Live with a Terminal Illness
Grief is common in people facing the end of their lives as a result of a terminal illness.
It’s a feeling that can cause terminally ill persons to experience even more pain than they do from their illness. However, it’s considered a normal reaction to their situation.
But in many terminally ill people, grief evolves into depression.
Experts say the risks of depression increase as the disease advances and causes more painful or uncomfortable symptoms.
The more a person’s body changes, the less control they feel over their lives.
Additionally, some people who are terminally ill have more risk factors for depression.
These include:
history of depression
past attempts at suicide
social stress
Problems with substance abuse
addiction
family history of depression
Some medications may also contribute to depression.
Depression is a serious mental condition, but it can be treated. Treating depression in people with a terminal illness can significantly increase their quality of life.
What Symptoms Are Considered “Normal” for Someone with a Terminal Illness?
There is no “right” way for people to feel at the end of their lives.
Any combination of the following symptoms is considered “normal” in terminally ill people:
disbelief
panic
anxiety
anger
bitterness
denial
vulnerability
sadness
frustration
loneliness
peace
acceptance
What Is Considered Depression?
Depression is classified as having the following experiences that last for at least two weeks, and are severe enough to interfere with everyday life:
sadness
frustration
anxiety
depressed mood
Reduced interest in activities
change in sleep routine
change in weight
loss of energy
trouble making decisions
change in eating habits
Recurring thoughts of death or suicide, or a suicide attempt
In the terminally ill, it can sometimes be hard to tell whether some of these symptoms are caused by the person’s primary illness or by depression.
A subtle sign of depression in the terminally ill is pain that doesn’t respond to treatment as expected.
People who think or attempt suicide are thought to be suffering from depression. They may also repeatedly request that doctors help hasten their deaths.
This kind of request, however, may be a person’s attempt to exercise autonomy over how they live and not depression.
How Is Depression Diagnosed in Someone with a Terminal Illness?
Because depression is not always clearly identified, it tends to be underdiagnosed in people with terminal illnesses. This means many terminally ill people with depression are left untreated.
It’s important for doctors to carefully examine terminally ill people for depression if they show symptoms.
A doctor will make a diagnosis of depression by doing the following:
Taking a medical history
doing a physical exam
sometimes performing lab tests, such as blood and imaging tests
What Types of Treatments Are Available for Someone Who Is Depressed and Terminally Ill?
Early diagnosis and treatment of depression in people with terminal illnesses is the goal.
Treatments for depression in the terminally ill are generally the same as for the general population:
psychotherapy
lifestyle modifications
medication
a combination of treatments
Psychotherapy
Psychotherapy involves attending sessions with a therapist who offers support and advice.
A therapist can help a person with a terminal illness better understand their condition and how to come to terms with the end of their life. This understanding can help reduce their depressive symptoms.
Lifestyle Modifications
Adding certain habits to the lifestyle of a person with a terminal illness can be beneficial.
Medication
Both pain relievers and antidepressants appear to help alleviate depression in the terminally ill.
Several types of pain medications and antidepressants can help. Some common antidepressants include:
selective serotonin reuptake inhibitors (SSRIs)
serotonin-norepinephrine reuptake inhibitors (SNRIs)
norepinephrine-dopamine reuptake inhibitors (NDRIs)
tricyclic antidepressants
monoamine oxidase inhibitors (MAOIs)
mood stabilizers
antipsychotics
Some antidepressants and pain medications can interact with other drugs or can worsen certain medical conditions.
Doctors should thoroughly review a terminally ill person’s medical history before prescribing any medications for depression.
Coping with Depression and Terminal Illness
Those with a terminal illness may find it helpful to talk to friends and loved ones about their condition. It can benefit the terminally ill for relatives, friends, and caregivers to offer an empathetic ear.
However, it can be painful and challenging for the listeners. Those close to the terminally ill person may find it hard to talk about that person’s illness.
In that case, it can be helpful to seek out support groups for the terminally ill person.
Hearing the stories of those in a similar situation can often help the terminally ill person better cope with their illness.
Doctors can recommend support groups, or you can research groups online. If you find a group online, monitor the group discussion to ensure it is appropriate.
Others with terminal illnesses find it helpful to express their feelings creatively. Being creative can ward off feelings of depression.
Some forms of creative expression include:
keeping a journal
painting
playing an instrument
It may not be possible to fully stop a terminally ill person from feeling grief, but it is possible to prevent and treat their depression.
Alleviating depression in terminally ill people can greatly increase their quality of life.
