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Background: Approximately 8 million Americans suffer the loss of an immediate family member each year. Chronic depression may develop following bereavement-about 15% of the bereaved are depressed at 1 year. Several studies of psychotropic medications have demonstrated improvement in depression ratings, but little data exists for selective serotonin reuptake inhibitor treatment in bereavement-related depression., Methods: Thirty adults were treated with escitalopram for 12 weeks in open fashion for a major depressive episode following loss of a close family member (parent, sibling, child, or spouse/significant other). Main outcome measures were the Hamilton Depression Rating Scale, the Montgomery-Asberg Rating Scale, the Texas Revised Inventory of Grief, and the Inventory of Complicated Grief., Results: Twenty-nine of thirty participants returned for at least one set of efficacy measures after starting medication. Nineteen subjects (66%) experienced a 50% or greater improvement on the Hamilton Depression Scale. Fifteen subjects (52%) achieved remission, defined as a final score of 7 or less on the Hamilton Depression Scale. Escitalopram significantly reduced depressive symptoms (P<0.001) over time. Subjects with uncomplicated grief and those with complicated grief improved similarly over time. Subjects with and without PTSD improved to a similar degree. Escitalopram was well tolerated., Limitations: Open-label design, psychotherapy was not controlled, relatively short treatment period, variation in grief scales make comparisons to other studies difficult, all subjects with complicated grief also were clinically depressed, and gender discrepancy of sample., Conclusions: Escitalopram improved depressive, anxiety, and grief symptoms in individuals experiencing a major depressive episode related to the loss of a loved one.

The article explains why the bereavement exclusion was initially introduced in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and carried over into a revision of DSM-III (DSM-III-R), the fourth edition of DSM (DSM-IV) and a text revision of DSM-IV (DSM-IV-R), based on a series of studies of the bereaved. Depression in widows and widowers as compared with married adults are tackled as well as the differences between bereavement and major depression.

The article discusses the signs, symptoms and course of bereavement. It differentiates bereavement, grief, mourning, and complicated grief. The three stages of bereavement as numbness, depression and recovery are defined. Different studies of the bereaved discussing symptoms, psychiatric disorders, mortality and special groups with situational factors reportedly help discern those who need prompt clinical intervention.

The article discusses bereavement-related depression issues faced by clinicians and whether, when and how to intervene. Identification and facilitating healthy, adaptive mourning, and recognizing and treating are mental health agenda for bereavement. It references a study bereavement studies and bereaved people requiring treatment. Understanding the symptoms and course of adaptive grief and the occurrence of significant complications of grief are considered important in clinical management of bereaved people.

The article offers clinical information on bereavement-related depression in older people. Bereavement is defined as the reaction to a loss by death, which is characterized with anger, painful emotions and preoccupation with thoughts of the deceased. A study found that bereavement can lead to chronic depressive syndrome in older people. Therapeutic approaches for bereavement-related depression include psychotherapy and pharmacotherapy.

This is a 13-month follow-up study of 105 two to 17 year-old children bereaved of one parent, with 85 controls. Data were gathered on physical and mental health in the children and surviving parents, the child's sex and age and the bereaved parent's sex and psychopathology being included as risk factors. Dysphoria, falling school performance and withdrawn behaviour were significantly increased in bereaved children of both sexes at all ages, while temper tantrums, bedwetting and the depressive syndrome only increased in the age and sex categories normally associated with these conditions. A global index of psychopathology was increased compared with controls on most subgroups of bereaved children (P less than 0.0001), the highest scores for both sexes being associated with having a mentally ill (usually depressed) widowed mother. The results are discussed and suggestions made for future research. [ABSTRACT FROM AUTHOR]

The article examines the condition of 109 widows and widowers one year after the death of their spouses. The researchers aim to clarify the natural history of widowhood depression. According to the authors, short interviews were administered to the subjects to gather and examine variables pertaining to the objectives of the study. The proponents consider some symptoms for depression diagnosis including loss of appetite, sleep difficulties, fatigue, and agitation or retardation. Base on the results of the study, the authors conclude that grief is not a model for psychotic depression.

An abstract of the article "The Depression of Widowhood," by Paula J. Clayton, James A. Halikas and William L. Maurice. A group of 109 selected widows and widowers with an average age of 61 were studied one month after the death of their spouses. Bereaved persons with reactive depression was compared with fewer depressive symptoms. After the observation, the result shows that few differences were found and most were related to the diagnosis of depression in one group.