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Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.


Caregiving Chronicles Q&A: How depression can impact older adults and caregivers
By Douglas Flynn / October 21, 2014
Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, allowed Caregiving Chronicles to get some valuable insight from several of its staff nurses for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about depression, particularly how this illness can affect older adults and the caregivers themselves, with Pamela Fishman, LSW, CHP-SW, a social worker at the Natick VNA.

A certified Hospice and Palliative Care Social Worker, Fishman has been a social worker for more than 20 years and is a member of the National Association of Social Workers, the Social Workers Hospice and Palliative Network, the National Hospice and Palliative Care Organization and the National Hospice and Palliative Care Nurse Association.

Additional information about depression is available on CaregivingMetroWest.org on our Depression page in the Health Conditions sections. In addition, information on local resources to help older adults and caregivers suffering from depression such as the Elder Community Care program, other mental health organizations and geriatric psychiatrists serving the MetroWest region can be found on the Elder Mental Health Resources page in the Resources in MetroWest section.


CGMW: What is depression? Is it really a “medical” condition?
Fishman: According to the National Alliance on Mental Illness (NAMI), “Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness. … Left untreated, depression can lead to serious impairment in daily functioning and even suicide, which is the 10th leading cause of death in the U.S.”

The National Institute of Mental Health says that depression can be caused by a combination of factors that are “genetic, biological, environmental, and psychological” in nature.

CGMW: What are the symptoms to look for? How do they differ from symptoms of Alzheimer’s or other dementia?
Fishman:
Symptoms of depression may include weight loss, confusion, delusions or hallucinations, irritability or loss of appetite. NAMI says that some “general clues that someone may be experiencing depression are persistent and vague complaints; help-seeking; moving in a more slow manner; demanding behavior.”

Some other symptoms of depression include feelings of emptiness or feeling persistently sad or anxious; thoughts about suicide or attempts at suicide; feelings worthless or helpless; and a decrease in energy, to name a few.

The Mayo Clinic says that depression and Alzheimer’s disease share a number of qualities, including:
- Loss of interest in once-enjoyable activities and hobbies
- Social withdrawal
- Memory problems
- Sleeping too much or too little
- Impaired concentration

CGMW: How common is it for older adults to suffer from depression?
Fishman:
There are 35 million Americans over the age of 65. NAMI says that “more than 6.5 million” of them are affected by depression. Unfortunately as we age, we are prone to medical issues which cause changes in our health and lifestyle. These changes can feel like losses and thus create feelings of sadness. We grieve losses of our health, independence, way of life and, of course, the loss of loved ones – something that grows more common as we age.

CGMW: What are the dangers of depression? Why is it important to get it diagnosed and treated?
Fishman:
Unfortunately, it took the untimely death of beloved American icon Robin Williams to start a national conversation about depression.

Of course, suicide is a terrible outcome of depression. A recent article in the Washington Post indicated that of those aged 55 to 64-years-old, suicide is the eighth leading cause of death.

Our physical health can be significantly impacted by our emotional health. Some other dangerous effects of depression include a substantial decrease in physical health; insomnia and other related conditions; substance use or abuse; feelings of hopelessness; and an increased risk of dementia.

These are just a sampling of depression dangers. Each of these dangers has its own list of side effects or conditions that can be debilitating to the person suffering from depression as well as those around him.

CGMW: What are the treatment options (medication, therapy, etc.)?     
Fishman:
As with depression itself – the condition has many different facets – there are many ways to treat depression. Typical treatment options include medication and talk therapy. Hospitalization or electric shock therapy (ECT) may be appropriate for those who do not respond positively to medication or traditional therapy; or transcranial magnetic stimulation, which stimulates nerve cells in the brain.  

There are different types of antidepressant medications that treat depression. They are prescribed by a doctor based on symptoms, other health conditions and more. If you feel that your loved one is suffering from depression, talk to his/her primary care physician to determine what antidepressant might be best. Most people respond positively with traditional treatment including medication combined with talk therapy.

CGMW: Are there local resources to help?

Fishman: There are a number of places to get further information and help. Here are a few:

National Alliance on Mental Illness – Massachusetts
U.S. Department of Health & Human Services
Massachusetts Department of Mental Health

Of course, there are many wonderful resources on CaregivingMetroWest’s website for elder mental health.

CGMW: Why is it important that caregivers seek help for themselves, as well as their care recipients, if feeling depressed?
Fishman:
The feelings of hopelessness that accompany depression can make someone feel that nothing will get them out from under the “black cloud” of that depression. This can be especially dangerous for caregivers who are charged with caring for someone who can’t care properly for himself or herself.

Many of us have read about the importance of caregivers caring for themselves, and addressing one’s own depression a major reason behind that. When a caregiver is depressed, he or she doesn’t have the capacity to care for himself or herself, let an individual under his or her care.

Those with chronic illness who are also depressed may experience a worsening of their illness due to a compromised immune system.

Mental illness, due in part to Robin William’s death, is now part of the national conversation. Perhaps it will also be viewed less as a stigma and be treated with the same attention as physical illness.

If you feel depressed or suspect that a loved one you are caring for is depressed, seek the help of a medical professional. And know that you’re not alone. Globally, 350 million people suffer from depression; in our own country, about 10 percent of the population suffers from depression.

Depression is nothing to be embarrassed about. It’s an illness that affects millions of people worldwide. Start a conversation about it. Get screened. And get help.


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The BayPath Family Caregiver Support Program and CaregivingMetroWest.org has been made possible by funding from the Older Americans Act as granted by Executive Office of Elder Affairs. Participants may make a voluntary donation toward the cost of this federally funded service. Click here for more information.

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