Depression: spectrum from response to a crisis → adjustment disorder → major depressive disorder.
Under-recognized and under-treated.
Depression associated with increased somatic symptom burden when controlled for disease, treatment status, and prognosis.
Good screening tool for all ages with advanced disease is geriatric depression scale.
Medications
Considerations:
- activating (duloxetine, bupropion, or nortriptyline) versus sedating features of the antidepressant,
- tolerability of the antidepressant (sertraline and escitalopram) and
- potentially useful side effects or other indications of the antidepressant (mirtazapine in insomnia/weight loss, venlafaxine, duloxetine in neuropathic pain)
Ketamine – Consult PC
- 0.1-0.5mg/kg sc over 30-60 min for short prognosis. May be given intranasally
Methylphenidate
- useful in patients with very short life expectancy
Other therapies
- supportive psychological and spiritual counseling