To The Editor: The syndrome of complicated grief is not formally recognized in DSM-IY but it is associated with significant functional impairment and distress (1). A grief-focused psychotherapy, complicated grief therapy, recently demonstrated efficacy for complicated grief in a randomized ctAitrolled trial (1). To our knowledge, there are no randomized controlled trials of pharmacotherapy for complicated grief. An open-label study of paroxetine in combination with a version of complicated grief therapy did not allow determination of medication efficacy beyond that of psychotherapy on grief symptoms (2). Open-label bupropion showed modest effects for grief (3), but nortriptyline demonstrated no significant effect on grief in open-label (4) and randomized controlled trial (5} studies of bereavement-related depression. We prospectively examined four individuals with a primary diagnosis of complicated grief (defined as a score of >25 on the Inventory of Complicated Grief >6 months after the death of a loved one} in a 10-week pilot study of open-label escitalopram. The institutional review board of Massachusetts General Hospital approved the study. Participants gave written informed consent and received escitalopram flexibly in doses of 10 to 20 mg daily.
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