FDA-Approved Medications for Prolonged Grief Disorder
There are currently no FDA-approved medications specifically for prolonged grief disorder (PGD). The FDA has not granted approval for any pharmacological agent to treat this condition, which was only recently codified as a distinct diagnostic entity in ICD-11 and DSM-5-TR 1, 2.
Evidence-Based Treatment Approach
First-Line Treatment: Psychotherapy
Cognitive-behavioral therapy (CBT) specifically targeting grief should be the primary treatment for PGD, as it demonstrates the most robust evidence for efficacy 1, 2, 3.
- Prolonged grief-specific CBT (PG-CBT) shows large effect sizes (Cohen's d=1.61 in treatment completers, d=1.32 in intent-to-treat analysis) with acceptable dropout rates (21% in one trial) 4
- Treatment typically consists of 20-25 individual sessions over approximately 6 months 4, 5
- Third-wave CBT demonstrates statistically significant reductions in grief symptoms (SMD=-1.00; 95% CI=-1.41, -0.58) and is particularly effective for secondary outcomes including depression (SMD=-0.60), PTSD (SMD=-0.99), and anxiety (SMD=-1.44) 2
Alternative Psychotherapy Options
When PG-CBT is unavailable, consider these alternatives in descending order of efficacy 2:
- Behavioral therapy (SMD=-1.05; 95% CI=-1.71, -0.38)
- Family therapy (SMD=-0.87; 95% CI=-1.59, -0.16)
- Psychodynamic therapy (SMD=-0.88; 95% CI=-1.67, -0.10)
- Standard cognitive therapy (SMD=-0.84; 95% CI=-1.57, -0.12)
Role of Pharmacotherapy
Antidepressant medication may serve as a useful adjunctive treatment to grief-specific psychotherapy, particularly for:
- Facilitating completion of grief therapy 1
- Reducing bereavement-related depression when present as a comorbid condition 1
- Managing comorbid symptoms (patients with PGD average 2.5 comorbid diagnoses) 4
SSRIs, particularly sertraline, should be considered when pharmacotherapy is indicated, as they have demonstrated safety in patients with psychological distress and minimal cardiovascular toxicity 6, 7.
Critical Clinical Considerations
When to Treat vs. When to Observe
Do not deploy grief therapy as a universal intervention for all bereaved individuals 1, 3:
- Grief therapy is efficacious only when targeted to individuals with persistent and elevated levels of distress 1
- Universal grief interventions show minimal to no benefits for adults or children 1
- Reserve treatment for those meeting diagnostic criteria for PGD (severe, persistent, and disabling grief) 1, 2
Common Pitfalls to Avoid
- Avoid prescribing medication as monotherapy without concurrent grief-specific psychotherapy, as there is no evidence supporting pharmacotherapy alone for PGD 1, 2
- Do not use benzodiazepines for anxiety management in elderly patients with grief, as they increase fall risk and anticholinergic burden 7
- Avoid tricyclic antidepressants due to cardiovascular toxicity including QTc prolongation and orthostatic hypotension 6, 7
Monitoring and Follow-up
When using adjunctive antidepressants 6:
- Allow up to 6 weeks for SSRI effects to manifest
- Monitor blood pressure in patients taking sertraline
- Screen for drug interactions, particularly with cardiovascular medications
- Assess for treatment-emergent suicidal ideation, especially in younger patients