Psychiatric Annals

CME Article 

Bereavement and Depression: Implications for Diagnosis and Treatment

Tracey Auster, BA; Christine Moutier, MD; Nicole Lanouette, MD; Sidney Zisook, MD

Abstract

Bereavement, the grief following the death of a loved one, is an unfortunately common yet excruciatingly painful human experience. Each year more than 8 million Americans encounter the death of a close family member. Two months after the death, about 20% of these grieving individuals (about 1.6 million people) meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for major depressive episode (MDE). Yet many clinicians are uncertain about whether and how to treat bereavement-related MDE. In large part, this uncertainty is due to diagnostic ambiguities and symptomatic overlap between bereavement and MDE, a quandary similar to debilitating medical illness where symptoms such as fatigue, low energy, or anorexia, overlap with symptoms of MDE.

ABOUT THE AUTHORS

Tracey Auster, BA, is with Harvard Medical School/Beth Israel Medical Center, Boston, MA. Christine Moutier, MD; Nicole Lanouette, MD; and Sidney Zisook, MD, are with University of California, San Diego School of Medicine, San Diego, CA.

Address correspondence to: Sidney Zisook, MD, 9500 Gillman Drive, 116A, La Jolla CA 92093.

Ms. Auster, Dr. Moutier, and Dr. Lanouette have disclosed no relevant financial relationships. Dr. Zisook has disclosed the following relevant financial relationships: Aspect and PamLab: Research grant support; and AstraZeneca and GlaxoSmithKline: Speakers’ bureau.

EDUCATIONAL OBJECTIVES

  1. Differentiate “normal” bereavement from bereavement-related major depression.
  2. Identify when bereaved individuals with depressive symptoms should be treated.
  3. Assemble an evidence-based treatment approach to bereavement-related depression.

Abstract

Bereavement, the grief following the death of a loved one, is an unfortunately common yet excruciatingly painful human experience. Each year more than 8 million Americans encounter the death of a close family member. Two months after the death, about 20% of these grieving individuals (about 1.6 million people) meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for major depressive episode (MDE). Yet many clinicians are uncertain about whether and how to treat bereavement-related MDE. In large part, this uncertainty is due to diagnostic ambiguities and symptomatic overlap between bereavement and MDE, a quandary similar to debilitating medical illness where symptoms such as fatigue, low energy, or anorexia, overlap with symptoms of MDE.

ABOUT THE AUTHORS

Tracey Auster, BA, is with Harvard Medical School/Beth Israel Medical Center, Boston, MA. Christine Moutier, MD; Nicole Lanouette, MD; and Sidney Zisook, MD, are with University of California, San Diego School of Medicine, San Diego, CA.

Address correspondence to: Sidney Zisook, MD, 9500 Gillman Drive, 116A, La Jolla CA 92093.

Ms. Auster, Dr. Moutier, and Dr. Lanouette have disclosed no relevant financial relationships. Dr. Zisook has disclosed the following relevant financial relationships: Aspect and PamLab: Research grant support; and AstraZeneca and GlaxoSmithKline: Speakers’ bureau.

EDUCATIONAL OBJECTIVES

  1. Differentiate “normal” bereavement from bereavement-related major depression.
  2. Identify when bereaved individuals with depressive symptoms should be treated.
  3. Assemble an evidence-based treatment approach to bereavement-related depression.

Bereavement, the grief following the death of a loved one, is an unfortunately common yet excruciatingly painful human experience. Each year more than 8 million Americans encounter the death of a close family member. Two months after the death, about 20% of these grieving individuals (about 1.6 million people) meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for major depressive episode (MDE). Yet many clinicians are uncertain about whether and how to treat bereavement-related MDE. In large part, this uncertainty is due to diagnostic ambiguities and symptomatic overlap between bereavement and MDE, a quandary similar to debilitating medical illness where symptoms such as fatigue, low energy, or anorexia, overlap with symptoms of MDE.

ABOUT THE AUTHORS

Tracey Auster, BA, is with Harvard Medical School/Beth Israel Medical Center, Boston, MA. Christine Moutier, MD; Nicole Lanouette, MD; and Sidney Zisook, MD, are with University of California, San Diego School of Medicine, San Diego, CA.

Address correspondence to: Sidney Zisook, MD, 9500 Gillman Drive, 116A, La Jolla CA 92093.

Ms. Auster, Dr. Moutier, and Dr. Lanouette have disclosed no relevant financial relationships. Dr. Zisook has disclosed the following relevant financial relationships: Aspect and PamLab: Research grant support; and AstraZeneca and GlaxoSmithKline: Speakers’ bureau.

EDUCATIONAL OBJECTIVES

  1. Differentiate “normal” bereavement from bereavement-related major depression.
  2. Identify when bereaved individuals with depressive symptoms should be treated.
  3. Assemble an evidence-based treatment approach to bereavement-related depression.

10.3928/00485713-20081001-01

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