Depression Flashcards
What is the problem with depression in palliative care?
It is common, but under-reported, under-assessed, and under-treated
Who can get depressed in palliative disease?
Any patient
What patients are at higher risk of depression in palliative care?
- Past history of depression
- Younger patients
- Patients with certain cancer types
- Uncontrolled pain and other symptoms
What types of cancer have an increased risk of depression?
- Lung
- Pancreas
What is the problem with depression and uncontrolled pain?
It is difficult to know if untreated pain is causing depression, or if depression is magnifying pain
How can depression make pain management more difficult?
Patients who are depressed often lose all motivation, and see little point in anything, including taking analgesia regularly or other medication
At what point in the disease process are patients more likely to get depressed?
- Initial diagnosis
- Time of diagnosis recurrence
- Time when they are told their disease is terminal
What % of patients with advanced cancer are depressed?
25%
What will happen to the mood of most patients with terminal illness?
They will feel sad
What might patients feel sad about in terminal illness?
- Life coming to an end
- Leaving loved ones
- What may happen to them as end of life approaches
What differentiates people who are sad about their terminal illness from those who are depressed?
Those who are sad will still be able to look forward to days out with family and friends, seeing visitors etc, whereas a patient who is depressed does not look forward with enjoyment to anything
Why do we need to think about depression in patients who seem to be far more unwell than their condition suggests they should be?
Because patients who are depressed are withdrawn, and often appear physically more unwell due to this
Why might screening tools be helpful for depression in terminal illness?
Many patients find it difficult to say they are depressed or to find the words to describe how they feel
What tools may be helpful for screening for depression in advanced cancer?
- Brief Edinburgh Depression Scale (BEDS)
- PHQ9 depression scale
What is the advantage of the BEDS?
It is quick and easy to use, with only 6 questions
What is each question scored out of in BEDS?
3
What score indicates possible depression in BEDS?
6 or more (out of 18)
What is each question scored out of in PHQ9?
3
What is the maximum score in PHQ9?
27
What does the PHQ9 categorise into based on scores?
Mild, moderate, or severe depression
What score on the PHQ9 indicates moderate-severe depression?
10 or above
What is important in the management of depression in terminal illness?
- Excellent psychological support
- Attention to pain management
- Support of patients and their families
Give some examples of diversional activities that might be helpful in depression in patients with terminal illness
- Craft
- Walking
- Meeting others
- Referral to hospice day care
- Access to complementary therapies
What is one of the most commonly used antidepressants in palliative care?
Mirtazapine
What is an additional benefit of mirtazapine in palliative care?
It has weight gain as a side effect, which may be beneficial to many palliative care patients
What needs to be ensured regarding antidepressant medication?
The patient is actually taking it
sorry this card is shit lol
How long do patients need to take anti-depressant medication for?
At least 3-6 months
Why do patients need to keep taking anti-depressant medications for 3-6 months?
Stopping medication too early can cause rebound and depression recurrence
Why do nurses have a pivotal role in the identification of depression in terminal disease?
Patients may choose to disclose to nursing staff that they are feeling depressed or are worried regarding their low mood, and then nurses can pass this information to the medical team
