Rare but real complicated grief proves debilitating

Editor's note: An earlier version of this article appeared on News Break.

When someone close to us dies, we are expected to grieve.

For a while. But then we are expected to get over it.

Putting a timeline on a person’s grieving process is impossible. Someone who loses a father they never spent much time with is not going to grieve the same as someone who loses their dad after providing direct care to them for many years.

Now research validates a rare condition called "complicated grief." The research, published in Annals of Internal Medicine, explains how those afflicted may suffer for extended periods. Symptoms are different from depression.

The study demonstrates the use of antidepressants is not necessary for treating complicated grief unless the patient has a co-occurring depressive disorder.

Father’s final years filled with angst, trauma, sadness

The grieving I experienced since my father’s death in 2015 has been complicated. I became homeless for a couple of years.

I experienced great trauma during my father’s dying process.

My dad died an unthinkable death. He was ravaged by strokes and seizures the final hours of his life. There was nothing doctors could do for him. It is the course that frontotemporal degeneration sometimes takes, and it isn’t always peaceful.

Had I not asked the state to intervene, I never would have seen my dad again. The cold-as-ice memory care facility trespassed me after I complained about dad’s care.

Private-pay facilities that do not receive Medicare/Medicaid funds can do whatever they want. They have been known to trespass powers of attorney who complain too much.

According to testimony from workers on duty one morning, my dad lay in a pool of blood for several hours. A massive amount of blood was lost during a spill of unknown circumstances. He finally was found by a nurse coming on to first shift.

I remember dad crying in the ER after I had walked there to meet him. I do not own a car because I sold it to pay bills.

His face was covered with blood. “He hit me David. He got me!” He said this in front of the doctor, the social worker, and me. I reported all of it to the state.

When grief begins to interfere with your life

With all of this, I can’t help but wonder: Am I suffering from complicated grief on top of my PTSD diagnosis?

Complicated grief is real. A clinical trial examined the disorder in 395 adults enrolled at academic medical centers in Boston, New York, Pittsburgh, and San Diego.

“Complicated grief occurs in about 7 percent of bereaved individuals and it is characterized by persistent maladaptive thoughts, dysfunctional behaviors and poorly regulated emotions that interfere with the ability to adapt to loss,” JAMA Psychiatry reported.

Co-occurring depressive symptoms are common but complicated grief is different from major depression, the authors explained.

I do not suffer from depression. But I remain angry about how the final year of my dad’s life was handled, and how I was treated as his caregiver.

And I miss my dad very much. Every day.

Journalists have a tough time letting things go, especially when a rotten story involves the center of their universe.

Talk therapy proves best treatment for complicated grief

Complicated grief can range in severity. It usually is treated with talk therapy plus a workbook. The effectiveness appears to be the same even when the patient is not given antidepressants unless a co-occurring major depressive disorder also is an issue.

For someone considered “moderately ill” on a complicated grief scale of four to seven, a four has symptoms “present and intrusive on most days at a level that is painful but bearable,” the researchers wrote.

“There is some interference with activities and relationships, but functioning is not substantially impaired. There may be some avoidance of reminders of the loss. A sense of purpose or meaning is usually present, but there may be confusion about this.

“Suicidal thoughts may be present, but there is usually a desire to live. Distraction is possible temporarily, but symptoms are persistent and clinically significant.”

Complicated grief a 'serious' and 'debilitating' condition

Treatment for complicated grief involves a 16-session protocol. Your therapist may ask you to reimagine situations you had with your loved one. She may even ask you to have a conversation with the deceased.

According to the JAMA Psychiatry report, complicated grief affects tens of millions of people around the world. It can be emotionally crippling.

“Complicated grief is a serious, prevalent, and frequently chronic and debilitating condition that needs to be recognized and treated,” the researchers concluded.

The JAMA Psychiatry paper supported the use of antidepressants when needed, especially in the absence of appropriate psychotherapy.

The antidepressant Citalopram, brand name Celexa, worked best on people suffering from depression before the loss of their loved one.

One of the study’s drawbacks was its homogeneity. Most participants were white, female, and well-educated.

The study’s authors concluded by saying doctors need to familiarize themselves with complicated grief. They called it a very real public health issue.

They also praised the effectiveness of talk therapy. They pointed out a “robust placebo response rate,” hinting therapy made a bigger difference than medication.

Doctors must learn to recognize and treat complicated grief, the authors reported. Only then can they “provide empathic support and gentle encouragement for re-engaging in daily activities.”