Pain expert Dr. Scott Fishman answers questions about end of life pain:
Q: Is depression a common accompaniment to end-of-life pain?
A: Depression and dying are an odd couple, and not as wedded to each other as many people assume. Most people think it is natural to be depressed at the end of life - a life is ending, they reason. Of course it is natural to feel sad about dying and to grieve over the loss of one's life.
It is often helpful, even therapeutic, for someone who is dying to be able to talk about these feelings and not to hide them for fear of upsetting loved ones. But persistent feelings of depression are not normal, even for someone who is dying. While depression may be understandable, it is never appropriate, and always needs treatment.
A patient may not use the word "depression" but his actions may suggest it. A patient I treated was so glum about his future and worried so much over his surviving spouse that he would feign sleep to stay in bed in the mornings. Previous small pleasures, like doing crossword puzzles or talking to friends, were no longer of interest to him.
Another patient was completely disinterested in eating. When I hear that a patient doesn't enjoy eating, I automatically suspect depression. In addition to prescribing an antidepressant, I also added a stimulant (amphetamine) to her morning drug regimen. Although the antidepressant medication took a couple of weeks to kick in, I knew that the stimulant would immediately improve her spirits and quite possibly her appetite.