4.2 Using antidepressants for grief
In addition to tranquilisers, antidepressant medication may be considered when a person approaches a doctor for help following bereavement. Prescribing doctors may feel under pressure to ‘do something’ to help the person who presents to them. Neither party may be aware of other options that may be effective in helping in these potentially difficult situations. Indeed, local support groups, psychotherapy, counselling and other possible alternatives may not be readily available.
Undoubtedly, there are pressures from some of the people, both bereaved and non-bereaved, who consult their doctors for the swift prescription of antidepressants. Mildred Reynolds, from the US organisation National Depressive and Manic-Depressive Association, relates her experience in getting effective medication for her problems:
out of desperation I consulted a psychiatrist who had done research at the National Institute of Mental Health.
At the first session, he told me that I had depression and that he thought medication would help. Furthermore, if the first one didn't work, there were others we could try. What a relief to hear that I was not just a ‘weak person’ as I feared, but that my problem was a medical illness, had a diagnosis, and could be treated. It gave me hope.
(Reynolds, 2002, p. 150)
In the doctor's mind there may be other pressures to prescribe antidepressants. Certainly, the general consensus is that many doctors quite frequently miss the signs and symptoms of treatable depression, especially in older people who present to them (Iliffe, 2005), and can sometimes overcompensate by prescribing medication to others, including bereaved people. Furthermore, many doctors are taught to treat the people who come to them for help by using guidelines that are based on apparently reductionist models of the human condition. The typical chain of events is: a person presents with certain symptoms; the symptoms are matched against formal diagnostic criteria; a ‘rational’ and unquestioning drug-based treatment regime is prescribed as the logical outcome. A typical example from a medical text states:
Management of late-life depression involves similar approaches to younger adults, although older people may take longer to respond. SSRIs [a common type of antidepressant medication] should be used as first-line treatment and lithium augmentation and electroconvulsive therapy are efficacious in those who do not respond after switching to an alternative antidepressant.
(Thomas and O'Brien, 2006, p. 127)
Activity 5: Are antidepressants helpful for grief?
Read the following case study and make notes in answer to the questions below it.
Indrajit and Heera
Indrajit's wife, Heera, died suddenly after a long-term chronic degenerative illness. They had married more than 25 years previously when Indrajit was 21. He was extremely shy and had depended on Heera's outgoing nature. They had two grown-up children who lived away from home.
After Heera's death, Indrajit was left alone for the first time in his life and found it extremely difficult to cope, despite the support from his and Heera's families. After five months he was still inconsolable. He was unable to work, could not sleep and spent most of the day just sitting in his kitchen, often in tears. His family thought that he needed help and persuaded him to see his GP, who prescribed an antidepressant, paroxetine.
Why do you think that Indrajit's GP prescribed an antidepressant?
How effective do you think this treatment would be?
Although this case study is very brief, it does appear that the GP was keen to provide a quick ‘remedy’ to the problems that Indrajit presented. In fact, most doctors would consider a diagnosis of depression if the person presents with a cluster of symptoms similar to those presented by Indrajit.
However, it may also be true that Indrajit was simply reacting normally to a stressful event, the death of his wife. Unfortunately, the doctor may be confusing the expression of grief in response to bereavement with symptoms that are a diagnostic pointer to an episode of serious depression. The symptoms may be the same, but the personal story that is the background to the symptoms will give all the necessary clues to differentiate between the two situations.
Although bereavement and other serious social events can trigger depression (Brown and Harris, 1978), there is no evidence that antidepressant medication has any positive effect on the experience of grief immediately following a bereavement (Wakefield et al., 2007). Evidently, one of the problems that arises is grief being mistaken for something else.