Article

A Post Hoc Comparison of Paroxetine and Nortriptyline for Symptoms of Traumatic Grief

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/1998; 59(5):241-5. DOI: 10.4088/JCP.v59n0507
Source: PubMed

ABSTRACT

This report presents the results of an open-trial pilot study of paroxetine for symptoms of traumatic grief, compared with the effects of nortriptyline in an archival contrast group.
Data are presented on 15 subjects (4 men, 11 women), ranging in age from 40 to 79 years (mean age = 57 years), who experienced the loss of a spouse (N = 8), child (N =5), grandchild (N = 1), or parent (N = 1). Subjects were required to have a baseline score on the Inventory of Complicated Grief (ICG) of > or = 20. Treatment with paroxetine began at a median of 17 months (range, 6-139 months) after the loss. Paroxetine-treated subjects received a psychotherapy tailored for traumatic grief. Depressive symptoms were assessed by using the Hamilton Rating Scale for Depression (HAM-D). The ICG and the HAM-D were administered weekly over 4 months of paroxetine treatment (median dose = 30 mg/day). The group receiving paroxetine were then compared with a group (N = 22) participating in a separate trial of nortriptyline (median dose = 77.5 mg/day) for treatment of bereavement-related major depressive episodes.
Level of traumatic grief symptoms (ICG) decreased by 53%, and depression ratings (HAM-D) decreased by 54% in paroxetine-treated subjects. Nortriptyline showed clinical effects comparable to those of paroxetine.
Paroxetine may be an effective agent in the treatment of traumatic grief symptoms. A comparison of the paroxetine-treated group with a nortriptyline-treated group suggests that both agents have comparably beneficial effects on the symptoms of traumatic grief (as well as those of depression). However, the higher rate of diagnostic comorbidity in the paroxetine-treated group, together with the greater chronicity of their symptoms and the greater safety of paroxetine in overdose, leads us to favor paroxetine over nortriptyline for traumatic grief symptoms in general psychiatric practice. Further controlled evaluation of paroxetine for traumatic grief is necessary.

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    • "However, none of them took into account the finding that grief symptoms tend to naturally resolve in time, even without intervention (Neimeyer & Currier, 2009). In addition, one study combined drug treatment with psychotherapy for traumatic grief (Zygmont et al., 1998), making it difficult to determine the impetus for any improvement . Given the limitations noted above, the authors of all four studies called for randomized controlled trials. "
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    ABSTRACT: page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
    Full-text · Dataset · Jan 2014
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    • "However, none of them took into account the finding that grief symptoms tend to naturally resolve in time, even without intervention (Neimeyer & Currier, 2009). In addition, one study combined drug treatment with psychotherapy for traumatic grief (Zygmont et al., 1998), making it difficult to determine the impetus for any improvement . Given the limitations noted above, the authors of all four studies called for randomized controlled trials. "
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    ABSTRACT: There is little evidence to guide the use of psychotropic medications immediately following bereavement. This article presents a review of the relevant literature, followed by a case series on the use of psychotropic medication in traumatically bereaved individuals. Of 20 active subjects, nine had been prescribed psychotropic medication in the days and weeks following a traumatic loss. The amount, type, and timing of medication in this sample is explored and compared to the extant literature. Results suggest that clinical practice may not be guided by empirical research in this area.
    Full-text · Article · Nov 2012 · Journal of Loss and Trauma
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    • "One publication has reported a post-hoc comparison of paroxetine and nortriptyline for the treatment of traumatic grief (an earlier term in the literature for CG). Zygmont et al examined open paroxetine (flexible dosing, 10 mg to 50 mg/day) administered for 16 weeks to 21 individuals with traumatic grief simultaneously participating in a psychotherapy treatment development study.25 Fifteen participants completed at least 6 weeks of medication, and 13 the full course of the trial (16 weeks). "
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    ABSTRACT: Complicated grief (CG) is a common and often under-acknowledged cause of profound impairment experienced after the loss of a loved one. Although both clinical and basic research suggests that pharmacological agents might be of use in the treatment of CG, research on pharmacological approaches to this condition is still scarce. Three open-label trials and one randomized trial on bereavement-related depression suggest that tricyclic antidepressants may be effective, although they may be more efficacious for depressive symptoms than for grief-specific symptoms. Four open-label trials (total number of participants, 50) of selective serotonin reuptake inhibitors (SSRIs) have yielded results, providing very preliminary support that they might be effective in the treatment of CG, both as a standalone treatment and in conjunction with psychotherapeutic interventions. These more recent studies have shown an effect on both depression and grief-specific scales. Furthermore, therapeutic interventions for CG may be more effective in conjunction with SSRI administration. Given the small number of pharmacological studies to date, there is a need for randomized trials to test the potential efficacy of pharmacological agents in the treatment of CG.
    Full-text · Article · Jun 2012
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