Thursday, June 11, 2009

Health tip

How to Help Someone With Depression
What you can—and can't—do for them.
By Stephanie Trelogan,

Seniors often face stressful situations, including chronic illness, financial problems, and loss of independence. Add that to physical and emotional isolation, and you've got a recipe for depression.

But there's a big difference between situational unhappiness and clinical depression. Feelings of sadness and anger are natural after a catastrophic event like a heart attack or the death of a loved one, but when those feelings linger for months on end and prevent a senior from getting any enjoyment out of life, it's more than a normal reaction to grief.

Here are some practical suggestions for helping someone with depression.

Know the warning signs
Sometimes it's hard to tell the difference between depression and just a case of the blues. Depression is more than just feeling sad or "down." Depression affects a person's thinking, emotions, behavior, and physical health. A depressed person may feel empty inside, or may no longer enjoy activities she once loved. She may complain of aches and pains that can't be explained or treated. When someone has several of these symptoms for weeks or months, it's likely that she's clinically depressed.

If you think someone has a case of depression, it's a good idea to familiarize yourself with the warning signs. And it's also helpful to know what specific indicators to look for:

Lack of interest in personal appearance. One of the most obvious signs of depression in the elderly is when they stop caring about their personal appearance. If your mother used to take great pride in her looks but no longer bothers with makeup, she may be feeling depressed.
Increased complaints about aches and pains. Depression can actually amplify physical pain, turning minor irritations into severe discomfort. If your once-stoic mother won't stop complaining about her sore feet, she may be suffering from more than just bunions.
Social withdrawal. Depressed seniors tend to push other people away—especially those they love the most. If the person you're caring for suddenly starts making excuses not to see you or other family members or friends, it's worth checking into what's really going on.
Bring up the subject of depression

Break the taboo.
Depression is a taboo subject for many seniors, and they may have an especially tough time thinking of it as an actual illness. But the first step toward helping someone who's depressed is letting her know you care and support her.

Broach the subject carefully. Instead of plunging directly into a tough discussion about therapy or treatment, try asking what's going on. "I've noticed you haven't been sleeping well and you've been so irritable lately. You just don't seem like yourself. Are you okay?" Of course, there's no guarantee that your tactful, gentle probing will open the floodgates, but it's worth a shot.

If she resists:Get her to a professional.

Know the warning signs

Break the taboo.

Encourage a visit to the doctor

If she agrees: In the best-case scenario, you've had a great heart-to-heart with the person in your care and she's agreed to talk to a psychotherapist or psychiatrist about her mood. In the worst case, she's repeatedly brushed off your attempts at discussion and doesn't want to hear another word about it. In that case, you might want to try another approach: Suggest a check-up with her primary care doctor. A senior may be less resistant to this idea, and she may be more willing to listen to a doctor who urges her to get help.

If she resists:
If she's resistant to the idea of seeing a doctor because she's embarrassed or afraid, help her understand that a diagnosis of depression isn't the shameful secret it once was. It doesn't mean she's "crazy" or is going to be taken away to a nursing home. What's more, her test results are private, so no one but she and her doctor needs to know.

If she refuses: If she absolutely refuses to see a doctor, there's not a whole lot you can do. You can't force the issue unless she's psychotic or suicidal, or her depression has progressed to the point where she can no longer take care of herself. If none of those circumstances apply, your best bet is to enlist other family members and friends to try to persuade her to seek help.

Support her during treatment

Provide practical daily help. When someone is diagnosed with depression, the doctor may prescribe antidepressant medications and/or psychotherapy. The doctor may also recommend lifestyle changes. You may need to drive her to appointments, remind her to take new medications, help her get out more, or help her make other lifestyle changes.

Get her to a professional.
Even if a primary care doctor diagnosed the depression, the person may still benefit from seeing a mental health professional. Not all primary care physicians are comfortable treating depression.

Provide reassurance. Seniors are often anxious about taking antidepressants, either because of the stigma they associate with such medications or because they're afraid of potential side effects. Assure the person in your care that the doctor can work with her to find the medication that's most effective with the least-severe side effects.

Other ways you can help

Simply supporting a senior as she struggles with depression can help a great deal. Here are some other things you can do:

Help her stay as physically active as possible. Make sure you talk to her doctor about what activities are appropriate before beginning any exercise program. Find activities you can do together, such as a morning walk around the neighborhood. Exposure to sunlight can help break the cycle of sleeping during the day that many depressed people fall into.
Structure the day around activities that give her pleasure and a sense of purpose. For example, meet friends for lunch or enjoy a leisurely walk through the mall.
Join a support group—for either or both of you. Talking to other people who're struggling with similar issues can be enormously comforting and helpful. It's also a great way to connect with other seniors and caregivers.
Remember that it's not all up to you

In the end, it's really the responsibility of the person who's suffering from depression to get help for herself. If she won't talk to her doctor or comply with treatment, you can't make her—and you shouldn't blame yourself. Keep offering support and provide positive reinforcement when she takes those difficult steps toward recovery.

But there's only so much you can do. If feelings of guilt or sadness overwhelm you, you may need help coming to terms with the fact that your loved one isn't going to get help. Ask your own doctor for information about support groups and other resources to help you manage your own feelings.