Complicated grief is prolonged grief and an area of interest of this group, who have done a reasonable, factorial trial. There is double randomization: to a medication (Citalopram:CIT) or placebo (PLA) and to complicated grief therapy (CGT) or usual care. I’m going to quote from the abstract, and a graph which shows two scales: a clinical global impression scale for grief. and the Quick Depression scale (the QDS). CG. although my initials, here means complicated grief.

Interventions All participants received protocolized pharmacotherapy optimized by flexible dosing, psychoeducation, grief monitoring, and encouragement to engage in activities. Half were also randomized to receive manualized CGT in 16 concurrent weekly sessions.

Main Outcomes and Measures Complicated grief–anchored Clinical Global Impression scale measurements every 4 weeks. Response was measured as a rating of “much improved” or “very much improved.”

Results Of the 395 study participants, 308 (78.0%) were female and 325 (82.3%) were white. Participants’ response to CGT with PLA vs PLA (82.5% vs 54.8%; relative risk [RR], 1.51; 95% CI, 1.16-1.95; P?=?.002; number needed to treat [NNT], 3.6) suggested the efficacy of CGT, and the addition of CIT did not significantly improve CGT outcome (CGT with CIT vs CGT with PLA: 83.7% vs 82.5%; RR, 1.01; 95% CI, 0.88-1.17; P?=?.84; NNT, 84). However, depressive symptoms decreased significantly more when CIT was added to treatment (CGT with CIT vs CGT with PLA: model-based adjusted mean [standard error] difference, ?2.06 [1.00]; 95% CI, ?4.02 to ?0.11; P?=?.04). By contrast, adding CGT improved CIT outcome (CIT vs CGT with CIT: 69.3% vs 83.7%; RR, 1.21; 95% CI, 1.00-1.46; P?=?.05; NNT, 6.9). Last, participant response to CIT was not significantly different from PLA at week 12 (45.9% vs 37.9%; RR, 1.21; 95% CI, 0.82-1.81; P?=?.35; NNT, 12.4) or at week 20 (69.3% vs 54.8%; RR, 1.26; 95% CI, 0.95-1.68; P?=?.11; NNT, 6.9). Rates of suicidal ideation diminished to a substantially greater extent among participants receiving CGT than among those who did not.

Conclusions and Relevance Complicated grief treatment is the treatment of choice for CG, and the addition of CIT optimizes the treatment of co-occurring depressive symptoms.

I am not sure if the authors are showing clinical differences except with their therapy, and then I am uncertain. I know that measurement of a phenomena and good clinical care leads to improvement: this is often called the “placebo effect”. In trials, one controls for it, but in clinical work one uses it, for that is why Doctor Kildare (who has superb bedside skills) gets good results while his colleague Dr Igor House (who has the patient manner of a troll) does not.

I also know that if Dr Kildare or Dr House stick to a manual when doing therapy they will both get better results.

What I am unsure about is if the differences between these groups are meaningful. I do know that depression hunts with loss. But the concept of complicated grief is fuzzy: between a normal and universal reaction, traumatic problems and mood problems. My concern is that we may be turning what should be a job for the padre and the family into another psychiatric condition.

We have too many of them already.

You cannot medicalize all suffering, for it is inevitable: in this life the mortality rate remains 100%.