Evaluating Optimal Therapy for Complicated Grief
Data from the first randomized clinical trial evaluating the efficacy of antidepressants with or without complicated grief psychotherapy for the treatment of complicated grief showed that adding citalopram to complicated grief treatment (CGT) helped treat concurrent depressive symptoms. Findings from the study were published in JAMA Psychiatry.
Researchers conducted a study to confirm the efficacy of targeted CGT by determining whether citalopram enhanced CGT outcome and evaluating the efficacy of citalopram without CGT. The study included 395 bereaved adults enrolled between March 2010–September 2014; those with concurrent substance abuse, psychosis, mania, and cognitive impairment were excluded. Study patients were randomized into groups that were prescribed citalopram, placebo, CGT plus citalopram, or CGT plus placebo.
All study patients received pharmacotherapy optimized by flexible dosing, psychoeducation, grief monitoring, and encouragement to engage in activities. One-half of the patients were further randomized to receive CGT in 16 concurrent weekly sessions. Every 4 weeks, the Complicated grief-anchored Clinical Global Impression scale was measured with ratings of "much improved" or "very much improved."
The results suggested the efficacy of CGT based on patients' response to CGT plus placebo vs. placebo (82.5% vs. 54.8%; relative risk [RR] 1.1, 95% CI: 1.16–1.95; P=0.002). Adding citalopram did not significantly improve CGT outcome (83.7% [CGT plus citalopram] vs. 82.5% [CGT plus placebo]; RR 1.01, 95% CI: 0.88–1.17; P=0.84) but depressive symptoms did decrease significantly more when it was added (CGT pus citalopram vs. CGT plus placebo adjusted mean difference -2.06, 95% CI: -4.02 to -0.11; P=0.04).
Study authors also noted that adding CGT enhanced citalopram outcomes when compared to citalopram alone (83.7% vs. 69.3%; RR 1.21, 95% CI: 1.00–1.46; P=0.05). Patients' response to citalopram did not significantly differ from placebo at Week 12 (45.9% vs. 37.9%; RR 1.21, 95% CI: 0.82–1.81; P=0.35) or at Week 20 (69.3% vs. 54.8%; RR 1.26, 95% CI: 0.95–1.68;P=0.11). there was also a substantially greater decrease in rates of suicidal ideation among patients receiving CGT vs. those who did not.
The findings from the study support CGT as the treatment of choice for complicated grief, and adding citalopram helped treat the concurrent depressive symptoms.
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