Grief is common in people facing the end of their lives as a result of a terminal illness. It’s a feeling that can cause a terminally ill person to experience even more pain than they do from their illness. However, it’s considered a normal reaction to their situation.
But in many terminally ill people, grief evolves into depression. In fact, researchers at Baylor University Medical Center believe it affects up to 77 percent of people with a terminal illness.
Experts say the risks of depression increases as a disease advances and causes more painful or uncomfortable symptoms. The more a person’s body changes, the less control they feel over their lives.
Additionally, some people who are terminally ill have more risk factors for depression. These include:
- past history of depression
- past attempts at suicide
- social stress
- problems with substance abuse
- family history of depression
Some medications may also contribute to depression.
Depression is a serious mental condition, but it can be treated. Treating depression in people with a terminal illness can significantly increase their quality of life.
There is no “right” way for people to feel at the end of their lives. Any combination of the following symptoms are considered “normal” in terminally ill people:
According to the Mayo Clinic, depression is classified as having the following experiences that last for at least two weeks, and are severe enough to interfere with everyday life:
- depressed mood
- reduced interest in activities
- change in sleep routine
- change in weight
- loss of energy
- trouble making decisions
- change in eating habits
- recurring thoughts of death or suicide, or a suicide attempt
In the terminally ill, it can be sometimes hard to tell whether some of these symptoms are caused by the person’s primary illness, or by depression. A subtle sign of depression in the terminally ill is pain that doesn’t respond to treatment as expected.
People who think or attempt suicide are thought to be suffering from depression. They may also repeatedly request that doctors help hasten their deaths. This kind of request, however, may be a person’s attempt to exercise autonomy over how they live, and not depression.
Because depression is not always clearly identified, it tends to be underdiagnosed in people with terminal illnesses. This means many terminally ill people with depression are left untreated.
It’s important for doctors to carefully examine terminally ill people for depression, if they show symptoms. A doctor will make a diagnosis of depression by doing the following:
- taking a medical history
- doing a physical exam
- sometimes performing lab tests, such as blood and imaging tests
Early diagnosis and treatment of depression in people with terminal illnesses is the goal. Treated for depression in the terminally ill is generally the same as for the general population:
- lifestyle modifications
- a combination of treatments
Psychotherapy involves attending sessions with a therapist who offers their support and advice. A therapist can help a person with a terminal illness better understand their condition, and how to come to terms with the end of their life. This understanding can help reduce their depressive symptoms.
Adding certain habits to the lifestyle of a person with a terminal illness can be beneficial. Practices such as meditation, yoga, and massage may reduce a person’s depressive symptoms.
Both pain relievers and antidepressants appear to help alleviate depression in the terminally ill. There are several types of pain medications and antidepressants that can help. Some common antidepressants include:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- norepinephrine-dopamine reuptake inhibitors (NDRIs)
- tricyclic antidepressants
- monoamine oxidase inhibitors (MAOIs)
- mood stabilizers
Some antidepressants and pain medications can interact with other drugs, or can worsen certain medical conditions. Doctors should thoroughly review a terminally ill person’s medical history before prescribing any medications for depression.
Coping and Support
Those with a terminal illness may find it helpful to talk to friends and loved ones about their condition. It can be helpful to the terminally ill for relatives, friends, and caregivers to offer an empathetic ear. However, it can be painful and challenging for the listeners. Those close to the terminally ill person may find it hard to talk about that person’s illness.
In that case, it can be helpful to seek out support groups for the terminally ill person. Hearing the stories of those in a similar situation can often help the terminally ill person better cope with their own illness. Doctors can recommend support groups, or you can research groups online. If you find a group online, be sure to monitor the group discussion to make sure it is appropriate.
Others with terminal illnesses find it helpful to express their feelings creatively. Being creative can ward off feelings of depression. Some forms of creative expression include:
- keeping a journal
- playing an instrument
It may not be possible to fully stop a terminally ill person from feeling grief, but it is possible to prevent and treat their depression. Alleviating depression in a terminally ill person can greatly increase their quality of life.