Prolonged Grief Disorder

The short version

●Prolonged grief disorder (PGD) is a newly recognized diagnosis (DSM-5-TR and ICD-11) for grief that remains intense, preoccupying, and impairing well beyond the expected period — at least 12 months for adults.
●It is marked by persistent yearning or longing for the deceased and preoccupation with them, plus intense emotional pain, identity disruption, difficulty accepting the death, avoidance, emotional numbness, or feeling life is meaningless.
●It is not "normal grief taking a while" and not the same as depression — it is a distinct, identifiable, and treatable condition affecting roughly 1 in 10 bereaved people.
●The first-line treatment is a specific, grief-targeted psychotherapy (complicated grief treatment / prolonged grief disorder therapy) — more effective than antidepressants or general therapy for PGD itself.
●Depression, PTSD, and suicidal thoughts commonly co-occur and should be screened and treated.
●Ketamine is not a treatment for grief; its only role is a co-occurring treatment-resistant depression, and grief-targeted psychotherapy remains the core treatment.

Clinical definition

Prolonged grief disorder is a condition, newly formalized in DSM-5-TR and ICD-11, in which grief following a death remains persistently intense and disabling far beyond the expected timeframe — at least 12 months after the loss for adults (6 months in ICD-11). The core features are persistent, pervasive yearning or longing for the deceased and/or preoccupation with thoughts or memories of them, accompanied by symptoms such as identity disruption ("part of me died"), a marked sense of disbelief about the death, avoidance of reminders, intense emotional pain, difficulty re-engaging with life, emotional numbness, a feeling that life is meaningless, and intense loneliness — to a degree and duration that exceed social, cultural, or religious norms and cause significant impairment. PGD is distinct from both normal grief (which, however painful, gradually accommodates) and from major depression and PTSD, though it overlaps with and frequently co-occurs with them. It affects roughly 10% of bereaved people, with higher rates after sudden, violent, or otherwise traumatic losses, and is associated with elevated suicide risk.

How it differs from related conditions

vs. Normal / acute grief

Painful but gradually accommodates over time, with the bereaved able to re-engage with life; PGD stays intense, preoccupying, and impairing past the expected period.

vs. Major depressive disorder

Depression is pervasive low mood and anhedonia across all of life; PGD centers specifically on yearning, longing, and preoccupation with the deceased. They overlap and co-occur, and each is treated.

vs. PTSD

When a death is traumatic, PTSD (intrusion, hyperarousal, avoidance of trauma reminders) can co-occur; PGD centers on the loss and separation rather than threat.

vs. Adjustment disorder

A broader, usually time-limited stress reaction; PGD is specifically grief-focused and persists past 12 months.

First-line treatments

Grief-targeted psychotherapy

Complicated grief treatment (CGT) / prolonged grief disorder therapy — structured approaches combining processing the loss, restoring engagement with life, and addressing avoidance; more effective for PGD than antidepressants or general supportive therapy.

Treating comorbid depression and PTSD

With their own evidence-based treatments, since they commonly co-occur and worsen outcomes.

Suicide-risk assessment and safety

Given elevated risk, especially around anniversaries and reminders.

Support and connection

Peer grief support and rebuilding social connection complement formal treatment.

When standard treatments fail

When grief-targeted psychotherapy and treatment of comorbid depression or PTSD do not adequately help, the steps are to confirm the therapy was genuinely grief-specific (general supportive therapy and antidepressants alone are less effective for PGD itself), address co-occurring conditions more aggressively, and maintain suicide-risk vigilance. Ketamine is not a treatment for grief, but where a treatment-resistant depression has developed alongside PGD, ketamine for that depression is a reasonable consideration — with the grief-targeted psychotherapy remaining the core treatment.

Where ketamine fits

Ketamine is not a treatment for grief or for prolonged grief disorder itself — the core, first-line treatment is grief-targeted psychotherapy, which specifically helps process the loss and restore engagement with life. There is no evidence ketamine resolves grief, and it would be a mistake to frame it that way. Its only legitimate role is when a treatment-resistant major depression has developed alongside PGD (a common and dangerous overlap given PGD's elevated suicide risk): there, ketamine can treat the depression with its usual rapid effect, potentially making a grieving person depleted by depression more able to engage in the grief work. The grief therapy still has to happen. Tovani screens for the PGD/depression distinction rather than offering ketamine as a grief remedy.

Where this fits with Tovani

Tovani treats the treatment-resistant depression that can develop alongside prolonged grief disorder — not grief itself, which calls for grief-targeted psychotherapy. Eligibility screening distinguishes PGD and bereavement from a co-occurring major depression, and pays attention to suicide risk, which is elevated in PGD. Patients are encouraged to engage grief-specific therapy; where a treatment-resistant depression coexists, ketamine for the depression is appropriate, with grief therapy continuing alongside. If you are having thoughts of harming yourself, call or text 988.

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Frequently asked

How long is "too long" to grieve?

There is no deadline on grief, and PGD is not about grieving "wrong." But when intense yearning, preoccupation with the person who died, and an inability to re-engage with life persist and impair you beyond about a year — exceeding your own cultural and social norms — that pattern is prolonged grief disorder, a recognized and treatable condition.

Is prolonged grief just depression?

No, though they overlap and often co-occur. Depression is pervasive low mood across all of life; PGD centers specifically on yearning, longing, and preoccupation with the person who died. The distinction matters because PGD responds best to grief-targeted therapy, which is different from standard depression treatment.

What actually helps prolonged grief?

A specific, grief-targeted psychotherapy (complicated grief treatment / prolonged grief disorder therapy) is the first-line and most effective treatment — more so than antidepressants or general talk therapy for the grief itself. Co-occurring depression or PTSD are treated alongside.

Can ketamine help with grief?

Not with grief itself — there is no evidence for that, and grief-targeted therapy is the core treatment. Ketamine's only role is a co-occurring treatment-resistant depression, which is common and dangerous given PGD's elevated suicide risk. The grief work still has to happen.

References

Szuhany KL et al. 2021, Focus (American Psychiatric Publishing) — Review of prolonged grief disorder: course, diagnosis, assessment, and the grief-targeted psychotherapies that are first-line treatment. (PMID 34690579)
Murrough JW et al. 2013, American Journal of Psychiatry — Ketamine RCT in treatment-resistant depression, the comorbidity that gives ketamine any role alongside PGD. (PMID 23982301)

Last reviewed by Dr. Ben Soffer, DO on May 31, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.