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Coping with Depression and the Holidays
Facts About Depression
The Holidays After the Terrorist
Nursing Home Residents
For most of us, the holidays are a time to gather
with friends and family, celebrate, reflect on the
past and plan for the future. However, for some, especially
older individuals, the holidays can be a difficult
time. During the holidays, older adults may feel more
acutely the passing of time, the absence of parents,
siblings and friends who have died, and the distance
of loved ones who have moved away. Traditional reunions
and rituals that were observed in the past may not
be possible and in their absence, the holidays may
seem devoid of meaning. This holiday season may be
particularly difficult as we adjust to a world forever
changed by terrorism.
It is normal to feel subdued, reflective and sad in
the face of these losses and changes. But family members
or friends may notice that a senior is experiencing
the “blues” for a long time and that what
they may have thought was simple sadness is actually
a serious case of depression.
Some major factors contributing to holiday depression in the elderly are:
- Financial limitations
- Loss of independence
- Being alone or separated from loved ones
- Failing eyesight (and lessening of the ability
to write or read holiday correspondence)
- Loss of mobility and/or the inability to get to
DEPRESSION IS NOT A NATURAL PART OF AGING
Everyone feels sad or blue sometimes, and the stress associated with holidays
may stir feelings of loss or separation. However, a person who is sad or anxious
around the holidays, can, in most cases, continue to carry on with regular
activities. Such feelings are generally temporary and the individual eventually
returns to his or her normal mood state. However, a clinically depressed person
suffers from symptoms that interfere with his or her ability to function in
every day life. These symptoms include much more than feeling blue.
When clinically depressed, the affected older person may lose the will to live.
These persons begin to question the value of life and may think of suicide.
There are often feelings of diminished self-esteem or excessive feelings of
guilt. As these symptoms develop, the older person may take to bed or not bother
getting dressed in the morning.
Appetite and sleep may suffer while lethargy sets in. The person may show little
interest in his or her own welfare and little interest in doing things that
in the past brought pleasure.
Recognizing depression in older individuals is not always easy. It often is
difficult for a depressed older person to describe how he or she is feeling.
In addition, the current population of older Americans came of age at a time
when depression was not understood to be a biological illness. Those who are
depressed may fear being labeled “difficult” or worse, or may worry
that their illness will be seen as a character weakness.
Those who are depressed, their families and friends may think that a change
in temperament or behavior is simply “a passing mood,” and that
the person will just “snap out of it.” Unfortunately, a person
suffering from depression cannot just “get over it.” Depression
is a medical illness that should be diagnosed and treated by trained professionals.
Left untreated, depression may last months or even years.
If left undiagnosed and untreated, depression can:
- Lead to a loss of independence
- Aggravate symptoms of other illnesses
- Lead to premature death
- Result in suicide
When properly diagnosed and treated, however, most
people recover from depression.
FACTS ABOUT DEPRESSION
Following is some information about depression in the elderly and how to help
those who might be suffering.
What are some of the warning signs of
The most common symptoms of late-life depression include:
- Persistent sadness
- Withdrawal from regular social activities
- Slowed thinking or response
- Lack of energy or interest in things that were
- Excessive worry about finances or health
- Frequent tearfulness
- Feelings of worthlessness or helplessness
- Weight changes
- Pacing and fidgeting
- Changes in sleep patterns (inability to sleep or
- Inability to concentrate
- Staring off into space (or at the television) for
prolonged periods of time
What triggers depression in older adults?
Chronic or serious illness is the most common cause of depression in the elderly.
However, the disease also can be caused by biological changes in the brain
and, thus, may occur for no visibly apparent reason.
As the body and brain age, a number of bio-chemical changes begin to take place.
Changes as the result of aging, medical illness or genetics may put the older
adult at a greater risk for developing depression.
Among older people, medical illnesses are a common trigger for depression,
and often depression will worsen the symptoms of those other illnesses. In
addition, some illnesses may hide the symptoms of depression. When a depressed
person is preoccupied with physical symptoms resulting from a stroke, gastrointestinal
problems, heart disease, arthritis or another affliction, he or she may attribute
the depressive symptoms to an existing physical illness, or may ignore the
symptoms entirely. For this reason he or she may not report the depressive
symptoms to a doctor, family or friends.
Is depression treatable?
Today, there are highly effective behavioral and pharmacological interventions
for depression in late life. In fact, most depressed elderly people improve
dramatically with treatment.
Antidepressant medications can
be very effective in treating depression by
beneficially affecting the level of certain
neurotransmitters in the brain.
Typically, it takes 4-12 weeks of treatment with antidepressant medication
to begin seeing results and medication is taken for six months to a year. It
is important to take antidepressant medications in close consultation with
a general practitioner or psychiatrist. Taking the wrong amount--too much or
too little--or discontinuing medication too soon may compromise the effectiveness
of the treatment.
Psychotherapy (talk therapy) can also play an important role in the
treatment of depression. Some patients improve notably with short-term talk
therapy (10-20 weeks); others may benefit from long-term therapy. Some patients
find group therapy with their peers helpful as they are able to share insights
with others who are going through similar experiences. It is very important
that the depressed person find a therapist with whom he or she feels comfortable
and who has experience with older patients.
What are some of the complications
in treating depression?
The treatment of depression requires patience and perseverance from the person
who is depressed as well as their family and friends. Each person has individual
biological and psychological characteristics that require specialized care.
Sometimes different medications must be tried for a successful recovery. This
is especially true with the elderly who have other serious illnesses or who
are otherwise in frail health.
What are the first steps in caring
for the depressed person?
An elderly person who may be depressed should see a medical professional--a
family doctor, a general psychiatrist or a psychiatrist specializing in the
elderly, called a geriatric psychiatrist. A complete physical should be part
of any evaluation since depression may be the result of another medical condition.
If the person is reluctant to see a doctor on his or her own, friends or family
can offer support by going with them.
How do you talk to someone who is depressed
Sometimes the hardest part in helping someone who is depressed or blue is finding
an approach that does not contribute to him or her feeling defensive, sad,
or helpless. If you are at a loss for words, you may want to consider some
of the following ways to begin:
- Discuss your own varied feelings or a time in your
life when you were depressed or blue. Knowing that
you understand may give them the means to talk about
- Acknowledge that the holidays can be difficult.
Many people don’t want to admit that
life is not always as cheerful as portrayed in the
media or in advertisements.
- If the older individual is not eating or has lost
weight, you might start by gently asking about their
appetite or why they do not seem interested in food.
- Once you have gotten past the initial awkwardness,
you may be surprised to learn that your loved one
will talk to you. At that point, it is up to you
to listen and offer support. Too often, younger friends
or family members do not want to hear some of the
less than pleasant aspects--emotional and physical--of
growing older. But one of the most important things
you can do is listen.
- Offer specific suggestions for help and be willing
to assist in implementing them. You may want to suggest
that your relative or friend visit the family doctor
or make an appointment with a psychiatrist. You may
want to be involved in helping them select a doctor
if they don't have one in mind. They may wish to
make the decision on their own, but, if not, it will
be a comfort to have help.
It may take more than one conversation and it may
take more than one day or one week to get the individual
to agree to get help. If they are struggling with depression,
they may not want to hear what you have to say and
may resist your suggestions. Be persistent. This is
a difficult process for you and the older individual,
but knowing that depression is treatable makes it easier
Remember, for many older family members and friends there may be a stigma attached
to asking for help and to having any discussion of depression or mental illness.
Part of your role is letting them know that depression is treatable, that their
lives can be better and that depression is not an inevitable part of growing
THE HOLIDAYS AFTER THE TERRRORIST
Today’s senior citizens are a resilient and resourceful group, and the
vast majority is managing the stress of recent events very well. However, during
the holidays, the elderly and their families should be sensitive to possible
responses to threats of terrorism.
Over the holidays, how might older individuals
respond to the threat of terrorism?
In addition to feeling depressed, seniors may find themselves irritable and
uninterested in previously cherished rituals or loved ones. Those traumatized
by earlier life experiences may become preoccupied with unwelcome images from
the past. Older émigrés who fled political terror or religious
persecution in their homelands may be particularly vulnerable. Near phobic
dread of travel or unwarranted worries over traveling family members can lead
to isolation. These are all symptoms of anxiety and depressive disorders as
well as acute and post-traumatic stress disorders.
Why might these responses be delayed?
During the holidays, we let our emotional guard down. Our psychological defenses
are loosened in anticipation of the warm, secure feelings associated with the
holidays. Seniors who have busied themselves and kept the terror out of mind
may find that the change of pace leaves them vulnerable. The delayed response
may also be triggered by seeing family members in distress. Reactions to stress
are emotionally infectious.
What are signs that an older person may
need help from a mental health professional?
- Suicidal thoughts are not the norm even in very
old persons and their presence indicates the need
for professional help.
- An escalation in the use of alcohol, pain relievers
(analgesics) or sleeping pills may indicate depression.
- Seniors who seem confused, cannot concentrate or
seem lost in the midst of family events may benefit
from a professional assessment.
- Shedding a tear of two during the holidays is a
sign of sentiment. But when crying becomes disruptive
or disabling it may be a sign of depression.
- Seniors who suddenly isolate themselves are clearly
What can friends, family members and caregivers
do to help?
The simple answer is to openly communicate one’s concerns. Offer to call
the individual’s doctor and accompany the senior to an appointment. A
conversation with the senior’s clergy can also facilitate referral to
a mental health professional. Do not ask the older person to follow through
without giving your support.
NURSING HOME RESIDENTS
Many families rely on nursing homes to provide the consistent care their older
relative needs. Holiday depression can arise--for many of the reasons previously
mentioned--when individuals are in nursing homes or other long-term care situations.
The holidays may be especially hard on these individuals because of the loss
of their own mobility.
What kind of care can a patient receive
for depression in a nursing home?
If your older family member is in a nursing home and you suspect he or she
is depressed, you may want to talk with the nursing home administrator or director
of nursing about the symptoms you notice. You may want to request a consultation
with a physician or psychiatrist. If the individual is in frail health, you
need to be especially certain that the doctor is trained in caring for the
mental health of the frail elderly whose ability to tolerate treatments may
be different from other elderly patients.
Remember that all patients should have access to the care they need--physical
and mental--regardless of the setting. If the individual is in a nursing home
and you suspect he or she is suffering from depression, insist that the nursing
home help provide appropriate treatment.
What questions should I ask about mental health care in the nursing home?
- Ask whether the facility provides physical and
social activities for the residents. Like all of
us, elderly family members need to get exercise if
they can and need to have positive interaction with
friends and peers.
- Ask about the qualifications of staff professionals
monitoring care, especially regarding the careful
dispensing of all medications.
- Ask specifically about mental health care, including
access to group therapy.
- Ask about the availability of psychiatric care
through a staff or affiliated psychiatrist.
How can I find a qualified geriatric psychiatrist?
The American Association for Geriatric Psychiatry has a network of members--experts
in the treatment of late-life mental illness--across the country who are
nursing homes or related facilities. If you would like a referral to one
of these doctors, contact AAGP's Foundation at 301-654-7850, e-mail info@GMHFonline.org or
request a referral through www.GMHFonline.org. The Foundation will provide the
names of board-certified geriatric psychiatrists practicing in your area.
How can I learn more about
mental health issues related to the elderly?
The Geriatric Mental Health Foundation offers consumer brochures on The
Role of the Geriatric Psychiatrist, Depression in Late-Life, and Alzheimer's
copies, free of
charge) as well
as other material visit www.GMHFonline.org.