Teamwork is usually required to get everyone present and seated with beverages, ashtrays, and any other comforts that seem appropriate. Families who do not wish to explore these crucial questions at this time should not be pushed. A chaplain, nurse, or other team member with counseling skills, present from the time the physician begins communicating the bad news, may be able to address sensitive issues that arise. Even when the family members are too shaken to sit down or participate in any dialogue, it is important to leave them a telephone contact at the hospital should any questions arise. Clinicians are often reluctant to use antidepressants for bereavement, at least for the first three to six months.
Studies are rare, and more are needed.
However, in one open trial, nortriptyline at a dosage to maintain therapeutic plasma levels was administered to 13 patients with Research Diagnostic Criteria diagnosed depression. The mean time from spousal loss was 11.9 months. There was a significant improvement in depressive symptoms, level of functioning, social support, and physical impairment. Hence, persistent grief may be a separate process.