The lead Editorial in this week's Lancet expresses concerns about the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association. Whilst previous editions of DSM have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder, the current draft of this fifth edition fails to do that. The Editorial says: "In the draft version of DSM-5, however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction."
The Editorial adds: "Medicalising grief, so that treatment is legitimised routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed. The evidence base for treating recently bereaved people with standard antidepressant regimens is absent."
Also highlighted in the Editorial is WHO's International Classification of Diseases, currently under revision as ICD-11. The WHO team behind this latest revision are debating a proposal to include a category on "prolonged grief disorder".
The Editorial says: "Bereavement is associated with adverse health outcomes, both physical and mental, but interventions are best targeted at those at highest risk of developing a disorder or those who develop complicated grief or depression, rather than for all."
It concludes: "Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. Putting a timeframe on grief is inappropriate—DSM-5 and ICD-11 please take note. Occasionally, prolonged grief disorder or depression develops, which may need treatment, but most people who experience the death of someone they love do not need treatment by a psychiatrist or indeed by any doctor. For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills."
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The Lancet