What are some of the ways that a doctor can distinguish grief from depression for patients at the end of life?

Expert Answers

EricWideraMD (Physician - Geriatrics (Verified) ) - 12 / 11 / 2012

Psychological distress is common, if not universal, in those facing the end of life. Grief is the healthy, adaptive, and highly personalized response to the losses individuals endure as their illness progresses. The response to these losses can be very intense shortly after a loss, but does generally decrease with time.

The manifestations with grief may overlap with more disabling psychiatric disorders such as major depression, however there are important distinctions. Feelings of pervasive hopelessness, helplessness, worthlessness, guilt, lack of pleasure, and suicidal ideation are present in patients with major depression, but not in those experiencing uncomplicated grief. For individuals diagnosed with depression it is important to seek professional help, as both psychotherapy and antidepressant medications have been shown to be effective treatments even for those near the end of life.

Clinical depression at the end of life is often not diagnosed and not effectively treated. We often hear expressions such as “of course he is depressed, wouldn't you be if you were going to die.” It is true that sadness is quite common in patients who are terminally ill. However, clinical depression is not universal. Most patients are able to experience happiness and find some pleasure in the life that they have left. Only for a smaller group of patients facing the end of life do we see pervasive sadness and despair that indicates a diagnosis of major depression.
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