Review
Difficulties in diagnosing and treating depression in the
terminally ill cancer patient
Mari Lloyd-Williams
Leicestershire
Hospice, Groby Road, Leicester LE3 9QE, UK
Correspondence to: Dr Lloyd-Williams
Submitted 26 January
1999;
Accepted 7 December 1999
It is estimated that for a quarter of all patients with
advanced metastatic cancer, depression will be significant symptom. However up to 80% of the psychological and psychiatric morbidity which
develops in cancer patients goes unrecognised and untreated. One of the
main difficulties in establishing a diagnosis of an illness where there
are no biological markers, physical signs, or diagnostics tests is
deciding what can be called "appropriate sadness" as patients
approach the end of life and what is a depressive illness.
Criteria for diagnosing depression are discussed together with reasons
why established screening tools used in other populations may not be
appropriate to screen for depression in terminally ill patients. The
use of antidepressants and the role of cognitive therapies are also
discussed. For effective treatment of a depressive illness, treatment
with antidepressant medication needs to be initiated sooner rather than
later and patients may need close supervision to ensure compliance. The
awareness of depression, the identification of symptoms, and the
initiation of treatment is essential if patients are to be offered
optimum palliation of psychological as well as physical symptoms.
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Key points
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Keywords: depression; terminal illness; screening
© 2000 by The Fellowship of Postgraduate Medicine
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