Depression

Depression refers to feelings of intense sadness and hopelessness felt for long periods of time. Feeling depressed over retirement, loneliness or the death of a loved one is normal in the course of life and does not classify as a psychological disorder. However, if the depression is long-lasting, hinders daily activities and is accompanied by feelings of worthlessness or helplessness, then it is classified as psychiatric condition that can be treated with therapy and medication.
22% of elderly people in India suffer from depression while many others remain undiagnosed. Depression among the elderly is often left untreated due to the prevalence of the Indian belief that an illness refers to a physical ailment. Psychological disorders are many a time disregarded as part of daily life and psychiatric disorders are not addressed because of the social stigma of being tagged crazy or mad.
In light of this, it is important to note that effects of depression go far beyond mood. Depression can cause sleep disturbances, withdrawal, diminished energy levels, decreased appetite and reduced mobility, along with suicidal thoughts and numerous other physical ailments.
However, depression is not an inevitable part of life. With help it can be controlled, managed and even avoided.

SymptomsCausesTreatmentTips for Caregivers

Depression can be conveyed through a huge range of symptoms varying from behavioral symptoms to emotional, psychological and physical.

  1. Behavioral symptoms
  • Constant sluggishness
  • Confusion and irritability
  • Easily agitated
  • Neglect of responsibilities and self-care
  • Withdrawal from family and friends
  • Decline in daily ability to function
  • Inability to find pleasure in any activity
  • Difficulty getting motivated in the morning
  • Behaving out of character
  • Denial of depressive feelings as a defense mechanism
  1. Thoughts
  • Indecisiveness
  • Loss of self-esteem
  • Persistent suicidal thoughts
  • Negative comments like ‘I’m a failure’, ‘It’s my fault’ or ‘Life is not worth living’
  • Excessive concerns about financial situation
  • Perceived change of status within the family
  1. Emotional symptoms
  • Moodiness or irritability which may convey anger or aggression
  • Sadness, hopelessness or emptiness
  • Feelings of being worthless
  • Feeling guilty
  1. Physical symptoms
  • Unusual increase or decrease in sleep
  • Feeling tired all the time
  • Reduced movement
  • Memory problems
  • Unexplained headaches, backache, pain or similar complaints
  • Digestive upsets, nausea, changes in bowel habits
  • Agitation, hand wringing, pacing
  • Loss or change of appetite
  • Significant weight loss or weight gain

As we grow, changes in our capability, lifestyle and independence puts us at a risk of depression. The following problems cause depression:

  • Health problems resulting from illness, disability, chronic or severe pain
  • Cognitive decline and loss of control
  • Psychological problems stemming from increased dependency, damage to body image due to surgery or disease, stress, hopelessness and helplessness
  • Loneliness and isolation arising as a result of living alone, due to loss of connection with family members, withdrawal from social circles or dissolution of social circles due to deaths and relocation or having no one to talk to and depend upon
  • Reduced sense of purpose due to retirement from work or loss of self-esteem due to physical limitations on activities
  • Fear of death or fear arising from anxiety over financial problems, family issues and bad health
  • Recent bereavements including death of spouse, friends, family members or pets

Who is prone to depression?

The elderly commonly experience physical illness, chronic pain and loneliness, and these can increase the chances of depression. Depression in the elderly could also be a side effect of a medical disorder or medication.

Medical conditions can cause depression either directly or as a psychological response to the illness especially if the disorder is pain inducing, life-threatening or disabling in nature.

Depression can be a symptom or side effect of the following disorders:

  • Parkinson’s disease
  • Thyroid disorders
  • Vitamin B12 deficiency
  • Alzheimer’s disease
  • Lupus
  • Multiple sclerosis
  • Dementia
  • Stroke (post-stroke depression)
  • Heart disease
  • Cancer
  • Diabetes

The stress, loss of control and helplessness experienced during the course of these illnesses cause emotional distress that can result in depression.

Depression could also be the side effect of medication, especially if treated for several illnesses simultaneously. Older adults are more prone to depression caused by medication because the body’s ability to process and metabolize drugs decreases with age.

The following medications could cause or accentuate depression:

  • Blood pressure medication (e.g. clonidine)
  • Heart drugs containing reserpine
  • Beta-blockers (e.g. Lopressor, Inderal)
  • Sleeping pills
  • Tranquilizers (e.g. Valium, Xanax, Halcion)
  • Calcium-channel blockers
  • Ulcer medication (e.g. Zantac, Tagamet)
  • Steroids (e.g. cortisone and prednisone)
  • High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
  • Estrogens (e.g. Premarin, Prempro)
  • Painkillers and arthritis drugs
  • Medication for Parkinson’s disease

If signs of depression become obvious after starting a new medication, report it to the doctor. The doctor may either lower the dose or switch to another medication.

 

Treatment options may range from self-help to anti-depressants, therapy and even herbal medication. Following are the options in detail:

  1. Self help
  • Exercise: Exercise releases endorphins in the body that creates a positive effect in the body and reduces our perception of pain. Physical activity goes a long way in treating depression. Moreover, it does not require lengthy or strenuous workouts. Undertaking simple physical activity such as walks in the park, simple household chores or walking up stairs will suffice. There are many safe exercises for disabled individuals as well.
  • Connect with others: Battling depression alone is very difficult. One may not feel like reaching out to others but talking and socializing with others will help become free from the feelings of loneliness and feel more connected to the world. Limit the time spent alone. Make new friends. Join a support group, a book club or a group of people who share similar interests.
  • Maintain life balance: Make sure life does not revolve around one specific thing. Broaden interests and find new things to do. If overwhelmed by anxiety or stress, learn a few mediation moves. One such practice involves closing eyes, breathing deeply and trying to visualize an object. It could be anything; a candle flame or butterflies are a few examples. Keep at it for about 10 minutes and it will help feel more calm and collected. Apart from this, there are a number of emotional management tricks that can be used to counter anxiety.
  • Proper sleep: Make sure to get at least 7 to 9 hours of sleep every night. Sleep deprivation will cause irritability and sluggishness and increase depressive symptoms.
  • Healthy diet: Choose healthy nourishing foods and take multivitamins. The nourishment will help feel more energized. Avoid junk food and excess sugar.
  • Take up hobbies: Take up old hobbies or find new ones. Find something that engages and entertains.. It will stimulate creativity and take mind off anxieties.
  • Volunteer: Helping someone else is the simplest way of feeling better. Moreover, it can help broaden the scope of thinking as well as social circle.
  • Get a pet: Pets make good companions and can help battle loneliness. Taking care of the pet will help stay engaged and also act as an exercise.

Things to keep in mind while dealing with depression:

Depression is not a weakness. Loss of self-esteem is a symptom of depression. Many people who feel depressed begin thinking less of themselves and start to condemn themselves internally. They may also refrain from asking for help for the fear of appearing weak. Thus, it is important to remember that depression is not a weakness. Rather, it is a condition that throws one into mental, emotional and physical stagnancy and can be countered by therapy and medication.

  • Be sure to talk to someone if feeling low, especially if suicidal thoughts sneak in. Avoid keeping intense depressive feelings unspoken.
  • Monitor drinking. It is very easy to give into alcohol while suffering from depression. Alcoholism is not a solution. It will make depression worse and may also react with medications, resulting in numerous complications. To prevent alcohol abuse, assign a drinking limit and stay within the limits. Keep family and friends informed.
  • Do not stop or change medications without getting consent from the doctor.
  • Do not worry over disturbed sleep. Once treatment begins, the sleep pattern will eventually get better.
  • Be kind.
  • Depression does not cause dementia.
  1. Anti-depressants

Though anti-depressants are widely prescribed to teenagers to counter depression, they are not prescribed to the elderly. This is because they decrease sodium (salt) levels, cause rapid bone loss and increase the risk of fractures and falls. Moreover, anti-depressants could react with other medications that the person is taking, resulting in complications. If an older adult is prescribed anti-depressants, he or she should be carefully monitored.

Anti-depressants may initially increase anxiety. They take 1 or 2 weeks to start working and reduce depression. Do not stop taking anti-depressants suddenly as this may cause withdrawal and mood swings.

  1. Herbal Medication

Herbal remedies are a good substitute for anti-depressants and are much safer for older adults. Occasionally, chemicals in the herbs may interfere with other medications a person is taking. Consult with the doctor before using any herbal medications. The following are the most common herbs used to treat depression:

  • Omega-3 fatty acids: Research on 22,000 participants in Ireland showed that people who took omega-3 acids were 30% less likely to suffer from depression.
  • Johns’s wort: A standalone treatment for depression. Should never be taken with other anti-depressants.
  • Folic acid: It cannot single-handedly treat depression but it relieves symptoms of depression when combined with other treatments.
  • SAM-e: A natural dietary supplement called S-adenosylmethionine that has helped counter depression in many studies. It may occasionally cause severe side-effects.
  1. Therapy

Therapy is the safest way to counter depression. There are a number of therapies available and each type bases treatment on its own theories. Therapy works well because it does not focus on depression, but rather the causes of the depression. Of the therapies available, the following are the most common in treating depression:

  • Psychotherapy: Focuses on past events that caused depression. Psychotherapy involves talking about personal problems and figuring out where it all began. This kind of therapy is helpful in getting things off the chest and finding a new perspective towards the problems.
  • Cognitive behavioral therapy: Focuses on thoughts and behavior. Most people have set ways of thinking that could depress even if there is no actual reason to be depressed. Cognitive behavioral thinking identifies unrealistic behavior, studies the thought behind it and corrects the thinking. It also offers an alternate behavior such as changing negative thinking patterns or recommending better coping skills.
  • Problem-solving therapy: Helps gain perspective on problems by breaking the issue down into manageable bits and developing solutions, along with teaching problem-solving skills.
  • Couples therapy: If the cause of depression is a spouse or a partner, couples therapy may help convey issues in a safer way.
  • Support groups: A self-help program that involves sharing experiences with people who have suffered similar problems. It is very helpful in offering insight into a problem and seeing how other people are dealing with it. Moreover, it is a good way to make friends with people who understand the same issues.
  • Bereavement counseling: Helps with accepting and moving on from the loss of a loved one by talking it over with a counselor.
  • Interpersonal and psychodynamic psychotherapy: A long-term therapy that focuses on long standing issues and helps understand how events from the past are affecting now.

Counseling treatments take a little while to work. Treatment may require anywhere from 5 to 30   sessions. Some therapists conduct weekly sessions, while others may spread sessions over 2 or 3 weeks.

Watching a loved one suffer from depression can be frustrating. Below are a few tactics with which one can help the individual with depression and establish a trusting relationship:

  • Offer encouragement.Depression normally causes a withdrawal from friends and family. The individual with depression will require verbal and nonverbal encouragement to re-connect and open up. Invite the person to spend time. Undertake some simple activity together that will engage them as well as create an opportunity to talk.
  • Listen and give importance.Allow the person to say all they want. Do not interrupt, but ensure they are being listened to. Avoid being preoccupied with other work while listening to the person talk. Maintain eye contact and try to understand the person’s issues. Avoid giving advice even if the solution is obvious; instead try leading the person to the solution. If asked for advice, state opinions but remember to be sensitive and accept the person’s problems as legitimate ones.
  • Provide assurance.People with depression may feel like they are never going to get better. Frequent reassurances can help.
  • Compliment whenever possible.People with depression may not think much of themselves. Compliments, appreciation and recognition can go a long way in empowering them and raising their self-esteem.
  • Food and health: Sometimes depression will cause a disregard for life. People may stop eating, sleeping and generally caring for themselves. This could accentuate their sluggishness. Try to ensure that they have regular meals and sleep properly. Taking care of them will let them know that they are being cared for which may make them feel less lonely.
  • Prevent them from drinking alcohol.Depression makes one susceptible to alcoholism. Try to prevent the depressed person from drinking excessively during social occasions.
  • In case of suicidal tendency, consult a psychiatrist immediately.If caregiver suspects a suicidal intention, it is best to seek professional psychiatrist’s help.
  • Encourage them to seek help.Remind them to take their medication and maintain a positive attitude towards their problems. If any concerns about their treatment, talk it over with their doctor.

 

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