Grief versus Depression in the Hospice Patient
Identifying the difference between normal grief and clinical depression can be a challenging task in the dying patient, but a task that is extremely important. Emotional distress is natural and expected when one is experiencing a serious illness and confronting the end of their life. The differentiation between a normal and appropriate reaction to death and a more serious psychiatric disorder, such as major depression, can be clinically taxing.
When an individual learns that they have received a terminal diagnosis, “preparatory” or “anticipatory” grief is a normal reaction. This is defined as the type of grief that the terminally ill patient has to undergo in order to prepare themselves for their final separation from their world. It is commonly accompanied by withdrawal from family and friends, intermittent sadness, crying, anxiety and deliberating on the past.
This type of grief is a normal, not pathological, life cycle event. These individuals are still able to retain the capacity for pleasure and look forward to items in the near future. They may have passive wishes for death, but there are no intense, persistent suicidal thoughts. Their symptoms often come in waves.
When It’s More Than Grief: Signs of Depression
In contrast to the normal reactions of “preparatory” grief, healthcare professionals categorize major depression differently. For example, there is a persistent flat affect or overwhelming feelings of hopelessness, helplessness, and worthlessness. The patient has little interest in activities that normally brought them pleasure. They often have sleep and appetite disturbances. We do not typically see a disturbed self-esteem and grief together; however, it is quite typical in depression. Individuals with severe major depression may experience an active desire for early death and have persistent, intense suicidal thoughts. They may experience feelings of guilt and have no sense of anything to look forward to in the near future.
Clinically significant depression is likely more common, 25-77% based on the study, in the dying population than in the general public. However, depression is not an inevitable part of the dying process. Therefore, screening for depression should be carried out in all terminally ill patients, as treatment is widely available and typically successful. First and foremost, we must ensure that all uncontrolled symptoms are treated, particularly pain. After these symptoms are addressed properly, supportive psychotherapy and/or pharmacologic therapy for the depression should be initiated based on the clinical scenario.
At Hospice of Southern Illinois, we have an expert team of social workers and bereavement counselors. They work hand in hand with our interdisciplinary team to ensure that our patients and their families receive the emotional and psychological support that they need. We also have a full-time pharmacist on staff. Our pharmacist tailors medications to patients’ specific needs.
Hospice of Southern Illinois has been your community, not-for-profit hospice for 40 years. We take great pride in partnering with your medical provider. There comes a time when compassionate care is the best care. Please visit hospice.org or call 800-233-1708 for more information.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.