Depression

Understanding the Problem

Older people often experience changes in their lives that can precipitate feelings of depression. Some people experience physical changes that affect their eyesight, hearing, or ability to move their bodies as they once did. Others experience adverse changes in their health or new medical conditions that require them to take a number of different medicines. Still others experience changes in their ability to think and remember.

In addition to physical changes, many older persons experience lifestyle changes. Some retire from their work and need to find new ways to fill their time or make themselves feel useful. Others move into a smaller house or apartment, or move in with family members who can help take care of their needs. Some elderly individuals move into assisted living facilities or nursing homes. Additionally, most older persons lose friends or family members (spouses, brothers or sisters) who pass away. Studies show that as many as 25% of people who lose a family member or close friend are seriously depressed for months after the death.

These types of changes are increasingly common the longer we live, and they can be difficult to cope with. This is especially true when several changes occur at the same time. The stress of dealing with these changes can cause many uncomfortable feelings including depression.

Sometimes older people are able to get over “the blues” after a short time. On the other hand, sometimes these feelings last a long time and can severely hurt their quality of life. When a person is sad, discouraged, pessimistic, or despairing for several weeks or months, and when these feelings interfere with being able to manage day-to-day affairs, we say that he or she is suffering from depression. Depression can last a long time if the person does not do something to stop it.

In addition to feelings of sadness, depressive symptoms sometimes include problems with appetite, sleeping, lack of energy, ability to pay attention to things, and loss of enjoyment of favorite activities. Other symptoms can be vague physical complaints such as headaches, constipation, or aches and pains in several parts of the body for which there is no medical explanation. Excess use of alcohol, especially if it is new or worse since the person has experienced a significant life event, may also be a sign of depression. Sometimes a depressed person thinks about suicide as a way out of his or her problems.

If an older person is depressed, he or she will have problems coping with the changes that are happening in his or her life. Depression works like a downward spiral. The person feels down, so he or she does not put energy into solving problems. When the problems get worse, they can make the person feel worse. And so it continues. This spiral pattern must be interrupted. Some kind of change has to happen, or these feelings will become severe and will last for a long time.

Depression can also be a side effect of some medicines, or it can be caused by chemical imbalances in the body due to medical illnesses. It can also be caused by the combination of several medicines taken at the same time. When this happens, changes in medical treatments may help the depression.

It is important to remember that, although depression commonly occurs among the elderly, it should not simply be accepted. There are several treatments available to help relieve depression and most people can find relief with one of them, regardless of their age or situation. People may also experience depression along with medical conditions. Even when everything is being done to treat the medical conditions, additional efforts often can be made to relieve the depression as well.

Some depressive symptoms are a normal response to the stresses and uncertainties people experience in their lives. Don’t expect to get rid of all of these feelings. However, you can help prevent feelings of sadness or discouragement from becoming severe or continuing for long periods of time. With help, you may keep depressed feelings under control. If the symptoms become severe, you can seek professional help.

If you are seen by a doctor, he or she may prescribe antidepressant medicine. If so, you need to ensure that the medicine is taken as directed. It might take several weeks or even months before the medicine is fully effective and it may be continued on a low dose after the depression subsides. Therefore, you may have to continue to monitor how the antidepressant medicine is taken for a long period of time.

Be sure to give the doctor a list of all prescription medicines, over-the-counter medicines bought at the pharmacy, and any herbal or other alternative therapies, as well as the dosage levels and the times they should be taken. Preventing negative drug interactions is very important.

Living with depression can be stressful for everyone involved in your life; spouse, children, caregivers, other family members, and friends. It is important to pay attention to your own emotional health so that you can do your best. It is important to ask for help.

Your goals are to:

• Work to manage depressed feelings and thoughts
• Keep an eye out for early depressive symptoms and get help to manage depression before the symptoms become severe
• Consider when professional help is needed and get assistance in getting this help

When To Get Professional Help

Symptoms indicating the need for professional help

If any of the following is occurring, you should get professional assistance:

Talking or thinking about hurting or killing yourself.
Older people are successful at committing suicide more frequently than people in other age groups. Anyone who talks about suicide should be taken seriously. If you think there is a possibility of suicide, this is a problem that requires professional assessment and help. Although it may be uncomfortable for you, you should seek professional assistance as soon as possible.

Not eating or drinking enough to sustain life.
This may also be a symptom of depression and it needs to be evaluated promptly.

Depressed in the past and have had at least two of the following symptoms consistently during the past two weeks:

• Feeling sad most of the day
• Loss of interest in almost all daily activities
• Difficulty paying attention to what he or she is doing and trouble making decisions.
  A person with a history of serious depression is vulnerable to depression after a major life stress. Major life changes such as a family member dying, becoming physically disabled, developing a chronic medical condition, or moving into a new home often trigger depression in such a person. When this happens, professional help is often required to relieve the symptoms.
• Acting sad, but not any events that could explain why
  Sometimes depression can be a symptom of the beginning of other medical problems such as thyroid disease, Alzheimer’s disease, or cancer. A doctor can help look for other causes for the depression and recommend the best treatment.
• Changes in memory, concentration, or personal hygiene
  When a person is depressed he or she may put less effort into bathing and grooming, and may become forgetful or easily distracted. These signs in elderly individuals become accepted as normal signs of aging or becoming “senile.” Regardless of the age of the individual, these are signs of a problem. A doctor can help determine what is causing these changes and refer you to a professional who can help.
• Dementia and also has depression symptoms
  Depression is frequently seen among people who have illnesses such as Alzheimer’s disease, Parkinson’s disease, and strokes that can cause dementia. People might think that depression is only another symptom of the illness of dementia. However, in some cases, a mental health professional can provide treatment for the depression separate from managing the dementia. Treating depression can improve a person’s quality of life and may even improve some of the difficulties he or she is having with day-to-day activities.
• Mood swings from periods of depression to periods of agitation and high energy
  Some people who have wide, uncontrollable swings in mood may have a “manic-depressive” illness. They cycle between being depressed with low energy and having a great deal of energy with feelings of agitation or feeling “high.” In many cases, the cycles aren’t connected to what is going on around them. A professional assessment is required to determine if medicine is necessary.
• In a nursing home and noticeable symptoms of depression
  Living in a nursing home can cause people to develop depression. You can be helpful to the staff by noticing and pointing out changes in your mood or behavior. If you notice signs of depression, discuss them with someone on the staff.

How to get professional help

Getting help for depression is just like getting help for physical problems. Asking for help does not mean you are saying you are crazy. The problem could be caused by the stress related to life changes that are occurring or to medical treatments being received. Depression could be an understandable reaction to whatever is going on in the person’s life.

Some people are hesitant to ask for professional help with their emotional problems because they are embarrassed. They think that seeing a psychologist, psychiatrist, or social worker means that they are weak, strange, or unable to handle normal things that happen while “growing old.” Many people were raised to believe this. However, being upset during life changes is normal at any age. So is getting help for the sadness.

Professionals such as social workers, clergy, psychologists, psychiatrists, and geriatricians are skilled and experienced in helping people deal with emotionally stressful experiences. They are there to help you with this kind of problem just as your family doctor is there to help with physical problems.

• Ask for help from a family medical doctor
  Doctors familiar with your other medical conditions and treatments can evaluate whether the depression is due to the disease or the treatment. If it is due to the treatment, then a change in treatment may be needed. Doctors can also evaluate whether antidepressant medicines might help and can prescribe them if necessary.
• Ask a mental health professional such as a psychologist, psychiatrist, or social worker for help
  Mental health professionals are experienced in helping people with many types of emotional problems. They can be especially helpful when there is a history of depression and when the depression is not due to other medical diseases or treatments. Certain mental health professionals like geriatric psychologists and geriatric psychiatrists specialize in treating elderly people. These professionals may be especially helpful in meeting your special needs. Mental health professionals can be very helpful when depression is a reaction to the stress of life events and life changes.

Changing depressed feelings takes time. It usually takes several sessions with a counselor or therapist before one begins to feel better. It also takes time for medicine to work, and the doctor may need to adjust the dose before the medicine is helpful.

Helping Yourself

Family members and friends can help you overcome or deal with depression. Communicating that you need help is the first way to start. A lot of times people want to help but are unsure or unaware how to do this. Explaining your situation and some of your needs is important.

Schedule positive experiences for yourself.
Keep doing things that make you feel good. Sometimes having someone share in a favorite activity is one way keeping your mind off your depression.

Get the companionship you need.
Being with others is as important for you. Continue to do things with people you like and enjoy. This helps to prevent and manage your own “blues.” If you feel yourself becoming depressed, seek out other people to talk to and do things with. Some people find it helpful to talk to other people about their problems. Others find it more helpful to talk about things that have nothing to do with their problems. This depends upon how you feel and the person you are talking to.

How to prevent or decrease depression

Much of the work in controlling depression has to come from the person who is depressed. This section describes several things that a person can do to prevent or decrease depression. You should read the suggestions carefully.

Pleasant, satisfying experiences help people cope with stressful events they encounter in their lives. Having fun makes people feel better physically and emotionally. When people regularly do things they enjoy, they keep a positive outlook on life and are less likely to become depressed during difficult times.

One of the most important things a person can do is find a balance between his or her problems and the enjoyable things in life. Your goal is to arrange as many pleasant, positive experiences as possible. Focus your attention on three types of activities:

1. activities with other people,
2. activities that give a sense of accomplishment, and
3. activities that make you feel good. By engaging in positive experiences, you can overcome depression.

Increase activities that are done with other people

Being with people you know and enjoy is an excellent way to take attention away from negative thoughts and feelings. It provides opportunities to think about one’s own life in comparison to others and to recognize the good things in one’s life. It provides opportunities to give as well as to receive help, to share experiences and perspectives, and to get help in dealing with problems that are causing depression. Most important is that other people can express caring and love. Knowing that other people care and are available to help when needed gives strength and confidence to people who are having difficulty coping.

Three types of people can be especially helpful in preventing someone from experiencing depression. Make a list of friends and family members using the following categories:

• People who are sympathetic and understanding.
• People who give good advice and who can help solve problems.
• People who can turn attention away from problems and toward pleasant experiences.

Setting reasonable, attainable goals

Depressed people tend to set goals that are too high, and when they do not reach their goals, they become even more depressed. When you plan positive experiences, be sure that your goals are reasonable. It is better to set a low goal and accomplish more than you expected than to set too high a goal and fail. When working around new limitations, be creative. Usually, there is more than one reasonable way to solve any problem.

Checking on Progress
Talk regularly about your feelings. If you show that you are comfortable talking about feelings, other people will be more aware of depression and more sympathetic and more likely to help you deal with depression.

Watch for indications that professional help is needed.

What to Do If You’re Plan Isn’t Working
Ask yourself if you are expecting change too fast. It usually takes time to manage depression. Look for a small improvement at first. Remember, your efforts may be successful even if they just keep depression from getting worse.

If these techniques do not seem to be helping and you been feeling very depressed for several weeks, review this chapter to be sure you have tried all of the ideas. If so, you should seek professional help. You may need to bring someone during the visit to the psychiatrist or psychologist.

Techniques for Controlling Negative Thoughts

Trying some or all of these techniques might bring some results in overcoming depression. Using these techniques may help to stop depressed feelings before they get out of control.

Reminiscing. When you start to feel down, try thinking about positive things that have happened in the past. Remembering the past helps you to re-experience positive thoughts and feelings. It can also help you to feel better about how life is going for you overall.

Storytelling. Children and young adults are often very interested in what you did in your life. Tell them stories about yourself. Simple things like what your first grade teacher looked like or where you had your first job may be interesting to them. If the children do not live nearby, type or record your stories.

Look at old photographs and memorabilia. Looking through photo albums and keepsakes can help jog your memory and remind you of more stories to talk about.

Play old music. Most people find music enjoyable, and old songs can also bring back memories of good times you have had. Do be aware, however, that certain music may cause sadness and longing for a deceased family member or good friend.

Take a trip to a place that brings back memories. Visiting places such as the street where you once lived, the school you attended, or the church, mosque, or synagogue you attended can also bring back memories for you. Take someone along who would like to know about these places and the meaning they had in your life.

Call or visit an old friend. Who can understand your past experiences better than someone who shared them with you? If you have an old friend, talk to him or her when you start to feel down. Bring up old times. Talk about something important you did together or something funny that happened.

Research your family history. Many people enjoy finding out about their ancestors-who they were and what they did. You can pass on this information to younger family members to carry on your family history. Most older people can remember things that happened a long time ago, even when they have trouble remembering what happened recently. Don’t worry about things you can’t remember; just enjoy what you can.

Companionship. Elderly people spend a lot of time alone. Unfortunately, time alone is when negative thoughts can go around and around in your head. Therefore, try to plan doing at least one activity each day with another person. For example, try taking walks with someone, joining a support group, having a meal with a friend, or talking on the telephone. Use brain storming techniques to think of other ways you can spend time with others. (In brainstorming you let your imagination go free and think of ideas without worrying about whether they are practical. Then you go over your idea list and try to think of ways to make them practical. Finally, you select the ideas that are practical and the most helpful.)

Thought stopping

One of the hardest things about depression is getting stuck in a whirlwind of negative thinking. Suddenly depressing thoughts are going around and around in your head. It does not take long for this to make you feel bad; and then it may seem like you cannot stop. But you can!

Thought-stopping techniques help you to “snap out of it” when that whirlwind of negative thoughts first starts. If you catch it early, you can stop yourself from getting extremely upset. The trick is to do this when you first notice a negative thought.

When you first feel yourself in the negative-thinking whirlwind, try one of these techniques:

• Yell “STOP” loudly in your mind. Silently scream, “STOP,” pretending it is very loud. The idea is to “wake yourself up,” to become aware of the danger of getting stuck in negative thoughts. You can start by going to a private place and shouting “STOP” aloud. Then gradually shift from shouting out loud to doing it only in your mind.
• Imagine a big red STOP sign. Think of what a STOP sign looks like. Try to see it clearly. Make sure it is a red sign. Practice imagining it so that you can bring it to mind easily. Then, whenever you catch yourself starting negative thoughts, think of this sign to stop yourself.
• Splash some water on your face. Splashing water on your face is another way to wake yourself up from the negative thinking. Pay attention to how the water makes you feel, rather than dwelling on the negative thoughts.
• Move to a new spot. Getting up and moving to a new spot gives you a change of scenery. Use the new surroundings to help you think about other things. Go outside and get some fresh air; take deep breathes.

You have to fight negative thoughts. You may need several of these techniques to control strong negative thoughts. If you’re feeling depressed, you might think, “These techniques are silly. They could never work.” Actually, research has shown that they can work. Give them a try.

Arranging a time and a place for negative thinking

This technique allows you to think about negative things, but puts you in control of when and where to do this thinking.

• Find a negative-thinking “office.” This can be a room, a chair, or a certain window. Make this the only place you let yourself think negative thoughts. Your “office” space can be any place you choose. This should not, however, be your bed or the seat where you have your meals. These need to be “safe zones.” Once you choose your negative-thinking “office” try to think negative thoughts only in this one place.
• Schedule a time each day to think negative thoughts. Scheduling a time to think about negative thoughts can help you take control of them. It is best not to make this time around mealtimes, just before going to sleep, or just before expecting to see people. These meal, sleeping, and visiting times should be relaxing. Also, make your negative thinking time no longer than 15 minutes and always stop at the end of 15 minutes. A timer can help you stop on time.

Attending to positive thoughts

It is impossible to think two things at once. When negative thoughts begin, start thinking about other activities that can “push out” or replace the negative thinking. Try one of these ideas:

• Prayer. Go to a quiet place and pray. You can read and recite prayers or pray silently. Beware of letting your praying turn into time spent thinking about problems. If praying makes you uncomfortable or turns into time thinking about problems, then reading the Bible or other religious writings may be helpful.
• Taking a vacation in your mind. Close your eyes and think about your favorite spot. Spend a few minutes there on a mental vacation. Relax and enjoy it.
• When you take your mental vacation, work your imagination by thinking of as many details as possible:
• What does it feel like? Is there a warm breeze? Imagine how it feels on your skin.
• What does it sound like? Are there waves gently crashing on the beach? Are people laughing, or is music playing? Imagine it as clearly and vividly as you can.
• What does it look like? Is the sky clear and blue? Or are you in a room? Imagine what the room looks like. Try to see it as completely as you can.
• What does it smell like? Is it the salty smell of the ocean? Do you smell the fragrances of a garden or a big dinner? Make it as clear as you can.
• What does it taste like? Are you drinking a nice cool drink? Feel it in your mouth and taste it.

Use this exercise to fill your mind with pleasant details. This exercise is also helpful when you are feeling anxious and need help falling asleep.

Arguing against negative thoughts

The goal of this exercise is to make yourself see both sides of the situation. Things are not as bad as they seem when you are depressed. One way to help yourself see the other side is to actively argue against the negative thoughts.

You can fight your negative thoughts. You can challenge the accuracy of your thinking. Every situation has at least two sides to it. When people are depressed, they tend to see only the bad side. When they are not depressed, they usually think of both sides. Use this exercise to force yourself to actively take the other side. Have a debate with yourself.

• Ask if your negative thoughts are really true? Be clear about what evidence supports these thoughts.
• Take the other side. Argue the exact opposite. Think of every reason why your thought may not be true or may be exaggerated. Don’t give up too easily. Really argue as if you were arguing with someone else.
• Be as complete as possible when arguing against your negative thoughts.

Solving day-to-day problems that are causing you stress

Use a problem-solving approach to solving some of the day-to-day problems that are contributing to your feelings of depression, such as finding ways to get around your disability, finding ways to get together with friends and family, getting to your doctor visits, and so on. Solutions to these problems may be as simple as getting a hearing aid, or making arrangements with the local transit system to take you to your appointment. With these problems solved, you will have more energy to put toward relieving your depression.

Keep in mind that depression is an illness that affects all aspects of your life. It is important to get help from family members, friends, and medical professionals. Always remember you are not alone. There is no quick fix for depression; it will not disappear right away. It takes time and effort for people to cope with depression.