A Sydney psychiatrist has questioned expected changes in the DSM-5 which will allow psychiatrists to diagnose major depression in grieving patients only two weeks after their bereavement.

Speaking to Psychiatry Update Professor Gordon Parker of the University of New South Wales said grief was a normal phenomenon that generally did not require medical treatment, whereas clinical depression was a diagnosable mental disorder which responded to various forms of treatment, including drugs.

“By pathologising and medicalising grief and indirectly encouraging doctors to prescribe antidepressants for it, psychiatrists run the risk of losing a lot of our credibility,” he said.

Previous DSM criteria for a major depressive episode had specifically excluded grief states unless symptoms persisted for more than two months or were particularly severe.

In a discu ssion paper published this month in Acta Psychiatrica  Scandinavia, Professor Parker argued that there are major differences between grief and clinical depression.

Grieving people did not have the same problems of self-esteem as the depressed, he noted, and the recurrence rate of major depression in the bereaved was no greater than in the general population.

The bereaved were also less likely to have impaired role functioning or comorbid disorders, he said.

Another distinction was that clinical depression lacked the stages – from initial shock and numbness through to yearning,  anger, guilt and eventual resolution – which were integral to grief.

There were also huge differences in treatment response, he said.

Rather than try to shoehorn grief into the domain of clinical depression, it might be better to go the other way and consider whether many reactive depressive conditions would fit more comfortably within a grief paradigm, Professor Parker suggested.

As first appeared in Psychiatry Update, 4 April 2013