Depression in palliative care

Taxing experiences

Having an incurable illness means constantly having to let go of something: health, plans for the future, hopes and dreams regarding a future shared with loved ones, role at work or as a participant in hobbies, sexuality, and strength and freedom in terms of bodily functions and movement.

In the final stages of illness, we become increasingly dependent on others, and require more and more care and nurture. When treatment doesn’t go as planned, we have to face disappointment, depression, and grief. We may think that the treatment has failed, and we may blame either our care team or ourselves. We may criticise ourselves for not seeking treatment sooner, or refuse to accept the progression or advanced stage of our illness. Our first reaction to letting go is often bitterness, anger, or depression. If we’re unable to adapt to our new stage of life, we risk becoming trapped in our negative emotions.

However, it’s often possible to slow down the progression of illness and relieve its symptoms with medical treatment, giving us more time to adapt and find balance.

Reaction to loss

When we have to let go of our functional capacity or our hopes for the future, depression is a common reaction. When we’re depressed, it’s hard to find the words for what’s on our mind; we lose our temper more easily, and we may avoid spending time with our loved ones. We often even end up avoiding activities that normally bring us joy and pleasure. We feel inferior and ashamed, and are unable to connect our feelings with the change in our mood or to seek help.

Depression makes us lose our ability to think straight. Our perspective becomes narrow or black-and-white. The future seems scary, and we’re unable to see anything good around us. Most of the thoughts on our mind are negative, and we find it hard to believe that other people have anything to offer to us. We may think that we are nothing but a burden to other people. In the case of severe depression, we may even start to think that death should come sooner.

Depression makes it hard to see the change in one’s mood or to seek help. If the symptoms persist, depression often becomes more severe.

Physical symptoms

Depression may be accompanied by physical symptoms, such as increased pain, sleep problems, loss of appetite, fatigue, or weight loss – all symptoms that resemble those of a serious illness.

Although professionals working with people who have serious long-term illnesses are experienced in identifying and treating depression, sometimes even a severe case of depression can’t be detected during an appointment. In such cases, bringing loved ones along is of great help.

When treating depression, the number one priority is noticing the patient’s lowered mood and bringing it up. When being forced to face difficult information and grief, it’s understandable to react with depression and sadness.

The comprehensive nature of incurable illness

Having a serious incurable illness has a profound impact on both body and mind. When depression related to a serious physical illness requires medical intervention, the symptoms are usually mild to moderate and respond to treatment. The strain caused by illness may also reactivate depression experienced earlier in life. On the other hand, sometimes a mental disorder that previously interfered with life becomes more manageable at the end of life.

Sharing our feelings

In most cases, the more we are able to share what has happened to us with others, the less likely we are to be trapped in a state of depression. Once we find the courage to voice our feelings and share them with another person, our life starts to feel a little bit easier to deal with. Sometimes even feelings such as bitterness, anger, or hopelessness give us strength that helps us carry on with life. Sharing our feelings gives us the opportunity to find comfort and a new perspective. When we put our experiences into words, depression begins to give room to hope. Even at the very end of life, we can discover new things in life and experience happiness.

Connection to others

Being together in a safe atmosphere helps us access our emotions. Having a good therapeutic relationship and positive memories of care and nurture experienced earlier in life provides us with the courage to identify and give words to how we’re feeling.

Need for medical intervention

If depression persists, medical treatment is required. Some of the main symptoms of depression requiring treatment include persistently low mood and difficulty taking an interest in or finding enjoyment in things, even things that previously brought pleasure and joy.

Seeking help

At some point in life, any one of us may be in need of a psychiatric evaluation or treatment for depression impacting our quality of life. This can take place at a psychiatric outpatient clinic, at a substance abuse services unit, or in primary mental health services, among other places. However, mild or moderate cases of depression can often be treated with the help of your attending physician and other members of your care team. If you or those close to you suspect that you are dealing with depression requiring treatment, let your care team know, so that they are able to set aside time for talking about your situation during your appointment. Talking about and making sense of your situation in life and your state of health with your care team are a part of assessing and treating depression.

Treatment with medication

Symptoms of depression can be relieved with antidepressant medications. Over the past decades, antidepressants have advanced a great deal, and most people are able to find the proper medication to manage their symptoms.

Depression may also be related to insomnia or severe pain, in which case the primary treatment is ensuring good sleep or sufficient pain management.

Making sense of your life

A person’s ability to cope in difficult life situations varies based on previous experiences and other recent causes of stress. When faced with a serious illness, we all need support and patience. Making sense of and giving structure to your life experiences through writing, drawing, painting, or music forms a good basis for the grieving process.

Doing things together

Feeling down decreases our quality of life, which also leads to less zest for life. When facing a difficult life situation, we often find hope and a renewed interest in life in the presence of loved ones, in doing things together, or by turning our attention to things such as listening to music, watching a film, or observing the diversity of nature.

For a person experiencing depression, finding the right words may be difficult. In such situations, taking part in an activity familiar to you often lifts the mood, even if at first you feel like your mind isn’t in it.

Striving for wellbeing and happiness

The aim of palliative care is to promote wellbeing and a sense of safety. Gratitude for the life lived may bring some happiness even while being surrounded by illness. Likewise, self-management of depression focuses on striving for personal wellbeing and happiness. Taking an active role in the choices and decision-making concerning your care also helps you move forward with managing your depression symptoms. In such situations, it’s important to share your hopes and expectations with those close to you and those involved in your care. When we feel heard regarding our everyday experiences, our life begins to feel more meaningful. When it comes to existential questions, finding answers may improve our existential and spiritual wellbeing.