Introduction: For approximately 25% of palliative care patients, depression is a significant symptom, but is frequently unrecognised and untreated. This study was carried out to determine how senior doctors working in palliative medicine assessed and managed depression and highlight any difficulties encountered when managing the depressed patient in palliative care.
Method: Both open and closed questions were used in a questionnaire which was sent to all palliative care units who had a designated medical person in the UK. This included questions on assessment and both pharmacological and non pharmacological management of depression, difficulties encountered, their qualifications and current post.
Results: The response rate was 66%; two thirds (90) of respondents were consultants and a further 21 medical directors. The majority (73%) routinely assessed for depression with 27% using the HAD scale and 10% asking the patient "are you depressed"? The most frequently prescribed medication was SSRI (80%). Less than 6% prescribed psychostimulants. Almost all respondents reported difficulties with the assessment and management of depression, which mainly focused on distinguishing symptoms of depression from sadness and whether it was appropriate to treat patients when life expectancy was short. 47% of respondents identified difficulties in accessing psychiatric input - mainly relating to long delays between referral and appointments and lack of access to psychiatry services. Discussion Depression is identified as being a difficult symptom to manage by many senior palliative care physicians in the UK and suggestions will be made as to how some of these issues can be addressed.