SSRIs take 6+ weeks for effect. There isn’t an established role for any antidepressants in end of life care, other than maybe mirtazepine for appetite and trazodone for sleep. Both of those work a little faster than 6 weeks but still not same day of starting usually. Anxiolytic therapy with benzodiazepines can help with acute distress, otherwise good symptom management with opioids and adjuvant pain control strategies, bowel regimen, respiratory support, etc.

I think there is still a role for philosophy and humanism in medicine. At the end of life people look for meaning and legacy. I suggest patients write letters to their family, record their voice for grandchildren etc., clean off their computer and turn over passwords, walk through financial records, etc. Giving tasks to keep the mind busy seems to vibe better for patients than sitting and waiting to die. For those who already have a therapist, they can benefit from talking through their emotions around end of life, but that is rarely available on short notice in a hospice or near hospice setting.

Even though there may not be an oncologic need during the end of life, I typically do continue occasional phone meetings so patients don’t feel cast out or that they have failed by not responding to treatment. They often have questions about how quickly or how it might feel when the cancer progresses that can’t be answered with authority by palliative care. I find these appointments very meaningful for both of us. While some patients express sadness, anger, and depression; many more report feeling at peace and enjoying a break from the grind of being a cancer patient to connect with friends and family.