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DEAR DR. ROACH: My sister died about a month ago. We were very close, and I was with her when she died of a brief but serious illness. The day after, I felt completely unbalanced. I had brain fog and nausea, which comes and goes, as well as extreme exhaustion and tinnitus. I saw my general physician and asked for a full blood test, which came back normal. She said that all signs pointed to grief and stress from a traumatic event.
I then went to my doctor of otology, who did a full ear exam and concurred with my physician. I’ve had many people who’ve passed away in my life, including parents and friends, and I’ve never experienced anything like this before. Now, one month later, I’m still not physically recovered.
I’m taking magnesium and ashwagandha per my doctor’s request, and my otologist gave me a prescription for 10 mg of nortriptyline to be taken for the short-term future. I haven’t started it. What are your thoughts on treatments for grief, and how long do you think this will last? -- K.G.
ANSWER: I’m very sorry for your loss. Acute grief reactions are very much like depressive illnesses, and a severe or prolonged grief reaction is often treated the same way as we would treat major depression. This includes the use of medications, psychotherapy, or a combination of both.
Symptoms of severe grief, like depression, can include body symptoms, with fatigue or exhaustion being one of the cardinal symptoms used to make the diagnosis. Tinnitus isn’t usually a presenting symptom of depression, but it’s possible preexisting tinnitus that you maybe never noticed has become a problem with your recent trauma.
While supplements like magnesium and ashwaganda are sometimes prescribed for tinnitus, the evidence for their effectiveness is poor. Nortriptyline is an older antidepressant, but the starting dose that you’re recommended isn’t an effective antidepressant dose (75-100 mg being the usual dose). This dose is used for neurological conditions like chronic pain and is also sometimes prescribed for tinnitus, although the usual dose that has been shown to provide a modest improvement is normally closer to 50 mg. Nortriptyline is often started at low dose and then slowly increased, which might be your ear doctor’s plan.
The diagnosis of a grief reaction, just like depression, isn’t made through blood testing but by a careful interview with a trained clinician. It takes judgment to know when to consider antidepressant treatment, and I’ve had many patients who prefer talking therapy as their initial treatment. Without treatment, six months is a very rough guess of how long these symptoms will last, but the range can be shorter or much longer.
DEAR DR. ROACH: I read your recent column regarding carbonated drinks and tooth health. If a carbonated, fruit-flavored sparkling drink is a few days old and has lost its fizziness, does it still cause tooth damage? -- G.
ANSWER: The tooth damage comes from exposing your teeth to an acidic pH. All fruit juices are acidic to a greater or lesser extent, so any kind of fruit juice isn’t ideal for dental health. Carbonation does represent acid, so a less-carbonated drink is less acidic than a new, extra-fizzy one. But it still isn’t good for your teeth. Pure still water remains your best choice.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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