F32-3/F32.8-.9/F33.0-4/F33.8-9/F34.1 + (Z51.5)
DESCRIPTION
Depression is characterized by persistent feelings of extreme sadness and low mood associated with loss of interest in activities and inability to experience pleasure. There are often associated biological features of significant changes in appetite and weight, disturbed sleep, fatigue and poor concentration.
Diagnosis of major depression in a terminally ill patient often relies more on the psychological or cognitive symptoms (worthlessness, hopelessness, excessive guilt and suicidal ideation) than the physical/somatic signs (weight loss and sleep disturbance) described in depression in patients who are not terminally ill. The key indicators of depression in the terminally ill are persistent feelings of hopelessness and worthlessness and/or suicidal ideation.
Demoralisation is a phenomenon where hope and meaning is lost and where patients wish to hasten their death because they cannot foresee any future pleasure.
GENERAL MEASURES
Exclude physical reversible causes e.g. hypothyroidism, hyperthyroidism, or hypercalcaemia.
MEDICINE TREATMENT
- SSRI, e.g.:
- Citalopram, oral.
- Initiate at 10 mg daily for 2 weeks.
- Then increase to 20 mg daily.
OR
If sedation is required:
- Amitriptyline, oral, at bedtime.
- Start with: 25 mg, increase by 25 mg/day at 3–4 day intervals.
- Dose range: 75–150 mg daily.
Note: Effect of SSRIs are only apparent after 2-3 weeks of treatment, so they should be reserved for patients where end-of-life is not imminent.