Definition
- Depression is characterized by persistent feelings of extreme sadness and low mood associated with loss of interest in activities and inability to experience pleasure. There are often associated biological features of significant changes in appetite and weight, disturbed sleep, fatigue, and poor concentration.
- Diagnosing and providing treatment for a major depressive episode in patients with a terminal illness can improve quality of life.
- Diagnosis of major depression in a terminally ill patient often relies more on the psychological or cognitive symptoms (worthlessness, hopelessness, excessive guilt, suicidal ideation) than the physical/somatic signs (weight loss, sleep disturbance) described in depression in patients who are not terminally ill.
- The key indicators of depression in the terminally ill are persistent feelings of hopelessness and worthless and/or suicidal ideation.
- Depression in palliative care is likely to be significantly under-recognized and undertreated as the symptoms overlap with symptoms of the underlying condition.

Scope
- Treatment of pain and other reversible physical symptoms should be instituted before or concurrently with initiation of specific depressive treatment.
- Psychological approaches to depression in palliative care, particularly cognitive behavioral therapy, are important.
- Management of depression includes the use of pharmacological and non-pharmacological treatment approaches.
- Anxiety commonly exists as comorbidity with depression in palliative care.

Adapted from Radbruch L et al. Essential medicines in palliative care - An application for the 19th WHO Expert committee on the selection and use of essential medicines. Kindle Edition, 135 pp. Published June 5, 2013 by IAHPC Press. Available at https://www.amazon.com/Essential-Medicines-Palliative-Care-Application-ebook/dp/B00D7S2D0C