DEPRESSION
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DEPRESSION
The Temporary Death of the Soul
William Styron
Depression kills. If not the body, then at least the spirit. If you have never had it, count yourself fortunate, but recognize that as you get older, it tends to creep into your life or that of loved ones. It is something to be treated, not to be ashamed of. It's nothing "different" than diabetes or a heart condition- an organ (the brain) is malfunctioning and needs to be treated and monitored.
Women tend to have more depression than men, but men fall more victim to its problems later on in life.
Here are some major signs of depression (University of Alabama)
1. Loss of interest or pleasure in usual activities such as golf, gardening or walking
2. A generally depressed outlook, or dysphoria which can appear as sadness, irritability or anxiety.
Other symptoms
1. Sleep disturbances such as insomnia
2. Appetite disturbance and rapid weight gain or loss
3. Displays of excessive guilt or self reproach
4. Lack of energy or constant fatigue
5. Sudden increase in agitation and restlessness or sudden slowdown in motor skills
6. Diminished ability to concentrate or indecisiveness
7. Decrease in sexual drive
8. Talk of suicide, worthlessness or becoming a burden
Older people suffer additional factors that may bring on depression
1. Loss of a spouse
2. A change in living conditions- such as a move to a nursing home
3. dwindling savings and restrictions on economic freedom
4. Declining health or serious medical problems which can lead to a feeling
of worthlessness.
Contact: The National Depressive and Manic Depressive Association, 730 N. Franklin Street, Suite 501, Chicago, Ill, 60610, 800 826-3632
The Depressive Awareness, Recognition and Treatment Program and the National Institute of Mental Health, 24 hour hot line at 800 421-4211
AARP Fulfillment (EE0713), PO Box 22796, Long Beach, CA 90801-5796 and request
Backgrounder: Depression in Later Life (D14220) or If You're Over 65
and Feeling Depressed (D14862).
DEPRESSION: Here is some commentary from The Caregiver's
Guide. Depression becomes a mood disorder if someone feels low, empty
and down in the dumps for more than two weeks with four or more of the following
symptoms
WORKPLACE DEPRESSION: (Working Woman) Signs of depression that you can spot among coworkers
1. Decreased productivity
2. Morale problems
3. Lack of cooperations
4. Safety risks, accidents
5. Absenteeism
6. Frequent statements about being tired all the time
7. Complaints of unexplained aches and pains
8. Alcohol and drug abuse
The article suggest that if you think someone is sliding into clinical depression you should first say something like, "your performance has slipped. If it doesn't get better we will have to do something to address it. I know you can do better". If that doesn't work, the managers should initiate another discussion and directly suggest the employee might need help- such as someone in personnel who has a background. Don't moralize, offer a diagnosis or even introduce the idea of an illness. If that doesn't work, they suggest a more emphatic approach to seeking assistance. If the employee complies, the manager should adjust the employees work schedule and make other adjustments for 30, 60 or 90 days. If all that doesn't work, it may be necessary to fire the worker just as you would anyone else who doesn't work out. Many companies are working with outside medical experts in helping employees handle depression. Companies have found that they can reduce behavioral health care costs substantially (one went from 15% of total medical plans costs to 8% in less than 10 years) and retain a valuable employee. Of course it's not all peaches and cream sine managers must spend more time monitoring a troubled employees. Help for managers is available :
Downtime: A Worksite Guide to Understanding Clinical Depression, $69.95 videotape and training manual from Wellness Council of America 402 572-3590
Depression : Corporate Experiences and Innovations, $25 form Washington Business Group on Health 202 408-9320
What to do when an Employee is Depressed, free from National Institute of Mental Health
Answers to Your Questions about Clinical Depression.
DEPRESSION: If you think you have depression, it is recommended that you get a good diagnosis from a mental health professional, not just your family doctor. It is also suggested that you see a psychiatrist or therapist who specializes in your illness and who should be affiliated with a college, university or referred by one. You may contact these organizations for more info.
American Psychiatric Association, Washington, DC 202 682-6220
National Foundation for Depressive Illness, New York, 800 248-4344
Depression and Related Affective Disorders Association, Baltimore, MD 410 955-4647
American Society for Adolescent Psychiatry, Bethesda, MD 301 718-6502
American Academy of Child and Adolescent Psychiatry, Washington, DC 202 966-7300
International Committee Against Mental Illness, New York, 914 359-8797
DEPRESSION & DRUG THERAPY
Paraphrased from The Caregiver's Guide
If a psychiatrist has indicated that medication is the best alternative treatment
for current depression, it is your responsibility to determine if it is
appropriate for you or your loved one. Of course, if you are the one receiving
the medication, you probably are not of a clear mind to do the review so
you should request someone else to do it themselves or to be present when
the question s are asked.
1. What type of depression is this? What do you think caused it? If the patient
is a father or mother, the obvious signs may be death of a spouse, financial
troubles, etc. The not so noticeable causes might be from some friend of
theirs you have never met- or one you have not approved of. Try not to judge
and be as patience as possible.
2. What drug is being given? What classification of drug is it- tricyclic
antidepressant, lithium, minor tranquilizer, major tranquilizer, monamine
oxidase inhibitor or stimulant?
CAUTION: Over the last few years in particular, Prozac has been considered
by some doctors to be a wonder drug for "what ails you" and may be prescribed
too readily. You might wish to ask how often are drugs prescribed by the
doctor and perhaps get a second opinion. You have every right to confirm
a diagnosis with another doctor. Further, treatment for the body is many
times clear cut- you can feel and see the injury and can monitor how well
the healing process is taking. Unfortunately, you cannot monitor the mind
as easily and need to be extra careful before you agree to medication as
a quick relief opportunity.
3. How does the drug treat depression?
4. How long does the drug take to work? Some may offer relief in a week or
two. Others may take one, two or three months before any effects are shown.
Many might tend to cease treatment if there are no "immediate" results so
this is an important question.
5. How long must I keep taking the drug? Can I decrease the dosage in time?
Could I stop it altogether? As with #4 above, make sure you understand the
implications. Some patients think they feel better irrespective of the drug
treatment and are apt to stop medication. Then they revert back to their
"old" selves.
6. Will I need to try other medications later ? The issue to recognize here
is that some medications might work for awhile but offer only temporary relief-
maybe for just a week or so. Then the old symptoms will come back. You need
to be as mentally prepared for this as possible since you might have to start
all over again with another drug or therapy.
7. What are the side effect of the medication? Dizziness, constipation,
drowsiness, urinary retention/incontinence, dry mouth, Parkinson's types
symptoms, rapid heartbeat and difficulties with memories are just some. You
may not like being reminded of the problems you may encounter, but better
to be forewarned than be surprised and confused.
8. Are there other medications, foods, ointments, makeup, etc. that should
be avoided while taking this medication?
9. How will and how often will the doctor follow up? Is psychotherapy or
counseling recommended along with this treatment?
From personal experience with my mother who was treated for Alzheimers- the issues on medications were all apparent with her. Some worked, some worked for awhile, many had side effects and, even when more lucid, she would stop taking the medications.
Depression (1996): According to the National Institute of Mental Health,
more than 80 million Americans- about 28% of the U.S. total population, suffers
from a mental or attention disorder such as major depression, obsessive
compulsive disorder, panic disorder, anxiety disorder, drug dependence, alcohol
dependence or suicidal thinking. Of this group, about 20% will visit a doctor.
BUT ONLY ABOUT 4 TO 8 IN 100 WILL BE PROPERLY DIAGNOSED. The costs for these
disorders has been estimated at $273.3 billion in 1990. A doctors at the
University of Alabama says that's $98.4 billion due to lost and reduced
productivity; $65.6 billion for treatment and $43.7 billion for lost earnings
due to premature death and $65.6 billion for costs associated with factors
such as crime and fires. Many elderly feel that the simple fact of aging
causes depression. In a recent study, more than half the seniors over 75
felt that way. Of the 600 adults over age 21, nearly 93% believed that depression
is a normal side effect for people suffering from a serious medical condition.
About half thought that the lack of energy, recurrent thoughts of death,
and difficulty with concentration are natural parts of aging rather than
possible signs of depression. Faced with these misconceptions, AARP is attempting
to increase public awareness about depression in the elderly. Depression
affects about 15% of adults aver age 65 in the U.S. Although 6 million may
have clinical depression, only 1 million will be properly diagnosed. However,
if they are diagnosed properly, depression may be overcome in about 80%.
"Sustained depression that impairs function is not a normal response to disease
or any life event" says a doctor at the University of Washington.
SUICIDE: 20% of all suicides occur on the elderly over 65 years of age. And the rate of "success" is 50% higher than any other group since they use guns. The numbers are expected to increase as more people get older. The main reason for suicides is depression.
DEPRESSION AND YOUR HEART: (1996) Yes, you do see continual comments about depression since it is responsible for bad lives and premature deaths. According to surveys, depression of some form affects of the 1 million heart attack survivors and about 30% to 40% of the 350,000 bypass patients each year in the U.S.
NEUROPSYCHIATRIC CONDITIONS: (1996) A study by the Harvard School of Public Health, the World Health Organization and the World Bank show that the first three reasons for premature death and disability are still infectious diseases, but the fourth is clinical depression. They added when disability is added in, not just death, the impact is "huge". One author noted that "for every disabled person, there is a family of maybe four or five other people who are profoundly affected economically and socially." In these families, there is anger, guilt and fear." Admittedly this study covers the entire world, not just the U.S. But the impact is relevant nonetheless. Depression kills.
DEPRESSION: (1997) According to the National Foundation for Depressive Illness, 15% of all self inflicted deaths are attributable to depression. The World Health Organization said that by 2020, depression will become the second leading health threat next to heart disease -up from number four now. Many people are unwilling to consider treatment because of the social stigma- "it must be a mere character flaw." According to doctors, however, up to 80% can be effectively treated.
A December article noted that people who suffer severe depression are four times more apt to have a heart attack than others. The heart attacks were probably due to the increased amount of stress that depression causes.
Depression is insidious and, left alone, it can kill.
WOMEN AND DEPRESSION: (1997) Depression hurts you both mentally and physically. The National Institute of Mental Health noted that depressed women had up to 14% lower bone density than women who were not depressed. They noted poor eating habits and lack of physical activity. Not surprising since when you are feeling down, one of the last things you wish to do is go out and do physical exercise.
MENTAL HEALTH: (Gail Sheehy 1997) Men have a tough time with depression as they grow older. And this feeling of despair can reduce the will to fight off diseases that happen as they get older. Studies have show that if you can stay mentally active and emotionally positive, your entire system will "perk up" substantially and be available to fight off "whatever ails you". Dr. LeShan, author of "Cancer as a Turning Point" has studied the psychological means of rebuilding the immune system by rebuilding a person's enthusiasm for life. Approximately one half of his patients with initially poor prognoses have responded with long term remissions and are still alive. And they have more zest and involvement with and for life.
MAJOR DEPRESSION: (1997) Affects 2.2 million (about 1.1% of the adult population). Marked by acute episodes of depressed mood or irritability with altered sleep or appetite, loss of energy, hopelessness, impaired concentration.
MANIC DEPRESSION: (1998) Also called bipolar disorder affects 1.8 million(1%). It is a cyclic illness involving episodes or mania and usually episodes of depression. Mania usually involves a minimum of one week period of elation, grandiosity or extreme irritability accompanied by a decreased need for sleep, pressured sleep, racing thoughts, increased directed activity and excessively risky pleasure seeking
OBSESSIVE COMPULSIVE DISORDER: (1998) Affects 1.1 million (0.6%) and involves obsessions or compulsions. Obsessions are recurrent and persistent unpleasant thoughts that go beyond the level of appropriate worries. Compulsions are repetitive behaviors or mental acts that the individual feels are necessary as a way of preventing distress or heading off a terrible act.
DEPRESSION AND MEN: 1998 (NY Times) I tell all students when doing estate planning and health care that the greatest problems that the men will face is depression. In years' past, the manly "John Wayne" attitude has primarily prevailed. Grin and bear it. Don't cry no matter what the problem. "Real men are supposed to be strong, silent, powerful, dominant". But many men also recognize that some of this is a lot of crap since it eats away inside and causes untold problems later on- namely depression. And depression kills. The greatest number of suicides is in white men. (About 18,000 clinically depressed people commit suicide each year). While they may "get away" with the bravado until they retire, they then may have to confront a lonely, scared little man. Women have been aware of this issue for years.
Depression Statistics: According to a Professor of Psychology, major depression affects about 3% of the elderly- 7% of the elderly have minor depression. Surprisingly, younger people have greater depression- about 6%. It's just that they tend to get treated while the elderly think it is simply a part of getting old (it ISN'T).
According to studies, about 24% of the population will suffer form a major depression in a year. About 9:10 can be helped.
MEN AND DEPRESSION: 1998 You may have seen the HBO special on depression that included the likes of Mike Wallace. In any case, the bottom line is if you have never had depression, count yourself lucky. But also recognize that if you are a man, there is a tendency to get it as you get older- and certainly the odds go up after you retire. Unfortunately, it is not something- as Wallace notes- that you can immediately put your finger on. It can insidiously creep up on you and get worse and worse to where your entire persona can change. Most of the time, it might be wife who spots the problems and suggests/demands that help be sought. But if you are by yourself, the condition can go untreated for a very long time culminating in thoughts of suicide (and the rate for white men is the highest).
Twenty five years ago, Wallace commented that "despite its epidemic proportions, depression has been shrouded in secrecy: something to hide, a skeleton in the closet associated with guilt and fear and shame."
Men tend to go untreated since, "the cardinal rule of manhood is you just suck it up" and move forward. Psychologist Terry Read in his book, "I Don't Want to Talk About it: Overcoming The Secret Legacy of Male Depression", one of the ironies about men's depression is that the very forces that help create it keeps us from seeing it. "For many men, to be depressed is to feel somehow less than a man, whereupon they fall prey to ‘Compound shame". "Depression is an attack on self esteem and HAVING depression is an attack on self esteem. Men become depressed about being depressed, ashamed about feeling ashamed".
So what to do? Give your self two to four weeks once you know that something is wrong. That is more than sufficient time to determine if it is just a "fleeting occurrence". If it still exists, treat it as though you had been out playing touch football and you sprained a knee. (Just think as though your brain had taken a hit- which is pretty much what has happened.) Go to a doctor. Tell him you feel like crap and want some way/something to get rid of the problem. Might take a little while and they might have to go through different medications, but that is not much different than the method or time involved in getting your knee better.
WOMEN AND DEPRESSION: (1988) Depression and other mood disorders are largely a woman's disease. At least twice as many women are likely to be diagnosed with clinical depression anxiety or panic attacks. Four times as many women have a seasonal effective disorder called winter blues. Additional study by the National Institute of Mental Health researchers using pet scans of brains noted that the areas that lit up in response to sadness was 8 times larger in women than in men. However such sensitivity to relationships may give women greatest strengths later life in perfecting their abilities to empathize.
While women tend to internalize pain and distress, men it do so through workaholism, alcoholism, avoidance of intimacy and aggressive or abusive behavior. Yet, most striking way, where the traditional male role is not as aggressive-among the Amish for instance-men and women report equal rates of depression.
DEPRESSION: (1998) The general tendency is to believe that women become more depressed in men. The study by the Research Institute on Addiction's indicated that men drink alcohol and get depressed just as often as women when work and family clash.
However, the worst problem is with teenagers. Over 2,000 committed suicide last year. 87% of boys ages 14- 18 who attempt suicide have a previously diagnosed disorder- usually depression. Here are a few sites where one can get help:
Covenant House Hotline: 800 999-9999. Crisis intervention, referral and information for troubled teens and families
Families Anonymous: 800 736-9805. Support for friends and family concerned about a loved one's drug or alcohol use
DEPRESSION: (1998) This is insidious. It is not just having a bad day. It is the (at times) unending gloom that can permeate your being. It affects about 15 million Americans at some point in their lives. They spend about $3 billion annually on drugs to combat it- though about 20% do not get any benefits from such medications. But there is a new drug called MK-869 which appears to bring remarkable improvements. Works as good as Paxil without the side effects.
DEPRESSION: (1999) "The secret depression of some "strong" black women, burdened by responsibility for family survival and undervalued by society, may lead them to abuse alcohol and drugs, author Meri Nana-Ama Danquah says. But a religious culture that stigmatizes depression as a turning away from God and alcoholism as a sin discourages many of these women from seeking medical help. Recent statistics show less than 10% of the tens of thousands of African American women suffering from depressive disorders seek professional help, compared to some 60% of whites."
Also recognize that depression is insidious for white retire men. In fact, outside of teenagers, white men over the age of 65 commit the most suicides.
Depression"most of the cost associated with depression could be avoided- it can be treated successfully 85% of the time. But many sufferers don't seek help." The National Institute for Mental Health estimates that 11% of the U.S. population seeks treatment but that a full 22% experience have some sort of mental illness. Women are twice as likely to suffer depression and about 20% experience a from of depression in their lives.
1990 study by the Analysis Group and MIT
| Health Problem | Billions of Dollars |
| Cancer | $104 |
| AIDs | 66 |
| Depression | 43.7 |
| Coronary Heart disease | 43 |
| Stroke | 18 |
| Multiple Sclerosis | 5 |
| Cerebral Palsy | 1 |
DEPRESSION IS INSIDIOUS: 1999 studies indicate that from "30% to 50% of visits to doctors' offices are for complaints that can't be pinned down medically. The bottom-line reason is often depression, anxiety, substance abuse or the result of various life stresses."
MORE DEPRESSION: (1999)During a lifetime, 5% of men will suffer depression- women at twice that rate. But women tend to handle it better. Depression affects 17.6 million Americans each year. Depressed men tend to sleep and eat less and to feel agitated. Women tend to sleep and eat more and to feel persistent fatigue.
MALE DEPRESSION: (1999) According to a Rand study published in the Journal of Consulting and Clinical Psychology, 70% of depression in men goes undiagnosed. If you are a man and have never experienced depression, recognize that you may well get it once past age 60/65. Better read what it is and what you can do about it.
DEPRESSION: (2000) Here is quiz on depression symptoms. Yes responses = 1, No = 0
Losing interest in things you usually enjoy Yes No
Thoughts of death or suicide
Feeling Blue
Feeling worthless or guilty
Loss of energy or feeling tired all the time
Trouble sleeping or sleeping too much
Problems concentrating and thinking
Decrease or increase in appetite
Feeling slowed down or restless, unable to sit still
If you answered yes to number 2, see a physician immediately
If the score is five or more, see a health practitioner. Even a score of 3 or 4 may indicate problems and they probably need to be talked through. Depression is NOT just having a bad day. It can be an endless and mind numbing process of hopelessness.
And if you're over 50 and suffer from depression, you may have experienced a minor stroke without even realizing it. An AP release noted that researchers say they have found a connection between depression and "silent strokes." They're called silent because they lack classic stroke symptoms such as slurred speech, blindness and lack of motor skills."A psychiatrist noted that as we get older, the risk for stroke goes up. The same risk factors for stroke may be the risk factors for late-life depression."
Depression Killing the Elderly ( Archives of Internal Medicine 2000) This study set out to determine whether there is a link between symptoms of depression and mortality in the elderly, a subject over which there has been much debate in recent years. Investigators found that a high baseline depression score was an independent risk factor for six-year mortality (24% higher risk than those with lower depression scores). Motivational depletion ("I felt that everything I did was an effort," "I could not get going on anything") may be a key underlying mechanism for the depression-mortality effect.
Not only that , but depression in elderly is more prevalent and untreated than previously reported. (Archives of General Psychiatry 2000) Previous estimates of the prevalence of depression in the elderly have varied. There are few large population-based studies; most of these focused on individuals younger than 80 years. No U. S. studies have been published since the advent of the newer antidepressant drugs. In this large scale study, the authors estimated lifetime prevalence of major depression as 20.4% in women and 9.6% in men, decreasing with age. These estimates for prevalence of major depression are higher than those reported previously in North American studies. Treatment with antidepressants was more common than reported previously, but was still lacking in most individuals with major depression.
Indicator 16: Depressive Symptoms
| TABLE 16: PERCENTAGE OF PERSONS AGE 65 OR OLDER WITH SEVERE DEPRESSIVE SYMPTOMS, BY AGE GROUP AND SEX, 1998 | |||
| TOTAL | MEN | WOMEN | |
| 65 TO 69 | 15.4 | 12.1 | 18.0 |
| 70 TO 74 | 14.3 | 10.3 | 17.2 |
| 75 TO 79 | 14.6 | 10.4 | 17.4 |
| 80 TO 84 | 20.5 | 17.1 | 22.4 |
| 85 OR OLDER | 22.8 | 22.5 | 23.0 |
| Note: Definition of severe depressive symptoms:
four or more symptoms out of a list of eight depressive symptoms from an
abbreviated version of the Center of Epidemiologic Studies Depression Scale
(CES-D) adapted by the Health and Retirement Study. Reference population: These data refer to the civilian noninstitutional population. Source: Health and Retirement Study. |
|||
Elderly Depression: (2000) It has been estimated that only 10% of depressed elderly persons receive treatment. Reasons for the lack of treatment in this population include: the widespread belief that depression is normal or expected with aging, conscious underreporting or denial of symptoms by patients due to shame or stigma, and symptoms of depression in late life may be atypical, sometimes called "masked depression."
Depression: In a typical office of 20 employees, 4 will suffer from a mental illness in a year. Depression hits some as early as 20 and costs U.S. businesses about $70 billion annually in medical expenditures, lost productivity , etc. Yet most employers don't have a clue.
One major company did a check to find out why its health care costs were going up so much. Treating depressive disorders was found to be almost as expensive as the treatment for heart disease.
Has your health been a problem of late? Have you had any recent colds or virus-like symptoms?
Have your own medical needs such as routine check-ups and doctor consultations been overlooked because of your busy schedule?
Has anything changed in your family structure, and is communication between your spouse and children now an issue?
Has your energy and vitality been absent recently?
Are you sleeping well?
Do you have a persistent feeling of sadness?
Have you had thoughts of death or suicide?
Aside from respite care, there are some other recommendations that may ease your feeling of depression. They are:
Involve other family members in your caregiving, and set up a schedule that can allow you some freedom and relief to get out for a while.
While your caregiving role is not likely to change significantly, give your loved one as much independence as possible if they are still capable of dressing and bathing themselves, for instance. This can provide you with some freedom and strengthen your mental well-being.
Do not be afraid to ask for your friend’s help. Even if it is as simple as bringing over dinner one night, just this simple kind of assistance can go a long way to maintain your connection with friends in times of need.
Focus on your dietary needs and eat well-balanced meals that can improve health and keep you feeling strong and mentally fresh.
Perhaps the simplest, yet most overlooked task to relieve depression comes with exercising. Activities such as walking or stretching have relaxing qualities that can improve emotional well-being quickly.
Depression: (2001) Community primary care practices can successfully improve quality of care for their depressed patients at relatively modest cost and with substantial and sustained benefits for patients and society, study results show.
Underwriting and depression: (2002) WHY CAN'T CLIENTS WITH A DEPRESSION HISTORY QUALIFY FOR PREFERRED?
The short answer is that depressed people experience a death rate twice that observed in the general population from both natural and accidental causes. There are three primary types of depression:
Dysthymia - a low grade depression present for at least two years.
Major Depression - A more extreme version of Dysthymia that can be either unipolar or bipolar. Bipolar is classified as having one or more periods of elevated or irritable mood.
Seasonal affective disorder - Major depression which occurs at specific seasons.
The increased mortality from natural causes is due to common conditions such as heart disease, lung infections and influenza. Accidental deaths are probably related to greater risk taking behavior. Clients with a psychiatric illness are more likely to be either victims or perpetrators of violence and are more prone to abuse alcohol and drugs.
The most serious complication of major depression is suicide. A quarter of all patients diagnosed with major depression attempt suicide at least once and 15% of patients ultimately die by suicide.
Factors associated with a poor risk are three or more episodes, lack of a maintenance dose medication, multiple drug therapy, poor compliance, hospitalization and substance abuse.
Minor depression is usually Table 2 within the first year of diagnosis and standard thereafter. Major depression is usually rated Table 2 to 4 if under good control.
Depression in the Elderly is Often Under Diagnosed
Emotional: An Australian study showed that 13% of married men and women each had mental illnesses/emotional disorders. Divorced had 25%. Single women at 22% and single men at 26%.
Nip Depression in the Bud: Warning Signs to Look For 2002
Depression: (2003) Depression prompts many people to gain weight, which triggers the release of inflammatory molecules that threaten the heart. This chain reaction could help explain why depressed people have a much higher risk for heart attacks.
Depression and a free kit: (2003) Depression costs American business an estimated $30 to $44 billion, with over half of this cost derived from absenteeism and lost productivity. This May, as part of mental health month, Horizon Behavioral Services is offering a kit called “Mental Health Solutions Everyday.” The kit stresses the importance of caring for your mental health as part of your everyday routine. “Depression can effect workers’ productivity, judgment, ability to work with others, and overall job performance. It doesn’t make sense for employers to ignore the impact of depression on their employees or their bottom line. “Organizations need to help employees learn to recognize and cope with depression and job related stress, so that employees can get help and lead productive and rewarding lives.” All workers can experience family, mental health, and personal problems that affect their health, job satisfaction and productivity. Each year, 217 million workdays are completely or partially lost among employees with mental disorders aged 18 through 54. And, unfortunately 66 percent of the 28 million employees with mental disorders do not receive treatment.
Depression in the Elderly is Often Under Diagnosed (Jennifer B. Buckley)
Overcoming Sadness and Depression, Naturally (2003)
Depression: - (2003) If you have depression after surgery, the odds of dying go way up. People with moderate to severe depression at surgery were more than twice as likely to die after a major operation than non depressed people. Sustained mild depression doubles death risk.
Nip Depression in the Bud: Warning Signs to Look For By Mary Damiano (2004)
While caregivers are defined as the people taking care of those needing help, they sometimes overlook the fact that caregiving responsibilities can take a toll on their own health.
In addition to physical ailments, caregivers are at risk for depression. Depression can strike anyone, at any age. Caregivers need to be especially aware of depression because of the great load they carry. Many caregivers work at a full-time job and take care of a family in addition to their caregiving responsibilities. They often sacrifice their own health, well-being and social life in order to do everything that needs to be done.
One common denominator among caregivers is the desire and the belief that they must do everything themselves. Often, caregivers do not ask for help, opting instead to inadvertently play the part of the martyr. This leads the caregiver to become overwhelmed and an overwhelmed person is fertile ground for depression to dig in and take root.
The great strain caregivers face on a daily basis can lead to depression. One way to stop depression before it strikes is to be aware of the warning signs. According to the Administration on Aging, here are some red flags that depression might be creeping in:
Sad, discouraged mood
Persistent pessimism about the present, future and the past
Loss of interest in work, hobbies, social life and sex
Difficulty in making decisions
Lack of energy and feeling slowed down
Restlessness and irritability
Loss of appetite and loss of weight
Disturbed sleep, especially early morning waking
Depressive, gloomy or desolate dreams
Suicidal thoughts
If you feel yourself exhibiting these behaviors, do not discount them. They should be taken as seriously as you might treat a fever that won't go away or a persistent cough.
Below are some expert tips on what caregivers in particular can do to stop depression before it gets out of control:
Talk regularly with family, friends, or mental health professionals— it is very important that you do not isolate yourself. Join a local support group, or find one online. Share your feelings so they don't build up and escalate into problems.
Set limits— this can be hard for caregivers, because they are used to taking on everything that needs to be done. It's okay to say no to taking on more than you can handle.
Eat nutritiously, exercise regularly and get enough sleep— this can be difficult because of the irregular schedules caregivers must keep. But think of it this way: your body and mind are machines, and they must be properly maintained in order to function at their best. Nutritious food, exercise and sleep are the things that fuel these machines. Just as you would not let your car run out of gas, don't let your body run out of its fuel.
Let go of unrealistic expectations— caregivers often have unrealistic expectations of themselves, and therefore push themselves to meet these goals. Accept the fact that you can't do everything. Ask for and accept help, from friends, family and local agencies. Whatever you do, don't be a martyr.
Keep a sense of humor— we all know that laughter is the best medicine, so go ahead and take a few spoonfuls daily. Relax with a funny movie or TV show. Put on a comedy tape to listen to while you do your chores. Find the humor in everyday things.
Depression- Diseases and conditions
Depression in the Elderly is Often Under Diagnosed, By Jennifer B. Buckley It has been estimated that 15% of older Americans experience depression at some point in their elderly years. In nursing homes, around 20% of residents are depressed, and it is also common with elderly people living with a serious medical condition like cancer or heart disease.
Temporal relation between depression and cognitive impairment in old age: prospective population based study, David J Vinkers, Jacobijn Gussekloo, Max L Stek, Rudi G J Westendorp, Roos C van der Mast
NOT JUST ‘SEASONAL AFFECTIVE DISORDER’: IN OLDER ADULTS, DEPRESSION CAN BE A CHRONIC DISEASE (Nancy Ceridwyn 2004)
Every year, the holiday season brings out stories about lonely, depressed older adults. Though many of us see depression as a seasonal or transient mood change, for many people ages 60 and older, depression, depressive symptoms, and anxiety are a year-round chronic and debilitating illness.
Older adults do not fit snugly into clinical profiles of people affected by depression and anxiety, yet depressive symptoms and behaviors that identify anxiety are seen in 19 percent of community-dwelling people ages 60 and older. Unfortunately, even if older adults recognize these feelings, and even if low-cost treatment is readily accessible, the stigma of mental illness inhibits many elders from seeking help.
Eighty percent of older adults treated for an episode of depression successfully recover. However, depression in late life tends to recur. New encounters or even continuing environmental conditions may trigger depression or contribute to anxiety disorders.
Campaigns to stem the environmental conditions that bring on depressive symptoms and that improve opportunities for healthy living have anecdotally improved the mental well-being of older adults. For example, over and over, aerobic exercise has been shown to decrease depressive symptoms. It may provide a buffer for nondepressed older adults, keeping their mood elevated so that stressors of later life do not trigger depression or anxiety. In addition, weight training may have antidepressant properties and has been reported to improve sleep quality.
Poor nutrition in and of itself does not cause depression but can play an important role in affecting its onset and length. The debate continues on the specifics of nutrition and mental wellness. Yet we know that within the brain, poor nutrition can cause impairment of blood circulation, which is important in supplying neurons (brain cells) with the building materials they require for proper function. In 2002, the University of North Carolina Student Health Services showed that skipping meals and eating sweets, coupled with poor appetite or inability to purchase healthy foods, can be associated with depression. The financial constraints of a fixed income may force older adults to eat foods of poor nutritional value.
Other barriers to mental wellness involve misuse of alcohol and medications, side effects of medications, sleep disturbances, and the emotional impact of living with one or more chronic illnesses such as heart disease, stroke, cancer, Parkinson’s disease, arthritis, and chronic pain.
Researchers looking for ways to promote “successful” or “vital” aging agree that enhancing mental wellness and preventing depressive symptoms are key to ensuring an active, engaged old age. Their suggested prescriptions for mental wellness include exercise, healthy eating, stress reduction, laughter and humor, optimism, sleep, emotionally enriched environments, and purposeful living.
Depression: (2005) Depression greatly diminishes a person’s quality of life, personal joy and productivity. Too often elderly persons who reside in assisted living facilities, nursing homes, or live alone suffer from depression. Their declining health and functioning, multiple life changes, and diminished personal resources are factors predisposing them to depression. Unfortunately, those family members who care for them also suffer disproportionately from depression and other adverse health conditions.
Depression is a medical condition, which affects the whole person; body, mind and spirit. Societal stigma and misunderstandings continually affect detection, treatment and prevention of depression. Depression can be managed and treated so that the person’s quality of life, personal joy, and productivity can return. Because depression is a common and personally devastating condition for elderly people, it is essential that family members and caregivers watch for warning signs and help their elders to seek treatment.
“Major depressive disorder,” often referred to as depression, is a common illness that can affect anyone. About 1 in 20 Americans (over 11 million people) get depressed every year. Depression affects twice as many women as men. Late-life depression is quite different from depression in the non-elderly population. In the United States, about 15% of elderly people living in the community (e.g., living at home or with family members) are depressed, while 30-40% of those residing in nursing homes are depressed. Major depression occurs in approximately 1-4% of the community-based elderly; this rate increases to 10-12% in medical care settings and 20-25% in nursing homes.
Family caregivers experience high rates of depression and illness while caring for loved ones. According to a 1998 study by the National Family Caregivers Association, 61% of "intense" family caregivers (those providing at least 21 hours of care a week) have suffered from depression. Some studies have shown that caregiver stress inhibits healing. A 1999 study published in the prestigious Journal of the American Medical Association found that elderly caregivers with a history of chronic illness themselves who are experiencing caregiving related stress have a 63% higher mortality rate than their non-caregiving peers.
Is it Depression or Dementia?
Several of the symptoms related to changes in thinking or cognition. Knowing whether the main problem is depression or dementia is often difficult. Depression can imitate dementia and both depression and dementia can have depressive symptoms. Depression can also be superimposed on dementia. In the early stages of dementia, the person may know that his/her memory is declining and this loss can lead to depression. Only a qualified medical professional can conclusively make the distinction between the two. It is helpful to keep notes on suspected dementia-like problems.
Category Depression Dementia
Memory Impaired concentration. Selective and “patchy”
Worries about memory. Can’t remember short-term information.
Thinking Themes of helplessness, hopelessness, or self-deprecation Difficulty with abstraction, impaired judgment, difficulty finding words.
Orientation Oriented to time, place and person. Impaired orientation.
Language Able to speak, write and use language appropriately. Can’t use objects properly.
(e.g. brushes hair with toothbrush); Has trouble naming objects (e.g. calls a cup a "you know what I mean").
Response when
Mini-Mental Status
Test is given. Feels it is worse than it is. Makes comments Tries to hide impaired memory by social about poor memory conversation or becomes irritable.
Sources: RSI, Inc. and “Geriatric Nursing & Healthy Aging”
Makes sense: Fifty-seven percent of people who apply for long-term care insurance after their 80th birthday are declined coverage...
Depression: The Rising Toll of Depression Measured in Disability, Death, and Dollars (2006)
Depression drains more than $83 billion annually from the American economy; affects 19 million Americans; is the leading cause of disability in the U.S.; and results in thousands of preventable suicides, according to a report by the Depression and Bipolar Support Alliance (DBSA). The “State of Depression in America” report illustrates what is says is a reactionary mental health system, which focuses on crises, such as suicide attempts, rather than on prevention and long-term wellness. According to the DBSA report, only 57% of people with a major depressive disorder receive any treatment and only 22% receive adequate treatment. Parents surveyed in 19 states surrendered custody of more than 12,700 children over to the juvenile justice system so that their children could have access to mental health services.The report makes a number of recommendations to improve the mental health care system, including the following:
Congress must equalize Medicare reimbursement coverage to patients for mental health care services. Medicare provides reimbursement for only 50% of mental health outpatient services compared to 80% of non-mental health outpatient services. Ending this disparity would set a marker for private insurers to similarly provide equal coverage for mental health benefits.
Private insurers must provide greater incentives for primary care physicians to identify and treat depression. Since reimbursement for many providers is based on the number of patients they see, the system creates disincentives to screen patients for depression. Providers also are more reluctant to take on new patients if reimbursement for a mental health evaluation is lower than for other standard medical care procedures.
The government and private sector must enact loan forgiveness programs to provide incentives for students to specialize in mental healthcare
Academic and private researchers must expedite research to develop better treatments.
The government and private sector must promote increased access to peer support services. Both the Substance Abuse and Mental Health Services Administration and the President's New Freedom Commission Report emphasize the need to shift towards a consumer-driven treatment model. In particular, peer support services will address the needs of minority groups in seeking treatment. In addition, peer support is proven to be a cost-effective and beneficial component of treatment.
Depression and nursing homes: (2006) A total 13,261 respondents said they had "felt sad or depressed much of the time" during the past year of the survey. By the end of the study period, 2,005 of them -- 13 percent -- had been admitted to a nursing home, Harris and Cooper report in the Journal of the American Geriatrics Society.
Diabetes and heart failure were the most strongly associated with subsequent nursing home admission, but depressive symptoms was the third greatest predictor, surpassing other chronic heath conditions like cancer and arthritis, study findings indicate.
Other factors associated with an increased risk of nursing home admission included older age, low income and decreased physical functioning. In fact, for each additional impairment on a rating scale of a senior's ability to perform daily living activities, the risk of nursing home admission increased by 27 percent.
The relationship between depression and nursing home entry may be due to depression's effect on disease states and lifestyles, the researchers speculate. Studies have shown that depressed individuals may have higher levels of certain risk factors for high blood pressure and cardiovascular disease, for example, while other studies have linked depression to increased alcohol drinking and poor diets.
On the other hand, depressive symptoms may simply be a marker of another condition, such as early Alzheimer's disease.
Psychological distress: Six psychological distress questions were included in the adult component of the National Health Interview Survey. These questions asked: "During the past 30 days, how often did you feel 1) so sad that nothing could cheer you up, 2) nervous, 3) restless or fidgety, 4) hopeless, 5) that everything was an effort, or 6) worthless?" Response codes (0--4) for the six items for each person were summed to yield a point value on a 0--24 point scale. A value of 13 or more was used to define serious psychological distress.
When Depressed Husbands Refuse Help (Beverly Wax 2007)
What Wives Can Do
Totten was able to help her father get diagnosed and treated for depression; but only after tragically losing her brother to suicide over fifteen years ago because he was never diagnosed. She realized her dad was exhibiting signs of depression and started Families for Depression Awareness, after finding no help for families who wanted to get involved in a relative’s treatment.
Totten says she had to call her father’s doctor and tell him her father had depression. But she didn’t know how to get him to see the doctor. “Finally, my dad said he thought he had the flu, but he didn’t. I agreed with him and was able to get him to the doctor under this pretense.”
With a resistant spouse, Totten believes women need to take a similar tack. “Call the doctor and explain that your husband has depression. Explain what the symptoms are. Then, make the appointment for him. Go with him. If he resists, ask him to do it just for you, to make you feel better.”
Anne Sheffield, author of Depression Fallout, www.depressionfallout.com, agrees with Totten. “Denial is very common, particularly in men. They think depression is a sign of weakness, or someone with it is mentally defective.” She reinforces that wives should not be accusatory and instead need to address different behaviors, like sleep problems, “It’s better not to say: I think you have depression. He is most likely to come back with `If anyone’s depressed it’s you!’”
She points out even though men may willingly go to talk therapy, sometimes they are unwilling to take any sort of medication because of a possible loss of libido. “He doesn’t want to be stuck with no sex drive.” Sheffield stresses to try different or a mix of medications and “tell your husband to give it at least six weeks to work.”
How to Help Your Husband
See a doctor. Ask your husband to see a medical professional, offer to make the appointment, and make sure to go with him or call the medical professional in advance to state his symptoms.
Reach out. Find other people to help you get your husband into treatment, including mental health professionals such as a psychiatrist, psychologist, or social worker.
Show you care. Depressed men feel isolated in their pain and hopelessness. Listen and sympathize with his pain.
Talk about the depression’s impact on you and your children. Your relationship, including intimacy, household responsibilities, and finances, are also adversely affected when your husband is depressed.
Get educated. Read a brochure, Family Profiles (see www.familyaware.org), or a book, or watch a video on depression and share the information with your husband.
Use the Mood Questionnaire. Go through the confidential and anonymous Mood Questionnaire (see www.familyaware.org) with your husband that will guide him toward medical help.
Seek immediate help If at any time your husband talks about death or suicide or may be harmful to you or others, seek immediate help. Contact your doctor; go to your local emergency room, or call 1-800-suicide or 911.
What not to do
Men with depression are suffering from a medical condition, not a weakness of character. It is important to recognize their limitations.
Do not dismiss their feelings by saying things like “snap out of it” or “pull yourself together.”
Do not force someone who is depressed to socialize or take on too many activities that can result in failure and increased feelings of worthlessness.
Do not agree with negative views. Negative thoughts are a symptom of depression. You need to continue to present a realistic picture by expressing hope that the situation will get better.
Laura Rosen, PhD, co-author of When Someone You Love Is Depressed, says wives need to educate their husbands. “Leave brochures out; highlight a section so he has some understanding.” She suggests, “I’ve noticed you don’t seem yourself…it would help me if you talk about it; I’m up at night and really anxious.” Collaborate together and then go so far as to get a consultation, get a name, and make an appointment.”
Another way to get husbands educated is to have them take an anonymous depression questionnaire, like the Mood Questionnaire on www.familyaware.org, a quick screen for depression as well as for bipolar disorder and/or suicidal tendencies.
Steve Lappen, a writer and support group leader, who has himself been treated for bipolar disorder (manic depression), recommends that husbands watch the Real Men, Real Depression online video from the National Institute of Mental Health (NIMH). The film includes ‘tough guys’ such as a firefighter, a retired Air Force sergeant, and a police officer. The video shows men that depression is a treatable medical condition, not a sign of weakness and gives permission to men to ask for help. According to Lappen, “Men won’t even ask for driving directions, so we must let them know asking for help for depression is OK. Reaching out is a sign of strength, not of weakness.”
With Treatment, Relationships Return
Because depression ran in Phil’s family, Emme says, “Depression was the last thing Phil wanted to admit to.” His father’s mother had been in and out of depression for most of her life and relatives described her as ‘quirky’. Phil’s grandmother also had a sister who was institutionalized and lived out her days in the psych unit. Back in those days they didn’t diagnose depression by name; the ‘quirkiness’ ran in the family to include a couple of cousins as well.
Finally, Emme asked Phil’s brother, Seth, who had depression on how to help get Phil into treatment. Ultimately, their family doctor reached out to them. He had helped Seth get through his depression in 1986 and had been helping the family deal with Phil’s other brother, Jonathan, living with brain cancer.
It was at the end of a family session with the doctor that Seth stepped in and asked to spend time on what was going on with Phil. It was almost like an intervention. Emme says, “We all turned to Phil and said, ‘We love you, you’re here. You are clearly depressed.” They left Phil in the room with the doctor to discuss it. This was the beginning of Phil facing his depression through a combination of talk therapy and medication.
But this was not yet the happy ending. Emme threw herself into being Phil’s caregiver, even at times explaining to his doctor the status of treatment, symptoms and behavior. She offers concrete suggestions to other wives: learn everything you can about the illness; get a clear, medicine container to keep track of daily dosages when it is too overwhelming for your husband, make a chart listing his moods. Her biggest suggestion is to carry around one notebook at all times dedicated to your spouse’s treatment. She also suggests telling well-meaning friends and family to keep their private feelings about therapy and medication to themselves. Phil eventually had to turn to ECT (Electro-Convulsive Therapy), and is now recovered. Emme says, “It was our last resort and it was a lifesaver.”
Most importantly, Emme’s message is one of hope and survival. “My story is just one of many that are happening every day around the world.” Although their heavenly life turned into a living hell, Emme and Phil, along with untold other couples, conquer depression together and look forward to a new beginning in their relationship.
Depression: (2007) The good news from a federal study of 3,671 patients is that about two-thirds were depression-free after trying up to four different combinations of drugs or therapy.
Only 37% went into remission after trying the first drug. As each new treatment was tried, it worked on fewer and fewer patients. About a third did not go into remission, despite up to four rounds of treatments. And many dropped out, perhaps because they were discouraged or disliked the side effects. "But persistence pays off. "For those who hang in there, recovery is possible."
Patients were tracked for up to a year. Some got cognitive therapy, a structured type of counseling. No single drug relieved depression better than any other. Those who had to try more than one drug were most likely to relapse.
Real-world success in treating depression may be far less than in the research, Greden says, because primary-care doctors write about 70% of antidepressant prescriptions, and they're less likely to try multiple treatment steps. Also, the type of counseling used in the study isn't widely available to depression patients.
About 7% of adults suffer from major depression in any given year, and they typically wait about eight years before seeking treatment, according to a federal survey last year.
When Depressed Husbands Refuse Help By Beverly Wax
To the outside world, Emme lived a charmed life. She was a successful model, creative director of her own clothing line, a television host, lecturer, and mother of a beautiful baby girl. Only her family and closest friends knew she was actually dealing with a devastating situation that is all too familiar to wives across the country: a husband who has depression but won’t get help.
Phillip Aronson, the wonderful man she married, found himself in a downward spiral of depression, even attempting suicide at one point to escape his pain. Phil was always an energetic partner, excited to go to work each morning either to the showroom to check on the latest graphic designs for the Emme line or to attend meetings about some new project. He was a caring and loving father. But as depression enveloped him, Phil “had no energy, no appetite, no drive…and this was in sharp contrast to how he usually was. He was depriving himself of everything, and when you don’t nourish yourself —physically, intellectually, or emotionally—your body tends to shut down.”
In their recently released book written in both their voices, Morning Has Broken, A Couple’s Journey Through Depression, Emme says, “No one knew what it was like, to be caught up in it like we were…it’s a lonely thing to be married to a man in the depths of a depression with an infant daughter at home…it was all about getting through each day. I never felt more alone.” Soon, Emme realized he could not even watch their daughter, Toby, and everything changed: the logistics of running the household and her ability to work. Emme writes that every day they lost a little piece of Phil, and during the worst period, somebody needed to be with Phil at all times, “and that somebody needed to be me.”
Men and Depression
U.S. statistics state that women experience depression much more frequently than men: 1 out of every 4 to 5 women, compared to 1 out of every 8 to 10 men. However, many experts feel these statistics are simply wrong. “Men experience depression probably just as much as women, but they aren’t diagnosed,” explains Julie Totten, President and Founder of Families for Depression Awareness, a non-profit national organization. “Depressed men often get angry at others and abuse alcohol or drugs. Depressed women on the other hand may blame themselves, but then they ask their doctor for help.”
The consequences of untreated depression are serious and sometimes fatal. Depression is a leading cause of disability so many men can’t work. Depression also puts men at a high risk for suicide; they are four times more likely to take their lives than women.
Signs of Depression to look for in men:
Acting depressed, irritable or angry almost every day
Losing interest in pleasurable activities or hobbies
Talking of death or suicide*
Talking very negatively
Acting unreasonably, without concern for others
Abusing alcohol or drugs
Picking fights, being irritable, critical, or mean
Withdrawing from family and friends
Having trouble at work or school
Talking suddenly about separation or divorce
Complaining of aches and pains
Eating too little or too much
Sleeping too much or too little
* If someone is suicidal, treat it as a medical emergency. Call the person’s clinician, or call 911 or take him to your local hospital emergency room.
When husbands have depression, it can tear apart their marriage and family. Wives may take over and hope the problem will go away, or on the opposite end, withdraw, feeling betrayed and angry. More often, they alternate back and forth between these behaviors and emotions. Fifty percent of wives caring for a depressed husband will develop depression themselves.
The good news is that depression is highly treatable. Once diagnosed, most people who get help report substantial relief.
The problem is that many men deny they are depressed and resist treatment (usually medication and/or talk therapy). Their belief: depression is a woman’s disease.
Depression Affects Everyone
Dealing with a depressed husband who is in denial is not easy. But, by not addressing the issue, your husband continues to be ill or get worse, even suicidal, and you lose out as well. Depression makes men feel like they are worthless and hopeless. They can’t change how they feel without treatment. “Depression isn’t just your husband’s problem; it’s your problem and your children’s too. Luckily, there are ways to address the issue,” Totten explains. “The top priority is to get your husband into treatment. You have to ask yourself, ‘What have I got to lose?’ You simply need to take action for everyone’s sake.”