More than 1 in 10 Take Antidepressants

According to the CDC, and reported by NBC News, more than 1 in 10 adults take antidepressants.

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Can Caring for Others Affect Depression?

Can Caring for Others Affect Depression – Dr. Drew – CNN

Don’t Just Blame Dementia

Don’t Just Blame Dementia

BLOGGER: Michael B. Friedman, LMSW

After a person has been diagnosed with Alzheimer’s disease or other dementia, subsequent emotional, mental, cognitive, and behavioral problems are usually blamed on the disease.  Other possible reasons including behavioral disorders such as depression, anxiety, or substance abuse or ordinary human reactions to tough realities are very often ignored.

“Grandma seems terribly sad.”
“  Of course, she has Alzheimer’s”
“Grandpa has been nasty lately“.
“It’s the Alzheimer’s.
“  Uncle John doesn’t enjoy life anymore.”
“  Who would?  He has dementia.”
“  Mom isn’t eating much or isn’t taking her pills or isn’t getting any exercise.”
“It must be the Alzheimer’s”.

Not necessarily.  In fact, blaming dementia very often gets in the way of understanding what is really going on and doing something about it that will help.

If there were a pill that would reverse, stop, or — better yet — cure Alzheimer’s, it might be useful to understand the emotional and behavioral problems of people with dementia solely in terms of the disease.  But the best pills available now only delay the unavoidable decline in memory and other cognitive functions.  That’s worth doing, of course, for the people for whom the pills work.  But counting on the doctor to come up with medicine that will make a big difference usually is disappointing.

People with dementia experience many of the same emotions as people without dementia, but they are at higher risk than older adults without dementia for diagnosable mood and anxiety disorders, both of which can result in declines in cognitive functioning that are similar to the decline associated with dementia.

Unlike dementia, however, depression and anxiety can be treated effectively; and if they are, the loss of cognitive functioning that is caused by these disorders can be reversed.  To be clear, treating depression and/or anxiety does not reverse dementia and the loss of cognitive functioning caused by dementia.  But effective treatment for mood or anxiety disorders can result in overall improvement of functioning that can make a very big difference in a person’s life.

These days, of course, the first line of response to depression and anxiety is medication.  However wise that is for people without dementia, it is unwise for those with dementia.  Medication can be helpful, but it can also be dangerous.  At the very least, doses must usually be lower than for younger adults.

Better is to begin with interventions that do not rely on medications.  Some formal psychotherapies can be helpful, such as “cognitive-behavior” and “interpersonal” therapy.  Exercise, interesting activities, and social contact with people they enjoy can also be extremely helpful.

Most important is to understand (1) that people with dementia are adults with meaningful life histories, personal interests, individual desires, and a need for dignity and respect and (2) that behavioral “problems” are to a significant extent in the eye of the beholder.  People with greater understanding and tolerance of behavior, that most people find trying, are generally better able to help people with dementia to get the most out of life.

I don’t mean to make this sound easy.  Some people with dementia are so profoundly sad and lost in themselves that they may be impossible to reach.  Some people are “scared to death” by the slightest change in routine.  Some people completely deny that they have any need for help.  Some people are abusive towards anyone who tries to help them, evoking responses in kind from many — if not most — of us.

But many people could be helped to overcome emotional problems that co-occur with, but are not caused by, dementia.

In an ideal world everyone with dementia would be able to get a sophisticated assessment to distinguish between the effects of dementia and other disorders and then to get the treatment that would be most likely to be effective.  But in the real world there is a terrible shortage of physicians who understand the subtle differences between dementia and depression and other disorders.  In the real world there is a terrible shortage of geriatric psychiatrists and other mental health professionals.  And in the real world, paid and family caregivers usually do not get training and support to help them be more skillful with and tolerant of the people they care for.

Our nation needs major changes in policy to address these shortfalls.  In the meantime, however, we need to understand that there are ordinary emotional causes for the sadness, disengagement, and anger experienced by so many people with dementia and that we caregivers can do much to meet human needs often neglected because of a frightening diagnosis.

Grandma is sad?  Grandpa is nasty?  Maybe they are clinically depressed and could benefit from treatment.  Maybe she’s lonely and he feels he’s being treated like a child.  Maybe it’s something else.  But be careful not to jump to the conclusion that it’s because of the dementia.

 

Is Melancholy an Inevitable Outcome of Getting Old?

Elderly Depression: Is Melancholy an Inevitable Outcome of Getting Old?

BLOGGERS: Michael B. Friedman, LMSW and Lisa Furst, LMSW

Depression is dangerous and one of the most significant impediments to aging well.

People with depression[i] usually experience a profound sadness and sense of hopelessness that goes far beyond ordinary unhappiness.  They often experience terrible psychic pain, which some people report is harder to bear than severe physical pain.

People with depression often experience a profound disinterest in life.  What has made them happy and kept them vibrant no longer does.  Life may have no meaning for them.

People with depression often find it difficult to carry on ordinary life functions.  They may have trouble sleeping or sleep too much.  They may have no interest in food or may stuff themselves in futile efforts to counter their bad mood.  They may find it difficult to concentrate on work, day-to-day tasks, or social interaction.  They may ruminate about relatively minor matters and be unable to make a decision or forgive themselves for errors or discourtesies.  They may feel that doing anything takes too great an effort.  They may always expect the worst and give up without trying.  They may be angry much of the time, easily irritated by small aggravations.  They may often think about death, even about taking their own lives.

People with depression have lower life expectancy than those without.  The combination of depression and a serious, chronic physical illness, such as diabetes and heart disease, results in greater risks for disability and premature death than for people with the same physical conditions without depression.[ii]

People with depression are also more likely to be socially isolated and caught in a vicious cycle in which depression feeds isolation and isolation feeds depression[iii].

Most people who complete suicide are depressed.[iv] And the sense of hopelessness inherent in depression makes many people reluctant to seek or accept help.

Obviously, depression makes it hard to live well at any age, including old age.

The good news for older adults is that, contrary to common belief, depression is not a normal or inevitable outcome of aging.  But the ageist expectation that it is frequently results in failure to take steps to overcome it.  ”There’s nothing to be done.  They’re just old.”  This attitude too often robs older people of opportunities to enjoy life.

In fact, each year major depressive disorder affects fewer than 5 percent of adults 65 or older who live in the community.[v] The rate is higher among older adults with serious chronic health conditions, those who need home health care and those who are institutionalized.

A much higher proportion of older adults who live in the community — perhaps 20 percent — experience symptoms and forms of mood disorders, such as dysthymia or sub-syndromal depression[vi], that are not as severe as major depressive disorder but may have nearly as much negative impact[vii].

So, a significant proportion of older adults suffers from depression.  But, it is important to note, 75 to 80 percent of older adults do not experience depression in any given year.  Depression — to say it again — is not normal in old age, an encouraging fact for those who may feel hopeless about their lives.

Depression often can be treated effectively or overcome through other means such as meaningful relationships, activities, or spiritual experience.  Unfortunately, it often goes unrecognized.

One reason for this is that it may not look like “depression”.  Frequently, it is expressed through physical symptoms such as headaches, “stomach” problems, aches and pains, fatigue or insomnia.

Depression also can be hard to recognize because it does not necessarily involve having a depressed mood.  There are two “cardinal” symptoms of major depressive disorder — profound sadness for two weeks or more and loss of interest and pleasure in activities that have had the greatest personal meaning.  It is necessary to have one, but not both, of these symptoms to be diagnosed with major depression.  It may seem strange, but there is depression without sadness[viii].

In older adults, depression may be missed because it involves cognitive difficulties that get diagnosed as dementia.  This common misdiagnosis is terribly unfortunate because successful treatment of depression can restore cognitive capacities that have been lost due to depression — even in people with dementia.[ix]

Finally, depression can be hard to spot because many people with depression are able to hide it.  From the outside they may seem unchanged, even though they may be suffering terribly on the inside.

So depression is dangerous, and it often goes unrecognized and untreated, depriving older adults of opportunities to get the most out of life.  What can be done about this?  We will address this question in our next post.

In the meantime, if you or someone you care about needs help, call 1-800-273-TALK.

And to find a geriatric psychiatrist in your area, refer to the website of the Geriatric Mental Health Foundation, http://www.gmhfonline.org/gmhf/find.asp.

This article was co-authored with Lisa Furst, L.M.S.W., Director of the Training and Technical Assistance Center of The Geriatric Mental Health Alliance of New York and co-author of  Depressed Older Adults: Education and Screening

ELDERLY DEPRESSION AND HOW IT CAN BE OVERCOME

Although depression is not a normal outcome of aging, it is dangerous and one of the most significant barriers to aging well. ^[i] Fewer than 5% of older adults have major depressive disorder in any given year^[ii], but as many as 20% have significant symptoms of depression.^[iii] It is frequently unrecognized and untreated^[iv], resulting in much unnecessary suffering and lost opportunities to age well.

Fortunately, depression in old age can be overcome.  How?  There are four general, not mutually exclusive, approaches—(1) lifestyles that promote mental health in old age, (2) getting professional help, (3) developing skills to manage disturbing moods yourself, and (4) getting help informally from family, friends, and community resources such as clergy.

Mental Health Promotion: To vastly oversimplify, the keys to avoiding depression in old age are being physically healthy (a mix of luck and self-care), being physically and mentally active, being involved in personally satisfying activities and relationships, and achieving a sense that you have had a life of meaning and value.^[v]

Once depressed, however, maintaining such a life can be very difficult.  Despair can dissolve a sense of achievement in life and create the conviction that there’s no point trying to stay well, active, and involved.

Professional Interventions

Screening can be a first step towards dealing with a depressive disorder.  It should be routine in primary and specialty health care and in settings where older adults live or congregate, such as senior centers^[vi], but unfortunately it is not.

The most common screening instrument, the PHQ-9,^[vii] is filled out and scored by the person being screened, but diagnosis by a professional is needed to confirm a positive finding.

Treatment can be effective.^[viii] The most common forms of treatment are medication and psychotherapy.  Both cognitive and interpersonal therapies have been shown to be effective^[ix].  The combination of medication and psychotherapy appears to be most effective.^[x]

Great care is needed regarding medication for older adults, keeping doses as low as possible to avoid potentially severe side effects but as high as necessary to have a therapeutic effect.

Although highly controversial, electro-convulsive therapy (ECT) appears to be effective for some people with severely disabling depression who do not respond to other treatment.^[xi]

Increasingly, treatment for depression is provided by primary care physicians. They often do not have the time or training to provide sound treatment.^[xii] Various models of care management within primary care settings have emerged to provide needed follow-up and psychotherapy.^[xiii]

Many people with major depressive disorder need treatment by a mental health professional such as a psychiatrist, psychologist, clinical social worker, or nurse.  Unfortunately, there is a great shortage of trained geriatric mental health professionals.

Self-management: Some people with depression, particularly those with recurrent depressive episodes, develop effective self-management skills, sometimes on their own, sometimes with the help of a mental health professional.  These include self-observation skills that make it possible to anticipate depressive episodes, recognize them when they occur, resist the powerful urge to withdraw, remain active and involved with other people, control suicidal impulses, and know when to go for help.

It is very important not to confuse self-management, which can be effective long-term, with self-medication with alcohol and other drugs, which cannot.

Informal Interventions:  Most people who seek help turn to non-professionals—to family and friends they trust and to respected figures in their communities, especially clergy.

People who are willing, and have enough time, to spend with a person who is depressed can be extremely helpful.^[xiv] Talking—not about the depression but about anything of interest, having fun, socializing, or even  taking a walk can counter depression.

Spiritual experience is particularly helpful to people who find comfort through faith or religion.^[xv]

Informal interventions may not be enough for people with “moderate” or “severe” depression or during periods of profound hopelessness, psychosis, or suicidality.  Then professional help may be essential.

Do these approaches to overcoming depression work for all older adults who are depressed?  Of course not.  There are some who reject any offer of help because they are in a state of denial, feel too hopeless to believe that help is possible, or are too weary to make any effort.  There are people with depression who anger so easily or who are so unpleasant that they drive away all but the most saintly people who might be helpful.  And there are some people who do not respond to any form of treatment.

But these are the exceptions.  Yes, depression can be dangerous and is a barrier to aging well, but it is not an inevitable outcome of old age; and, when it occurs, it can usually be overcome.

Need help for yourself or someone you care about?

• To reach local mental health helplines call 1-800-273-TALK.
• To find a geriatric psychiatrist, go to www.gmhfonline.org/gmhf/find.asp.
• To find a clinical psychologist, go to http://locator.apa.org/
• To find a clinical social worker, go to www.helpstartshere.org/find-a-social-worker

(Michael Friedman is Adjunct Associate Professor, Columbia University Schools of Social Work and Public Health.   Lisa Furst is Director of the Training and Technical Assistance Center of The Geriatric Mental Health Alliance of New York and co-author of Depressed Older Adults: Education and Screening)

 

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Can Psychedelic Drugs Treat Depression?

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