Study Shows Depression More Likely During Last Year of Life
It’s well known that depression can affect the quality of life for many people, of all ages, and at all stages of life. However, a new study appearing in the Journal of the American Geriatrics Society on ScienceDaily has confirmed that nearly 60 percent of individuals in the last month before death suffered from depression. While a lot is known about depression in general, little is known about the factors surrounding depression in the last year of life. If you have a loved one undergoing end of life care in Santa Clara and elsewhere, this week’s blog will be of interest to you.
This latest interview-based study included nearly 3,300 individuals who died by the conclusion of the study. It found that depression symptoms increased on a gradual basis from 12 to four months before death, then escalated from four months to one month before death. Non-white adults, women and younger adults were found to have higher rates of depression symptoms. Those with cancer had escalating rates of depressive symptoms at the end of their lives, whereas those with lung disease and impairments in ADL (activities of daily living) showed persistently higher rates of depression throughout the entire year before death.
This is an eye-opening study, as it prompts healthcare providers to take psychological symptoms even more seriously when in the context of chronic illness, and not just throughout the lifespan. This awareness can reduce suffering and distress for the person facing end of life care. The study goes on to conclude that more research is needed in order to address the serious lack of skilled geriatric and end-of-life mental health providers — not to mention limited reimbursement structures in regards to psychological care, and failures in adapting and disseminating non-drug interventions for those who have limited life expectancies.
On top of that, a public health approach is vital in screening for and appropriately treating symptoms of depression across the lifespan. The study was very revealing in that it showed higher-than-previously-thought rates of depressive symptoms in the last year of life, as well as outlined differences in the burden of depressive symptoms, says the National Institutes of Health (NIH).
Managing Depression at the End of Life
It can be traumatic to know that you will die. We all know we will pass on someday, but to be faced with such a concrete knowledge of how and when we will go is life-altering, terrifying and profoundly sad. Even when faced with the knowledge a very close loved one will die, such as a spouse with whom you’ve been married for 50 years, one can become depressed as well.
Psychological distress is common in terminally ill people and is a source of abundant suffering. Grief is a universal, adaptive, and personal response to the multiple losses that can occur at the end of life, according to American Family Physician. These responses may be intense in the early stages after a loss manifesting itself in physical, emotional, cognitive, behavioral and spiritual ways; however, the impact of grief on daily life generally does decrease over time. It’s important to note that the symptoms of grief can overlap with symptoms of major depression or a terminal illness, but grief is still its own distinct entity.
Patients with depression nearing end of life may have feelings of hopelessness, helplessness, guilt, worthlessness, lack of pleasure, and suicidal ideation. While antidepressant medications reduce symptoms of distress and can enhance quality of life for patients with depression, doctors often consider prescribing psychostimulants, such as methylphenidate, for those suffering from depression with a life expectancy of only days or weeks.
Terminally ill patients undergo a variety of types of losses as they near the end of life. At first, these losses may include health, self-image, wealth, and sense of control. Then, those losses tend to accumulate over time and progress to loss of privacy, relationships, independence, dignity, cognitive ability, and physical function. Grief is a universal, albeit highly-personalized, response to all of these losses — indeed, it’s an expected part of living with a terminal illness such as cancer or congestive heart failure.
Depression vs. Grief
Depression shares a lot of common features with grief; however, they are distinct entities and must be treated as such. Depression can lead to significant suffering, lower the quality of life, cause physical symptoms such as pain to worsen, and make it impossible for a person to find meaning in life. It’s also been known to shorten survival, cause distress to family members, and interfere with relationships. Depression is also connected with an increased risk of suicide and a desire to hasten death. The challenge for any doctor is to distinguish between reactions to the loss for those who live with a terminal illness and those who have a major depression diagnosis.