It’s very likely, yes. October is National Depression Education & Awareness Month, an annual designation observed to raise awareness of the signs of depression and how people can get the help they need. The Depression and Bipolar Support Alliance say 14.8 million adults in this country suffer from Major Depressive Disorder, with suicide being the third leading cause of death for those between the ages of 15 and 24. Sadly, those numbers are on the rise. But what about people in hospice who are nearing the end of life? Are the depression rates high then as well? Again, sadly, yes. A study in the  Journal of the American Geriatrics Society on ScienceDaily says nearly 60 percent of patients in the month before death suffers from depression. If you have a loved one facing the end of life in Santa Clara and elsewhere, you will want to read on.

A lot is known about depression in general terms, but not much is known about the factors that surround depression in the last year of life. Yet, we know it exists. Depression brings about feelings of hopelessness, distress, worthlessness, and anxiety. But in the terminally ill patient, depression is compounded due to the knowledge that you will die, and soon. Of course, we all understand we are mortal and will pass on eventually, but when you know for certain that you will face that end within the next month or two, this can be terrifying and profoundly sad. Even if you are not the one in hospice — say it’s your spouse with whom you’ve shared 50 years of marriage or your aging parent with whom you are extremely close — it’s easy to become depressed as well.

Distress in the Terminally Ill

Psychological distress is a common trait in terminally ill people, which can lead to abundant suffering. According to American Family Physician, grief is a universal, personal, and adaptive response to the many losses that may occur at the end of life. They can be fairly intense in the early stages after a loss, characterized in physical, emotional, cognitive, spiritual, and behavioral ways; however, it’s important to know that grief in daily life generally decreases with time. The symptoms of grief often overlap with symptoms of major depression or terminal illness, but grief still acts as its own distinct entity.

Patients with depression at the end of life may feel:

• Hopeless
• Helpless
• Guilty
• Worthless
• Thoughts of suicide

It’s common for doctors to prescribe antidepressant medications to reduce the above feelings of distress and to enhance quality of life for patients suffering from depression. But for those who have depression as well as a life expectancy of only days or weeks, doctors may prescribe psychostimulants, such as methylphenidate.

Terminally ill patients suffer many losses the closer they get to the end of life. In the beginning, those losses may include self-image, health, a sense of control, and wealth. Those beginning losses accumulate as time goes by, with a natural progression towards loss of privacy, relationships, dignity, independence, cognitive ability, and physical function. Grief is universal, indeed, but it’s also highly personalized. Grief is also a valid response to all of the above losses and is an expected emotion for those facing a terminal illness such as congestive heart failure or cancer.

Loneliness

Never are you more aware of your lone place in the world than when you are facing the end of life. Even with all your loved ones around, it’s a terrifyingly lonely position to be in. No one can come with you. You have to do it alone. Talking with a counselor can help you sort out your feelings, or with very close friends or family members, hospice social workers, nurses, and end-of-life caregivers. Many people simply have that special gift for silence, just sitting and listening when you need it the most. It’s critical to find people that you can connect with at this juncture, to ease that sense of loneliness, says the American Cancer Society.

Grief

Another strong emotion you or your loved ones are feeling is intense grief during this last stage of life. You are grieving the loss of the life you had planned for and expected. You may be angry and wonder why this is happening to you, especially if you feel relatively well with not many symptoms. As a result, you’re having trouble grasping that loss will happen. You may also feel distanced from people around you who don’t seem to be coping with the impending loss very well. Many physical and emotional losses happen even before loss of life.

As the patient, remember that the people who love you are grieving too. They know they will soon lose you and this can be scary for them. As a caregiver, remember that your loved one is facing the end of their physical life. They are grieving for losses too. They may be worried about leaving you behind and whether you’ll be all right without them. These are all common feelings that should be talked about. The ability to connect spiritually to something greater than yourself may help family members heal after their loved one is gone.

Contact Pathways Home Health and Hospice

That’s why we offer bereavement support for family members in the form of grief counseling, support groups, workshops, and memorial services. For our hospice patients, we also offer counseling to help with depression during care.