Depression in Palliative Care
Depression is prevalent, but under-recognized, underdiagnosed, and undertreated in palliative care settings. Risk factors associated with depression in patients with advanced cancer are well defined and include a variety of medical and psychosocial factors. It is challenging to diagnose depression in palliative care settings because of the presence of overlapping physical symptoms specific to the cancer, such as fatigue and decreased appetite. Inclusive, exclusive, etiological, substitutive, and high-threshold approaches have been proposed to improve diagnosis of depression among medically ill patients. Management of depression in the palliative care settings comprises use of psychopharmacological agents and individual and group psychotherapies. The psycho-oncology clinician should take into consideration that antidepressants alone may not be adequate in patients with shortened life expectancies. Psychostimulants might be preferred in patients with less than a month to live. Cognitive behavioral interventions, supportive expressive group therapy, meaning-centered psychotherapy, dignity therapy, and mindfulness-based meditation therapy have emerged as effective psychotherapy modalities in decreasing depressive symptoms and suffering in advanced cancer patients.