What medication is used to treat bereavement disorder?

Medication for Bereavement Disorder

Bereavement disorder (complicated grief/prolonged grief disorder) does not have a specific FDA-approved pharmacological treatment, and psychotherapy—specifically Complicated Grief Therapy (CGT) or cognitive-behavioral therapy—should be the primary intervention. 1, 2

Primary Treatment Approach

Psychotherapy, not medication, is the evidence-based first-line treatment for complicated grief. The most robust evidence supports:

• Complicated Grief Therapy (CGT) as the gold-standard intervention, which combines acceptance of the loss with adaptation to life without the deceased through seven core therapeutic themes 1
• Cognitive-behavioral therapy (CBT) demonstrates superior long-term outcomes compared to supportive counseling, with moderate to large effect sizes in reducing prolonged grief symptoms 2, 3
• Exposure therapy combined with cognitive restructuring shows the strongest effects when exposure precedes cognitive work (ET + CR sequence) 3

When to Consider Pharmacotherapy

Medications should only be used when comorbid psychiatric conditions are present, not for grief itself:

For Comorbid Major Depression

• SSRIs (fluoxetine, sertraline) are appropriate when bereavement has evolved into a full major depressive episode with vegetative symptoms, suicidal ideation, or functional impairment beyond grief alone 4, 5
• Treatment should follow standard depression protocols: antidepressant plus psychotherapy, with 9-12 months continuation after recovery 4
• The bereaved person typically expects grief symptoms and feels "like themselves," whereas someone with major depression reports feeling "changed" and not their usual self—this distinction guides whether antidepressants are warranted 5

For Comorbid Anxiety Disorders

• Anxiolytics with antidepressants may be considered only when anxiety disorder (not normal grief-related distress) is diagnosed 4
• Avoid benzodiazepines in bereaved individuals due to increased substance use during bereavement and addiction risk 5

Critical Pitfalls to Avoid

• Do not prescribe medications for uncomplicated or even complicated grief alone—there is no rigorous evidence supporting pharmacological treatment of grief symptoms themselves, only for comorbid depression 6
• Do not mistake normal grief symptoms for major depression—bereaved persons may experience depressive symptoms (sadness, sleep disturbance, appetite changes) without meeting criteria for major depressive disorder 5
• Do not use benzodiazepines or sedative-hypnotics as they increase morbidity through substance misuse during this vulnerable period 5
• Do not rely on medication as monotherapy—even when treating comorbid depression, combine with psychotherapy for optimal outcomes 4, 1

Evidence Limitations

The systematic review of bereavement interventions found no consistent pattern of treatment benefit for any intervention except pharmacologic treatment of bereavement-related depression (not grief itself), and even this applies only when full major depressive disorder is present 6. The field suffers from excessive theoretical heterogeneity and methodological limitations 6.

Practical Algorithm

1. Assess for complicated/prolonged grief disorder (intense, prolonged, disabling grief beyond cultural norms)
2. Screen for comorbid major depression (pervasive anhedonia, worthlessness, suicidal ideation, psychomotor retardation)
3. If grief alone: Refer for CGT or CBT-based grief therapy 1, 2
4. If grief plus major depression: Initiate SSRI + psychotherapy 4, 5
5. If grief plus anxiety disorder: Consider SSRI (not benzodiazepines) + psychotherapy 4
6. Monitor substance use (alcohol, sedatives, cigarettes) as morbidity marker 5