Clinical Depression

Vignette:

An 89 year-old male with history of prostate cancer and metastasis to the spine lost the ability to walk. Since that time, approximately 6 months ago, he states his "mood stinks." Previously he had been fully engaged in life, enjoying friends, family, food, and nature, among other things. He is now tearful most of the time. He also suffers from anhedonia (lack of interest or joy in anything), and has been experiencing severe suicidal ideation. His goal of care is to discontinue medical interventions as he wants to die. What can be done to support this patient?

Discussion:

Patient likely has a clinical depression (Major Depressive Episode). Recommended the use of pharmacological psychostimulant such as methylphenidate. In addition, discussed non-pharmacologic adjuvants such as supportive psychotherapy, integrative therapies, and education for the patient and family.

Outcome

Within 48 hours, patient was no longer clinically depressed, had re-engaged with family and friends, no longer had suicidal ideation. He did not change his goal of care and died a week later; however his last week was transformed, and the experience of his friends and family were transformed for their lifetimes.

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