The latest revision of the Diagnostic and Statistical Manual of Mental Disorders may put an end to classifying bereavement as something other than depression. The current manual, DSM IV, has what is called a bereavement exemption, which says a person in mourning should not be classified as depressed.
Removing this firewall would allow medical professionals to pursue therapies —pharmaceutical and otherwise — that go along with a depression diagnosis, including anti-depressant medications as well as psychotherapy.
A key point of contention is whether removing the divide will simply mean medicating a condition which does not warrant treatment because it's considered natural, or missing the opportunity to halt depression that needs treatment.
Dr. Cheryl Chessick, director of women's studies and treatment for the University of Colorado School of Medicine's Depression Center, in Aurora, says death can trigger depression in some patients, particularly ones with a predisposition to depression or past experiences and “you want to be on top of it and you don't want to let it fester.”
However, Chessick says it's unlikely ending the bereavement exemption would trigger a spike in anti-depressant purchases, because doctors treat based on symptoms and what's available, be it alternative medicine, talk therapy, pharmaceuticals or a combination.
“It's a little bit like the three bears. You don't want to overtreat it, you don't want to under treat it,” she says.
That said, Chessick says that were doctors to prescribe for grief-induced depression they would be more likely to prescribe SSRis, like Zoloft, as opposed to medications like Seroquel or Abilify which are use to address resistant depression. Chessick also says drug therapy could include sleep aids, as sleeplessness is often linked to depression and anxiety.
University of Louisville's Dr. David Casey says there is room for prescription growth if grief came under the depression label because “when categories expand, more treatment is provided.” However, he says this does not mean more drugs will be prescribed. Casey also says that removing the bereavement exemption will not help doctors determine if a patient is more or less likely to sink into a depression that requires treatment.
“Many psychiatrists use the DSM as a guide but are more influenced by the person sitting in the chair in front of them” he says.
The DSM-5 is slated to be released in May 2013.