**4. Treatment and therapies**

When depression is identified in patients with terminal illness requires various measures to treat it. Treatment procedures could include pharmacological treatment, psychological treatment or the combination of both of these. A study was conducted to prove the efficacy of antidepressants in patients with depression in palliative care. It was found out the administration of antidepressants in these patients was found to be more effective than the placebo effect, and it was more apparent within 4–5 weeks and increased with its continuous use [35]. Patients showing depressive symptoms or depressed anxiety mixed symptoms were daily given oral doses of ketamine hydrochloride. In this 28-day trial, there was found to be a significant improvement in both depressive and anxiety symptoms in patients, the improvement was significant and gradual for 28 days with some rare side effects like diarrhea, insomnia, trouble sitting [36]. There is a slight misconception that the psychotherapeutic approach is not beneficial in severely depressed patients but in a study done by Driessen, et al., it was found that psycho-therapeutic approaches could be beneficial in both mild and severe depression [37].

### **5. Psychotherapy**

Depressive symptoms that diminish with psychological interventions can also be provided by medical caregivers apart from the specialist in psychological oncology. When the relation of health care workers with the patients is perceived as supportive then the patients with cancer tend to show less traumatic stress. Patients with leukemia significantly show stress symptoms which are associated with physical symptoms, psychological intervention could prevent traumatic stress in the patients. A study of breast cancer patients identified that women who don't have emotional support from family and friends have difficulty in interacting with nurses and physicians [38, 39]. For both undergraduate and postgraduate medical training, there is deterioration in clinical empathy [40].

Several types of psychological therapies are being performed depending upon the severity of depressive symptoms (**Figure 4**) stage of the disease, the interest of the patient and motivation to participate in psychological therapy. Cancer patients who were diagnosed with mild to moderate depression could be benefitted from cognitive behavioral therapy, methods of relaxation, approaches to problem-solving [40–42]. Supportive expressive therapy could be beneficial for the patients who have more advanced disease that targets the fear related with death and existential concerns. Many psychotherapies have been developed like meaning-centred group therapy which is beneficial spiritual and emotional wellbeing [43], dignity therapy which empowers meaning to life [44], mindfulness-based meditation therapy, effective in cancer patients [45], and managing cancer and living peacefully [46].

**Figure 4.**

*Therapies performed to treat depression.*
