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Am Fam Physician. 2005;72(11):2338

Depression with bereavement is common. Approximately 10 to 20 percent of bereaved persons experience complicated grief, which is different from depression. Complicated grief lasts more than six months after the death of the loved one and includes features of disbelief, anger, and bitterness about the death; painful emotions with intense yearning for the deceased; and preoccupation with thoughts of the loved one and intrusive thoughts related to the death. Complicated grief does not respond well to conventional treatment for depression. Shear and colleagues compared response to interpersonal therapy (IPT) with targeted complicated grief treatment (CGT) in patients with complicated grief.

Participants meeting criteria for complicated grief, determined by scores on a complicated grief inventory, were randomized to receive IPT or CGT. Treatment was approximately one session per week for 16 weeks. Highly trained and committed therapists delivered IPT or CGT. CGT was distinct because it included exercises involving confrontation with avoided situations, repeating the story of the death, and guided conversations with the deceased. Independent evaluators reviewed therapist assessments and patient self-assessments. Patients also were assessed with depression and adjustment scales before and after treatment.

Completion rates for CGT and IPT were 73 and 74 percent, respectively. Slightly fewer than one half of the patients in each group continued to take antidepressant medication that was prescribed before randomization. For a modified intention-to-treat group, the number needed to treat (NNT) was 4.3, and for patients completing the assigned therapy the NNT was 2.9. Self-reported time to response was shorter with CGT than with IPT. In terms of the inventory scales, outcomes were only marginally better for CGT than for IPT in the modified intention-to-treat group and significantly better for CGT in the patients who completed therapy. The success of CGT varied by type of loss (e.g., spouse, child); there was no such variation with IPT. Patients in both treatment groups did better on antidepressant medication. In the CGT group, response rates were 59 percent for patients taking antidepressants versus 42 percent for those not taking antidepressants; in the IPT group, response rates were 40 percent for patients taking antidepressants versus 19 percent for those not taking antidepressants.

The authors conclude that CGT yields better results than IPT but results in improvement in only one half of patients. Antidepressant medications helped improve outcomes in both groups but only marginally. The authors suggest that more research geared specifically toward complicated grief is needed, as is systematic study of combined medication and psychotherapy.

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