Prolonged Bereavement

Bereavement is a profoundly human and virtually universal experience. However, each person experiences grief in a unique way: while some experience little visible change, others face such intense distress that it severely affects their daily lives (Zisook and DeVaul, 1985).

What is prolonged grief?

Prolonged grief, also known as persistent grief disorder or complicated grief, refers to an emotional grief response that remains intense for several months after the death. In addition, this type of loss can aggravate previous conditions such as anxiety, post-traumatic stress disorder or depression, increasing psychological distress and hindering emotional recovery.

Diagnosis and symptoms of prolonged bereavement

According to the latest edition of the International Classification of Diseases (ICD-11) (WHO, 2018), the diagnosis of prolonged bereavement requires that the person experiences persistent longing or preoccupation for the deceased for at least six months after the loss, along with at least one additional symptom such as sadness, guilt, anger, difficulty accepting the death, social isolation or functional impairment.

For its part, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (APA, 2022), recognizes the diagnosis of prolonged bereavement and includes persistent longing or preoccupation for the deceased, plus at least three additional symptoms. However, in order to be diagnosed, twelve months must have elapsed after the loss.

Finally, in recent years, pre-death bereavement has begun to be considered (Wangliu and Che, 2025), which encompasses a picture of symptoms similar to those previously mentioned, with the singularity that it can occur several months before the death of the loved one, especially in those mourners who accompany a family member during a terminal illness.

This lack of academic consensus among diagnostic criteria is a reflection of an unmet need for social and therapeutic support in an increasingly individualistic society, which has lost its cultural habits to sustain the grief process at the family and community level (Mills et al., 2024).

Conventional treatments for prolonged bereavement: are they sufficient?

Pharmacological treatment for prolonged bereavement

To date, there is no strong evidence to support the use of any medication as the sole treatment for the management of prolonged bereavement (Simon and Shear, 2024). However, an increase in the prescription of antidepressants following bereavement has been reported, especially during the first few months after the loss (Ornstein et al., 2020). This underscores the urgent need to develop new therapeutic interventions that truly address the core of suffering in bereavement processes without causing side effects resulting from prolonged use of pharmacotherapy.

Psychotherapeutic treatment for prolonged bereavement

Psychological therapy for prolonged bereavement focuses on both fostering acceptance of the loss and restoring the mourner’s life. The model with the most scientific evidence and that has been shown to be most effective to date is cognitive-behavioral therapy. However, its level of effectiveness is moderate and tends to decrease if the intervention is delivered during the six months following the loss (Komischke-Konnerup et al., 2024). This limitation leaves many mourners unattended during the first months after the death of the loved one, precisely when grief is most acute and manifests itself with greater intensity.

New therapeutic approaches: Psychedelic Assisted Therapy for the treatment of prolonged bereavement

In recent years, interest in understanding and accompanying the processes surrounding the end of life and bereavement has increased significantly, approaching them from different perspectives.

In this context, psychedelic-assisted therapy has begun to stand out as an innovative and promising tool, especially in the prevention and treatment of prolonged bereavement (Ehrenkranz et al., 2024). Ketamine (Gowda et al., 2016), ayahuasca (González et al., 2020) or psilocybin (Morton, 2023) assisted therapy for the treatment of prolonged bereavement have not only shown significant antidepressant pharmacological effects, but also induce modified states of consciousness that can facilitate profoundly transformative experiences. Many people report experiences of reunion or connection with the deceased, opening an opportunity for resolution of unresolved issues and continuation of the bond. Others report a reconstruction of the bond with the loved one, favored by processes of compassion and forgiveness that emerge naturally during the experience with psychedelics (González et al., 2019). Furthermore, at the neurobiological level, the processes of neuroplasticity and neurogenesis induced by these substances translate into greater cognitive flexibility, which facilitates significant changes throughout the therapeutic and personal growth process.

Our model of support in prolonged grief processes

At Clínica Synaptica, we understand that prolonged grief can be a profoundly painful and difficult process to navigate. While research on the use of psychedelics such as MDMA, psilocybin or ayahuasca in the treatment of prolonged grief is ongoing, these compounds are not yet regulated by the European Medicines Agency (EMA).

Currently, the only psychedelic-based treatment approved for medical use is ketamine, specifically indicated for cases of Treatment Resistant Depression. However, the European regulatory framework allows the use of drugs in off-label modality, i.e., outside their official indication, when dealing with health conditions without specific approved treatments or when existing treatments have not shown efficacy.

Prolonged bereavement, in many cases, does not respond to conventional antidepressants, and it is estimated that only 50% of patients manage to adapt through cognitive-behavioral psychotherapy specialized in the treatment of bereavement (Simon & Shear, 2024). Therefore, at Synaptica Clinic we propose ketamine-assisted therapy as a therapeutic alternative, aimed at people who, after having tried to adapt with other therapeutic approaches, still experience persistent grief at the loss of a loved one.

Our model of accompaniment combines individual ketamine-assisted therapy with a psychotherapeutic approach focused on the reconstruction of personal meaning. In addition, we complement the process with supportive group spaces

References 

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