End of Life: Coping with Anxiety and Depression
People often assume that those diagnosed with a life-threatening illness will automatically experience depression.
True, people facing a serious illness are more likely than healthy people to suffer depression or anxiety. One study of terminally ill cancer patients, for example, found that at least 17% were clinically depressed.
But that's fewer than one in five patients. Not all people in need of palliative care will experience depression.
Experts point out that it's perfectly natural to feel scared, sad, and anxious about death and the dying process. That's because people are facing something that they've never had to deal with before. But the palliative care team can help them work through these feelings.
True clinical depression, however, goes beyond this usual sadness and anxiety. It's important to understand the difference between this kind of depression and the normal grieving process that occurs for everyone who faces death. Clinical depression is often underdiagnosed, but it should be identified and treated.
Here are some of the signs that you or your loved one may be experiencing clinical depression:
- You don't feel like doing the activities you normally enjoy, even if they are things you can still physically do.
- Even when you do participate in things you once enjoyed, you find that you are getting little pleasure out of them.
- You have major changes in sleeping or eating habits -- sleeping or eating much more, or much less, than usual. (These symptoms can sometimes be the side effects of certain medications or treatments.)
- You withdraw from your friends and family.
- You think or talk seriously about suicide.
If you see these signs in a loved one, or find that you're experiencing them yourself, it's important to talk with your doctor or someone else on your care team about them. Get immediate medical help if you or a loved one is having thoughts of suicide.
Clinical depression in someone who is dying can be treated.
Antidepressant treatments work just as well in palliative care patients as in the general population. The most effective treatments for clinical depression usually combine short-term psychotherapy with antidepressant medications as needed.
What if what you're experiencing is grief and anxiety, not full-scale depression? In this case you might not need medications for anxiety or depression, but that doesn't mean your care team can't help.
Palliative care professionals point out that coping with these emotions often involves educating not only the person who's facing the diagnosis but also the people who are caring for that person about what they can expect. A lot of anxiety and negative emotions associated with a life-threatening illness come from feeling helpless and not knowing what's happening. The social worker and other members of the palliative care team can answer questions, work with you through talk therapy, and help you live as well as you are able for as long as you can.
Much anxiety near the end of life may stem from not talking. Both the dying person and the people around the dying person are often reluctant to talk about what is happening because of how they think doing so will affect the other. Your palliative care team can help the family talk calmly and not be alarmist about the process, dispelling a lot of the anxiety and making it easier on everyone.