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Depression is an emotional state that can range between minor mood changes to a pathological inability to cope with life. It is not an uncommon experience of those faced with a life limiting serious illness. Depression can be situational as a response to diagnosis with serious illness, which is generally self-limited and responds well to education and support. Major depression on the other hand is a serious medical condition requiring both psychological and pharmacologic management.

• Assessment Depression can be subjectively assessed, like all symptoms, by using the PQRSTU mnemonic (see Symptom Assessment) or other numeric scales such as the ESAS (see Symptom Assessment). Screening tools such as the Geriatric Depression Scale, the Beck Depression Inventory, and the Patient Health Questionnaires 2 and 9 (PHQ-2, PHQ-9) may also be helpful. Cognitive status should be assessed as loss in cognitive function in elderly people with advanced disease may increase the risk of depression. Body language is yet another way to assess for depression. Frequent episodes of tearfulness or stooped posture also may be signs of depression.
• Treatment Nonpharmacologic treatment can include education about relaxation techniques, guided imagery, and music therapy. Pharmacologic treatment should be tailored to the individual needs of each patient and can include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) for geriatric patients due to lower side-effect profiles, or serotonin norepinephrine reuptake inhibitors (SNRIs) for those experiencing neuropathic pain. Consult an evidence-based guideline for further information about the palliative management of depression. Referral to an interdisciplinary palliative care team should be considered for those with complex medical and psychosocial concerns. For those experiencing major depression, referral to a psychiatrist and a therapist for ongoing pharmacologic management and counseling should be considered.

Additional Resource

Clinical Practice Guidelines

• Anderson, B.L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., Holland, J. C., Partridge, A. H., Bak, K., Somerfield, M. R., and Rowland, J. H. “Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults with Cancer: An American Society of Clinical Oncology Guideline Adaptation.” Journal of Clinical Oncology (2014). Retrieved from http://jco.ascopubs.org/content/32/15/1605
• Fraser Health
• Qaseem, A., Snow, V., Shekelle, P., Casey Jr., D. E., Cross Jr., T. J., and Owens, D. K. “Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians.” Annals of Internal Medicine 148 (2008): 141-146.
• (requires free registration)

References

• Block, S. D. (2006). “Psychological Issues in End of Life Care.” Journal of Palliative Medicine 9 no. 3 (2006): 751-772.
• Kuebler, K. K., Heidrich, D. E. and Esper, P. Palliative and End-of-Life Care: Clinical Practice Guidelines, 2nd ed. (St. Louis, MO; Saunders, 2007).
• 3. Noorani, N. H., and Mantagnini, M. “.” Journal of Palliative Medicine, 10 no. 2 (2007): 458-464.
• Wrede-Seaman, L. Symptom Management Algorithms: A Handbook for Palliative Care, 3rd ed. (Yakima, Washington: Intellicard, Inc, 2009).