Let’s talk about depression at the end of life.
I’m sure you’re aware by now that I don’t sugar-coat the realities of dying and death.
If all I did was share the beautiful, calm and non-problematic dying experiences I wouldn’t be doing justice to all of you who are struggling and you may feel more isolated and worry that you are doing something wrong.
You are not.
Dying can, indeed, be beautiful and life-enriching for some and for others it can seem like a hard slog to the finish line despite the best palliative care.
Depression is a common, although not universal, psychological condition among patients at the end of life and is estimated to affect around 5 -25% of palliative care patients and many experience depressive symptoms even when not given a clinical diagnosis. In fact, those receiving palliative care may face a greater likelihood of developing or worsening a clinical diagnosis of depression due to the awareness of their limited life expectancy. If left unrecognized and untreated this may lead to more severe illness symptoms such as pain, impair their ability to find meaning in life and consequently severely affect their quality of life, the quality of their relationships and bring about a poor prognosis.
The affect on the quality of their relationships can cause great distress to family, friends and care-givers at a time when a family member who is also a care-giver may be experiencing depression themselves form the huge burden of caring and the losses they have experienced and are yet to come.
The family dynamics face a major shift.
If the situation becomes intolerable family relationships can completely break down.
So let’s begin with this – do not confuse depression with grief.
Of course those dying will experience grief at their own demise and their own losses.
Grief and depression do share some distinct qualities and this is where the difficulties can sometimes lie.
Here are some of the symptoms of depression at the end of life:
irritability
insomnia or excessive sleeping
argumentative,
tearful
changes in appetite or an increased craving for food
lack of pleasure
more or less demanding of your time
agitation
sadness or unhappiness,
decreased concentration
forgetfulness or confusion
loss of energy/fatigue
feelings of
hopelessness
helplessness
guilt
resentment
worthlessness
thoughts of death or suicidal ideation.
Depression at the end of life (or at any time of life!) can cause significant suffering.
If in doubt reach out to your care provider – your gp or hospice/palliative care team.
Please don’t ignore it hoping it will go away – it won’t without some form of intervention.
If you recognise your own experience in this, past or present, know that you are loved and that it wasn’t/isn’t your fault.
With deepest care
Nancy x 
x
HELD 