A Study of Medication With or Without Psychotherapy for Complicated Grief

NCT ID: NCT01179568

Last Updated: 2017-01-24

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

395 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-03-31

Study Completion Date

2015-07-31

Brief Summary

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The major goal of this 4-site, double blind, placebo-controlled intervention trial is to assess the efficacy of medication (Citalopram) alone or with psychotherapy (Complicated Grief Therapy) to treat the symptoms of complicated grief.

Detailed Description

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Complicated grief (CG) is a debilitating condition that is estimated to affect millions of people in the United States alone. We conducted the first randomized controlled study to address this condition (MH60783) and confirmed efficacy of a targeted psychotherapy, complicated grief treatment (CGT). Participants in our prior study continued stable antidepressant medication while receiving CGT or Interpersonal Psychotherapy (IPT). Individuals taking antidepressants had better outcome in both treatments, though CGT was superior to IPT when administered with (60% responders v. 40%) or without (42% v.19%) antidepressants. Studies of antidepressant medication alone have shown mixed results with SSRIs appearing to be promising. However, there has been no randomized controlled study of SSRIs for CG. Determining the efficacy of SSRI treatment for CG, when administered with and without CGT, is of great public health importance.

We assembled 4 groups of investigators with strong track records in bereavement research and extensive experience with intervention studies and multicenter projects, to conduct a study of citalopram (CIT) efficacy. We plan to enroll participants with a primary diagnosis of Complicated Grief and randomly assign them (n=480; 50 at Columbia) to receive treatment with CIT, Placebo (PBO), CIT + CGT or PBO + CGT over a period of approximately 16 weeks. We want to determine whether citalopram shows a better response than placebo, when administered either with or without CGT. We will also address the question of whether CIT performs as well when administered alone as it does when administered with CGT.

Conditions

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Complicated Grief Bereavement

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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CGT with Citalopram

Targeted psychotherapy for complicated grief will be combined with SSRI medication.

Group Type ACTIVE_COMPARATOR

Citalopram

Intervention Type DRUG

16 weeks of medication provided flexibly up to 40 mg/day. Medication will be administered in a double-blind fashion.

Complicated Grief Treatment

Intervention Type BEHAVIORAL

Complicated Grief Treatment (CGT) is a targeted psychotherapy for complicated grief. The treatment integrates principles, strategies and techniques from interpersonal psychotherapy, trauma-focused cognitive behavioral treatment and motivational interviewing. Treatment includes 16 sessions provided within 20 weeks.

Citalopram

Citalopram is an Selective Serotonin Reuptake Inhibitor (SSRI) medication. It will be combined with grief-focused clinical management.

Group Type ACTIVE_COMPARATOR

Citalopram

Intervention Type DRUG

16 weeks of medication provided flexibly up to 40 mg/day. Medication will be administered in a double-blind fashion.

Placebo (Sugar pill)

Inactive medication. It will be combined with grief-focused clinical management.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

16 weeks of daily inactive medication. It will be administered in a double-blind fashion.

CGT with Placebo

The targeted psychotherapy for complicated grief will be combined with inactive medication.

Group Type ACTIVE_COMPARATOR

Complicated Grief Treatment

Intervention Type BEHAVIORAL

Complicated Grief Treatment (CGT) is a targeted psychotherapy for complicated grief. The treatment integrates principles, strategies and techniques from interpersonal psychotherapy, trauma-focused cognitive behavioral treatment and motivational interviewing. Treatment includes 16 sessions provided within 20 weeks.

Placebo

Intervention Type OTHER

16 weeks of daily inactive medication. It will be administered in a double-blind fashion.

Interventions

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Citalopram

16 weeks of medication provided flexibly up to 40 mg/day. Medication will be administered in a double-blind fashion.

Intervention Type DRUG

Complicated Grief Treatment

Complicated Grief Treatment (CGT) is a targeted psychotherapy for complicated grief. The treatment integrates principles, strategies and techniques from interpersonal psychotherapy, trauma-focused cognitive behavioral treatment and motivational interviewing. Treatment includes 16 sessions provided within 20 weeks.

Intervention Type BEHAVIORAL

Placebo

16 weeks of daily inactive medication. It will be administered in a double-blind fashion.

Intervention Type OTHER

Other Intervention Names

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Celexa CGT Sugar pill

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with Complicated Grief and this is the patient's most important (primary) problem
* Ability to give informed consent
* Fluent in English
* Willingness to have sessions audiotaped
* Willingness to undergo random assignment

Exclusion Criteria

* Diagnosis of one or more of the following disorders: Schizophrenia or other psychotic disorder, current (past 6 months) substance abuse, Bipolar Disorder, current manic episode, Dementia
* Pregnant or lactating women and women of childbearing potential not using medically accepted forms of contraception
* Acute, unstable or severe medical illness such as (but not limited to) stroke, epilepsy, or other neurodegenerative disorders, metastatic or active cancer, hepatic disease, or primary renal disease requiring dialysis
* Prior intolerance of citalopram
* Pending or active disability claim or lawsuit related to the death
Minimum Eligible Age

18 Years

Maximum Eligible Age

95 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

American Foundation for Suicide Prevention

OTHER

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Katherine Shear, MD

Role: PRINCIPAL_INVESTIGATOR

Columbia University

Locations

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VASDHS / University of California San Diego

San Diego, California, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

New York State Psychiatric Institute

New York, New York, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

References

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Simon NM, Thompson EH, Pollack MH, Shear MK. Complicated grief: a case series using escitalopram. Am J Psychiatry. 2007 Nov;164(11):1760-1. doi: 10.1176/appi.ajp.2007.07050800. No abstract available.

Reference Type BACKGROUND
PMID: 17974946 (View on PubMed)

Shear K, Frank E, Houck PR, Reynolds CF 3rd. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005 Jun 1;293(21):2601-8. doi: 10.1001/jama.293.21.2601.

Reference Type BACKGROUND
PMID: 15928281 (View on PubMed)

Schwartz D, Lellouch J. Explanatory and pragmatic attitudes in therapeutical trials. J Chronic Dis. 1967 Aug;20(8):637-48. doi: 10.1016/0021-9681(67)90041-0. No abstract available.

Reference Type BACKGROUND
PMID: 4860352 (View on PubMed)

Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003 Sep 24;290(12):1624-32. doi: 10.1001/jama.290.12.1624.

Reference Type BACKGROUND
PMID: 14506122 (View on PubMed)

Jacobs SC, Nelson JC, Zisook S. Treating depressions of bereavement with antidepressants. A pilot study. Psychiatr Clin North Am. 1987 Sep;10(3):501-10.

Reference Type BACKGROUND
PMID: 3684751 (View on PubMed)

Shear MK. Clinical practice. Complicated grief. N Engl J Med. 2015 Jan 8;372(2):153-60. doi: 10.1056/NEJMcp1315618. No abstract available.

Reference Type BACKGROUND
PMID: 25564898 (View on PubMed)

Calderon A, Irwin M, Simon NM, Shear MK, Mauro C, Zisook S, Reynolds CF 3rd, Malgaroli M. Depression is Associated with Treatment Response Trajectories in Adults with Prolonged Grief Disorder: A Machine Learning Analysis. medRxiv [Preprint]. 2024 Dec 12:2024.12.11.24318861. doi: 10.1101/2024.12.11.24318861.

Reference Type DERIVED
PMID: 39711702 (View on PubMed)

Na PJ, Adhikari S, Szuhany KL, Chen AZ, Suzuki RR, Malgaroli M, Robinaugh DJ, Bui E, Mauro C, Skritskaya NA, Lebowitz BD, Zisook S, Reynolds CF 3rd, Shear MK, Simon NM. Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder. J Clin Psychiatry. 2021 Apr 20;82(3):20m13576. doi: 10.4088/JCP.20m13576.

Reference Type DERIVED
PMID: 34000119 (View on PubMed)

Zisook S, Shear MK, Reynolds CF, Simon NM, Mauro C, Skritskaya NA, Lebowitz B, Wang Y, Tal I, Glorioso D, Wetherell JL, Iglewicz A, Robinaugh D, Qiu X. Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report. J Clin Psychiatry. 2018 Mar/Apr;79(2):17m11592. doi: 10.4088/JCP.17m11592.

Reference Type DERIVED
PMID: 29617064 (View on PubMed)

Shear MK, Reynolds CF 3rd, Simon NM, Zisook S, Wang Y, Mauro C, Duan N, Lebowitz B, Skritskaya N. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry. 2016 Jul 1;73(7):685-94. doi: 10.1001/jamapsychiatry.2016.0892.

Reference Type DERIVED
PMID: 27276373 (View on PubMed)

Related Links

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http://www.healstudy.org

Complicated Grief Research Group at University of Pittsburgh Medical Center

http://www.complicatedgrief.org/

Complicated Grief Program at Columbia University, New York

Other Identifiers

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R01MH060783

Identifier Type: NIH

Identifier Source: secondary_id

View Link

5971

Identifier Type: -

Identifier Source: org_study_id

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