occurred. In other cases, grief can interfere with sleep or affect health in other ways and require medication. And always, if grief interferes with life tasks over a protracted time, a psychiatrist, preferably one who understands complications of grief, should be consulted.
But medication alone cannot resolve grief or make it magically disappear. Medication is not a panacea, a cure for grief. Remember that there are multiple resources for grief. These include counselors, books, support groups, even newsletters such as Journeys. Carefully select the resources that can best assist on these very individual journeys with grief.
By Kenneth J. Doka, PhD, MDiv, Sr. Vice President, Grief Programs, HFA and recipient of the 2019 Lifetime Achievement Award from the Association for Death Education and Counseling.
