Grief is a normal response to loss and usually does not require treatment. Prolonged grief disorder, where intense yearning and impairment persist beyond a year, affects about 7 to 10 percent of bereaved people and responds to grief-focused therapy. Grief that brings major depression, suicidal thoughts or PTSD symptoms warrants psychiatric evaluation, and antidepressants help when depression is present. Stedfast Psychiatry treats grief, loss and complicated grief at 11641 Kew Gardens Ave in Palm Beach Gardens and by video across Florida; new patients call (561) 437-2199.
Grief, Loss and Complicated Grief at our Palm Beach Gardens office
For grief, loss and complicated grief treatment, residents of BallenIsles, Mirasol, Frenchman's Creek and Frenchman's Reserve and Jupiter, Lake Park, Riviera Beach and West Palm Beach are usually within a short drive. The office is just south of PGA Boulevard near Military Trail, a short drive from The Gardens Mall.
New-patient scheduling for Palm Beach Gardens runs through (561) 437-2199. Existing patients reach the office directly at (561) 402-3971. Free surface parking is available at the building, including accessible spaces near the main entrance. If a same-week in-person slot is not open, a video visit with the same provider usually is.
Both Deep TMS and Spravato are delivered on site at this office, so a patient who does not respond to medication can move to an interventional option without changing clinics.
Who you will see in Palm Beach Gardens
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Children and teens are seen by Louis Velazquez, Sophia Schulman, Ellington Curtis and Stephanie Mills.
Dr. Louis Velazquez, MD
Psychiatrist · Ages 4 to 80
Sophia Schulman, PMHNP-BC
Psychiatric Nurse Practitioner · Children 7+, adolescents and adults
Ellington Curtis, PA-C
Physician Assistant · Adults and teens 14+
Dr. Tanya Peguero Estevez, MD
Psychiatrist · Adults 18+ · English, Spanish
Stephanie Mills
Clinician · Adults and teens 13+
Signs of grief, loss and complicated grief
- Intense yearning or longing for the person who died
- Preoccupation with thoughts or memories of the deceased
- Feeling that part of yourself has died
- Disbelief or difficulty accepting the death
- Avoiding reminders of the loss, or being unable to stop seeking them
- Intense emotional pain, anger, bitterness or guilt related to the death
- Difficulty re-engaging with friends, interests or plans
- Emotional numbness or feeling that life is meaningless
How we diagnose it
A grief evaluation at Stedfast Psychiatry begins with listening: who you lost, how, and what your days look like now. We use the Prolonged Grief Disorder scale (PG-13) and the Inventory of Complicated Grief to measure intensity, and the PHQ-9, GAD-7 and PCL-5 to assess whether depression, anxiety or trauma symptoms are also present, since each calls for a different plan. We distinguish prolonged grief from major depression: in grief, the pain is focused on the loss and comes in waves alongside moments of connection and even humor, with self-esteem usually intact; in depression, the mood is pervasively low across all areas, with worthlessness, and often loss of interest in everything. We assess suicide risk carefully, particularly in older widowed men and in parents who have lost a child. We also review sleep, alcohol use, appetite and physical health, since all are affected by loss.
Prolonged grief disorder affects an estimated 7 to 10 percent of bereaved adults, with higher rates after sudden or violent deaths.
Source: American Psychiatric Association, DSM-5-TR (2022); Lundorff et al., Journal of Affective Disorders, 2017
Prolonged grief disorder therapy produced response in 71 percent of patients compared with 32 percent for interpersonal psychotherapy in the original randomized trial.
Source: Shear et al., JAMA, 2005
In a four-site trial, grief-focused therapy was effective for prolonged grief while the antidepressant citalopram alone was not better than placebo for grief symptoms, though it helped co-occurring depression.
Source: Shear et al., JAMA Psychiatry, 2016
Widowed adults have an elevated risk of death in the months after a spouse's death, sometimes called the widowhood effect, with risk highest in the first three months.
Source: Moon et al., PLOS ONE, 2011 meta-analysis
Treatment for grief, loss and complicated grief in Palm Beach Gardens
Medication management
Medication does not treat grief itself, and we do not medicate normal grief. When grief has brought on major depression, antidepressants such as sertraline, escitalopram or bupropion are effective, and treating the depression allows grief to proceed. For insomnia after a loss, short-term use of low-dose trazodone, doxepin or mirtazapine helps restore sleep without the risks of benzodiazepines or zolpidem, which we avoid because they blunt emotional processing and raise fall risk in older adults. When PTSD symptoms follow a traumatic death, SSRIs and prazosin for nightmares are used as in PTSD. Anxiety that spikes around anniversaries may be managed with short-term hydroxyzine. We review and often simplify medications in older adults who have lost a spouse, since the person who managed their pills may be gone.
Psychotherapy
Grief counseling provides a place to tell the story of the loss, make sense of it, and find a way to carry it, and for many people a few sessions are enough. For prolonged grief disorder, prolonged grief disorder therapy (developed by Dr. Katherine Shear, formerly called complicated grief treatment) is the best-studied approach: 16 sessions that combine revisiting the death, gradual re-engagement with avoided situations, strengthening the ongoing bond with the person who died, and rebuilding goals; it outperformed both interpersonal therapy and antidepressants in randomized trials. CBT for grief and meaning-centered approaches are also effective. For traumatic loss, trauma-focused therapy may come first. We also connect patients with support groups through hospices, GriefShare, The Compassionate Friends for bereaved parents, and survivors of suicide loss groups.
What to expect
Your first visit is a 45 to 60 minute conversation, in person or by video, with no expectation that you be composed. We assess where you are, whether what you are experiencing is grief alone or grief with depression, trauma or anxiety, and what would help. Some patients need a few counseling sessions, some need a structured course of grief therapy, and some need treatment for depression first. Follow-ups are scheduled to your needs. Telehealth is available throughout Florida and South Carolina and is often easier in the months after a loss.
The complete guide, including causes, subtypes and research, is on our Grief, Loss and Complicated Grief page.
Emergency and crisis resources near Palm Beach Gardens
In an emergency, call 911 or go to Palm Beach Gardens Medical Center Emergency Room (3360 Burns Rd, Palm Beach Gardens). The 988 Suicide and Crisis Lifeline is available by call or text 24 hours a day. Jupiter Medical Center Emergency Department and 988 Suicide and Crisis Lifeline are also listed on the Palm Beach Gardens office page.
Frequently asked questions
Who provides grief, loss and complicated grief treatment at the Palm Beach Gardens office?
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Every provider works under psychiatrist oversight and the same evaluation standard: about an hour for a first visit, validated screening scales, and a written plan.
Can I be seen by video instead of coming to Palm Beach Gardens?
Yes. Stedfast Psychiatry providers are licensed in Florida and offer video visits for evaluations and follow-ups. Some situations, including certain controlled-substance prescriptions and first visits for young children, require an in-person appointment at 11641 Kew Gardens Ave.
Does the Palm Beach Gardens office take my insurance?
We accept most major commercial plans and Medicare. Call (561) 437-2199 with your member ID and we will verify benefits before the visit. Self-pay new-patient evaluations are $185.
How soon can a new patient be seen in Palm Beach Gardens?
Most new patients are scheduled within one to two weeks. If you need to be seen sooner, ask about a video visit; those often open up within days. If you are in crisis, call or text 988 or go to the nearest emergency room rather than waiting.
Can I get Deep TMS or Spravato as a Palm Beach Gardens patient?
Yes. Deep TMS is delivered on site in Palm Beach Gardens. Spravato is available at Palm Beach Gardens, Palm Beach Gardens and Royal Palm Beach.
How do I know if my grief is normal or something more?
Normal grief is painful and can last a long time, but it changes: the waves become less frequent, you reconnect with people and activities, and you can think about the person with warmth as well as pain. Grief that is stuck looks the same at 18 months as at 3 months, with constant yearning, avoidance of reminders or inability to stop seeking them, and a sense that life cannot go on. If you are not sure, that itself is a good reason for a conversation with a clinician.
What is the difference between grief and depression?
Grief centers on the loss and comes in waves; you can still feel moments of connection and your self-worth is usually intact. Depression is pervasive, flattens everything, and brings worthlessness, guilt unrelated to the death, and loss of interest in all areas. The two can coexist, and about one in five bereaved people develops major depression in the first year. Depression responds to antidepressants and therapy; grief itself responds to grief-focused therapy. We assess both.
Nearby Stedfast offices
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.