special subjects
Symptom Relief for the Dying Patient
Depression and Suicide
Most dying patients experience some depressive symptoms. Providing psychologic support and allowing patients to express concerns and feelings are usually the best approach. A skilled social worker, physician, nurse, or chaplain can help with these concerns. A trial of antidepressants is often appropriate for patients who have persistent, clinically significant depression. Selective serotonin reuptake inhibitors (SSRIs) are useful for patients likely to live beyond the 4 weeks usually needed for onset of the antidepressant effect. Depressed patients with anxiety and insomnia may benefit from a sedating tricyclic antidepressant given at bedtime. For patients who are withdrawn or who have Symptoms and Signs , Serious medical illness is a significant risk factor for suicidality. Other risk factors for suicide are common among those sick enough to die; they include advanced age, male sex, psychiatric comorbidity, financial strain, an AIDS diagnosis, and uncontrolled pain. Cancer patients have nearly twice the incidence of suicide than the general population, and patients with lung, stomach, and head and neck cancers have the highest suicide rates among all patients with cancer. Clinicians should routinely screen seriously ill patients for depression and suicidal thoughts. Psychiatrists should urgently evaluate all patients who seriously threaten self-harm or have serious suicidal thoughts. 