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Rapid Responses: Rapid Responses published:
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Depression in terminal illness
- Stephen MW Hutchison (14 November 2008)
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Depression in terminal illness
- Morris Fraser (21 November 2008)
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Stephen MW Hutchison, Consultant Physician in Palliative Medicine Highland Hospice, 1 Bishop's Road, Inverness, IV3 5SB
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I was astonished, indeed angered by Dr Evans' nihilistic and patronising views about depression in terminal illness. Depression may render a patient incapable of addressing the enormous consequences of a terminal illness, can make symptoms refractory to treatment, and is a profoundly disabling and horrible experience, particularly for patients who have enough problems already. Of course we will respect a competent decision not to have treatment, and patient autonomy is crucial in palliative care. The suggestion that depression is the opposite of happiness about impending death is remarkably naive. We don't treat depression in this contect to make people happy about something as monumental as approaching death, but rather to deal with a potentially treatable component of terminal illness and to optimise the wellbeing of the patient. Yes it is indeed appropriate to tackle treatable issues even if it does take time and the drugs cause side effects. We recognise that occasionally a patient may be so near to death that there will not be time for conventional antidepressants to work. In such instances we would not embark on futile treatment, but would consider the use of steroids or psychostimulants. Dr Evans' negativity provides no basis for introducing Oregonian-type legislation elsewhere. I trust that I will never convey that attitude to my patients. Competing interests: None declared |
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Morris Fraser, Retired consultant psychiatrist 8660 De Panne, Belgium
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The letter from Lesley Evans is disappointingly naive. Depression, she writes, 'is not a psychotic disorder'. This is just plain wrong. Often depression is indeed a psychotic disorder, and the death wish is frequently driven by severe guilt-laden delusions or other false perceptions. Further, the object of treatment is not to make the patient 'happy about his or her impending death'. Indeed, there is no antidepressant known to medical science that can do this. Antidepressants are not 'happy pills'. Instead the therapeutic aim is, where possible, to relieve intolerable or handicapping psychiatric symptoms. The seeming implication that it is in some way wrong to relieve depression in a dying person on the grounds that this state is 'normal' appears to me bizarre. Competing interests: None declared |
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