Question from a Reader: About four weeks ago, I came off an antidepressant which allowed the unresolved grief issues over my brother’s death to surface. I believe that the antidepressant kept me from fully grieving his loss, which I am in the process of doing now.  A colleague, therapist, and good friend who has known me over the years knows exactly where I am and says perhaps just a small dosage of an antidepressant (not the one that I was on) could be beneficial until resolution and integration is accomplished.  I see my M.D. on Monday to explain what has been going on, and to get a med check (I am also on a thyroid medication). I seem to be doing well and don’t really want to take any more meds.  I would appreciate any advice in this respect.

My response: Since your physician knows your personal health history, he or she is in a better position to evaluate your need for medication, but I think you are wise to arm yourself with some useful information before meeting with your doctor on Monday.  Keep in mind, too, that while M.D.s are qualified to prescribe medications, not all physicians are knowledgeable about grief and the normal mourning process.  In his classic text, Grief Counseling and Grief Therapy, grief expert J. William Worden notes,

There has been much discussion among mental health professionals about the use of medication in the management of acute, normal grief. The consensus is that medication ought to be used sparingly and focused on giving relief from anxiety or from insomnia as opposed to providing relief from depressive symptoms . . . It is usually inadvisable to give antidepressant medications to people undergoing an acute grief reaction. These anti-depressants take a long time to work, they rarely relieve normal grief symptoms, and they could pave the way for an abnormal grief response, though this has yet to be proved through controlled studies. The exception would be in cases of major depressive episodes. Psychiatrist Beverly Raphael (2001) affirmed that, although our psychological understandings of bereavement have increased, there is not yet a good basis for biological intervention. Pharmacological approaches should, for the most part, only be provided where there is an established disorder for which they are indicated. I would concur with this (pp. 70-71).

In 1989, an Institute of Medicine Committee for the Study of Health Consequences of the Stress of Bereavement stated that it did not recommend the use of anti-depressants “for individuals whose grief remains within the normal bounds of intensity and duration.”

Notice that both these references speak about normal grief, or grief within the normal bounds of intensity and duration. Normal grief is neither an illness nor a pathological condition; it is a normal response to losing a loved one. However, since we all are unique human beings with our own individual backgrounds and experiences, what is normal can vary considerably from one griever to the next, and how our grief is expressed will vary as well.

Everyone grieves differently according to their age, gender, personality, culture, value system, past experiences with loss, and available support.  How you react to your brother’s death depends on how you’ve reacted to other crises in your life; on what was lost when this death happened (e.g., who you were in your relationship with your brother); on who died (i.e., what your brother meant to you and the role he played in your life); on when his death occurred (at what point in your life cycle as well as his); and on how (the circumstances surrounding his death, and how his death occurred).

As you probably already know, whether a person is grieving or not, using medications for sleeplessness, depression and/or anxiety involves certain risks, such as impaired motor coordination and mental acuity. Drug dependence, especially when drugs are taken in combination with alcohol, is also a risk. Be sure to ask your physician about any potential side effects and/or drug interactions, to avoid aggravating existing problems or creating new ones.

Before discussing  all of this with your doctor, you may find it helpful to review these articles as well:

Interview, Are We Medicating Normal Grief?

When and How to Use Medicine for Grief

You can also read a very personal account of one woman’s experience with antidepressants (and the comments it generated) in this entry on the Widow’s Voice Blog, Honest to a Fault .

Whether you decide with your doctor to continue taking medication or not, I also encourage you to educate yourself about the grief process, because your grief journey will feel so much safer and more predictable, you’ll understand yourself better, and you’ll feel less “crazy” and afraid. Visit my Grief Healing  website and some of the links listed on my Death of a Sibling page.

Using the search engine at the top of Open to Hope‘s Web page, type in the words “sibling loss” and see what articles come up for you.  Read and learn about bereavement through books, articles, audiotapes, seminars, workshops, classes and support groups. Visit sites specifically aimed at adults whose siblings have died, such as Adult Sibling Grief. Such activities expose you to models of survival and growth, and can give you hope that you can make it through this, too.

I hope this information proves useful to you, my dear, and for the loss of your beloved brother, you have my deepest sympathy.

© 2010 by Marty Tousley, RN, MS, FT, DCC