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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. The truth is that not all people in need of palliative care will experience depression, says Marsha Gallagher, LCSW, a social worker with Capital Caring, which serves more than 1,000 people living with advanced illness in the Washington, D.C. metropolitan area.

"It's perfectly natural to feel scared, sad, and anxious about death and the dying process ... because something is coming that they've never had to deal with before," Gallagher says. "The palliative care team, especially the social worker and chaplain, can help them work through that."

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.)
You withdraw from your friends and family.
You think and/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.

"Clinical depression in someone who is dying is treatable, just as it is for anyone else," says Gallagher.

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.

"Coping with these emotions often involves educating not only the person who's facing the diagnosis, but also the people who are going to be caring for that person, about what they can expect," says Gallagher. "A lot of anxiety and negative emotions around a life-threatening illness come from feeling helpless and not knowing what's happening. The social worker and 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.

"People think that the dying person doesn't know she's dying and don't want to tell her, and the dying person absolutely knows that she's dying but doesn't want to burden her loved ones. So nobody's on the same page," Gallagher says. "Your social worker can help the family talk calmly together and not be alarmist about it, and dispel a lot of the anxiety to make it easier on everyone."

WebMD Medical Reference

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