Citalopram May Offer Limited Benefit for Patients Experiencing Complicated Grief

Use of citalopram alone or in combination with psychotherapy for complicated grief (CG) may do little to help patients experiencing the persistent maladaptive thoughts, dysfunctional behaviors, and poorly regulated emotionality that characterize this chronic condition, according to findings published today in JAMA Psychiatry. However, a combination of citalopram and complicated grief therapy (CGT) may lead to improvements in patients with complicated grief and co-occurring depression. 

Although it is common for patients with CG to experience co-occurring depressive symptoms, the primary symptoms of CG and response to treatment differ from that of major depression. For instance, past studies have found patients with CG respond better to psychotherapy that targets adaptation to loss than interpersonal psychotherapy, which has well-documented efficacy for depression. However, it is unknown whether antidepressant treatment might enhance the efficacy of CGT or lead to similar outcomes without CGT.

To determine the effectiveness of citalopram alone or in combination with complicated grief treatment, Katherine Shear, M.D. (pictured above), a professor of psychiatry at the Columbia University College of Physicians and Surgeons, and colleagues randomly assigned 395 bereaved adults who met criteria for complicated grief (defined as 30 points or higher on the Inventory of Complicated Grief [ICG]) to one of four groups: citalopram only (CIT, median dose 40 mg for 12 weeks), placebo only, combined CGT and citalopram treatment, or CGT and placebo treatment. Follow-up assessments took place at 4, 8, 12, 16, and 20 weeks after the first treatment visit and 6 months after study treatment termination.

The authors found patients who received CGT with placebo showed greater improvements than those who received placebo alone (82.5% vs. 54.8%). However, the addition of citalopram was not found to significantly improve CGT outcome (CGT with CIT vs. CGT with placebo: 83.7% vs. 82.5%). However, depressive symptoms decreased significantly more with CGT when CIT was added (CGT with CIT vs. CGT with placebo: Quick Inventory Depressive Symptoms mean difference, −2.06).

“CG is a serious, prevalent, and frequently chronic and debilitating condition that needs to be recognized and treated,” the researchers noted. “Our results support the use of antidepressants in conjunction with CGT for relief of co-occurring depressive symptoms. When CGT is unavailable, CGT-informed supportive clinical management with or without antidepressants may be a helpful approach.”

For related information, see the Psychiatric News article “Progress Being Made at Understanding, Treating Complicated Grief.”

(Photo Courtesy of Columbia University Medical Center)