Dr Periyakoil initially gave us the choice of either listening to her lecture, or of having her lead a group discussion. The group opted for the lecture but as it ended we were in a giant discussion, and we had all learned something about how not only their families, but our patients with Long Term Illness grieve, too – for all that they have lost – and that their grief (a normal part of LTI) can mask and mimic depression, which is not normal and can and should be treated, no matter how late it is found. Depression in LTI is underdiagnosed and undertreated; incidence is 22 to 77%, so if you have four LTI patients, at least one of them is depressed and needs treatment.

Discussion ensued: depression can overlap with grief; normal dying can have features of both. How to tease out the depressed ones? Depression scales – rating systems which can be used by nonpsychiatrists to identify patients who are likely depressed – were presented, leading to the TIGDS (terminal illness grief depression scale) which isn’t perfected yet. Nor is our presentation of the possibility to our patients, who usually deny depression because of its stigma. Three video clips illustrated very different patients with simple anxiety, depression, and acceptance of terminal illness – which was inspiring.

James Condon, MD