Posts Tagged 'depression'

Depression and the Holidays

A great deal has been written about the topic of depression during the holiday season. I’m not going to rehash that. Today’s blog is more of a personal reflection on my professional experiences with depression among the elderly and individuals needing long-term care.

In one of my positions as a psychologist, I “covered” skilled nursing facilities. That’s the newer term for nursing homes. Today’s skilled nursing facility (SNF) is unlike the nursing home or old people’s home of the past. A SNF has both “patients” in the traditional sense, that is, individuals who are recovering from a medical or surgical illness, and non-patients. The non-patients are long-term residents or clients: the younger physically disabled, the frail elderly, and the mentally disabled. Each SNF is somewhat like a small town without children. There are town officials (registered and licensed practical nurses), town employees (certified nursing assistants, dietary workers, physical, occupational and speech therapists), citizens in no official capacity (clients or patients), county or state officials (owners, physicians), and visiting dignitaries (medical and psychological specialty consultants). What makes the SNF unlike a real small town, however, is that only the citizens actually live in the town. Everyone else is an out-of-towner with lives separate from the townies.

Now for the holidays. The holidays are everywhere: TV, SNF décor, the conversations of the out-of-towners. There are more visiting dignitaries, the ones who come once a year and sing or dance or give out small gender neutral and politically correct gifts. All, absolutely all, of the dignitaries mean well. They want to bring cheer and happiness to the townies. But they, too, go home.

The townies? Well, they are left with their memories and thoughts. Remember that year that Santa left his footprints in the ashes? Oh. No one but me is left to remember. Remember sliding down that big hill behind the school? I remember the feeling. But my body can no longer feel the experience or any, for that matter. Remember – no, I’d rather not. My mom drank and my dad scowled. Remember. No, I can no longer remember. What are the holidays? Where is everyone?

Some townies get out of town to family from out of town. They bring back peace and, best of all, they bring back hope.

Hope – one of the criteria for happiness and a stalwart defense against depression.

So, my blog readers, I wish you hope in this crazy world. Please spare a thought in your busy days for those who have little or none of it.

Recession, Anxiety and Depression

It would be easy to find fault and a bit of glee when we hear of wealthy people suffering psychological distress as a result of loss of money and status. But the wealthy and formerly wealthy are no more protected from mental disorders than those who are less financially fortunate. Perhaps the distress is even worse if the fall follows years of working towards the top. It certainly makes sense if the climb started from a very low position. It may also be worse in those with a strong sense of social responsibility.

 

An article in Saturday’s New York Times started this rumination. The article can also be accessed online at LINK.

 

The article highlights a private psychiatric facility in New York. The facility is accustomed to high profile and wealthy clients. But there is mention that the symptoms of “recession psychosis” (an unofficial diagnosis not listed in the Diagnostic and Statistical Manual of Mental Disorders) can also be found among those not in the upper layers of society. The symptoms include severe anxiety and suicidal tendencies set off by the economy. In addition, there is often paranoia related to global or local news. This sometimes translates into a survival mentality, such as not eating in order to have enough money to buy food or buying guns in order to feel safe. Individuals who are still employed may have periods of manic behavior as they strive harder and harder to prove themselves worthy of keeping their jobs. Alcohol and drug abuse become more common as individuals try to either calm themselves or to increase their energy so they can work non-stop.

 

There is no easy cure for this “psychosis.” Of course, curing the economy is necessary. But since predictions for that occurrence are conservatively one or two years, people who find themselves unable to cope with their anxiety and depression need to have help now. Anxiety and depression are more easily handled, with psychotherapy and medication, before they become severe enough to make a hospital admission necessary.

 

Now is not the time to cut back on health benefits. Now is not the time to cut back on stress reducing tactics such as exercise or meditation.

 

Now is the time to gather support from family and friends and to remain connected to community.

 

And remember – seek help if you need it.

The Most Depressing Day of the Year

The third Monday in January has come and gone. According to a British psychologist, Cliff Arnall, that day is the most depressing day of the year. Dr. Arnall’s basis for this is a formula he developed that takes into account the weather, holiday debt, resolutions that have failed and a work-to-be-done/motivation-to-do-it ratio. His formula doesn’t even take into account current events (economy, war, healthcare).

 

Aren’t you glad it’s over and what a depressing thing to look forward to! Talk about a self-fulfilling prophecy.

 

So, what are you going to do about it? Another Briton, Sophie Howarth, has an idea. Get together with like-minded people and celebrate what is good in your life (yes there is!!). Take time (a very little time) to moan and groan then move on. Learn about ethical living, meaningful relationships and enjoyment.

 

Think about the good things every day. No good things? Oh, come on! Winter is 1/3 over. The price of gasoline has gone down. We’re beginning to disengage from one war. My amaryllis is blooming. I still have Internet.

 

So – take heart and think positively. Depression is self-reinforcing, but so is optimism. 

Have a headache? Don’t take a pill

Today is Tuesday – that means the New York Times Science Section.  I always find a lot of interesting items in this section.  But, unfortunately, I don’t have time to write about them all.

So, since I have had acupuncture, I thought I’d start there and then write about one more item of interest.

Headache and Acupuncture

Sinced 1998, when the National Institutes of Health (NIH), accepted acupuncture as a “useful alternative” for the treatment of headache, 25 randomized controlled studies have looked at this ancient treatment.  Four of these studies compared acupuncture to massage, 16 studies compared acupuncture to acupppuncture-like placebo and seven compared acupuncture to medication. 

The sample sizes in the massage studies were too small to demonstrate significant results in either direction.  Acupuncture relieved headache for the majority of the individuals in both the placebo and the medication studies.  Furthermore, the individuals  in the medication studies preferred acupuncture because of fear of side effects from medication.

From my own experience (for a shoulder injury, not for headache), acupuncture was painless and gave me a legitmate reason to put my feet up and rest during the day.  The acupuncture results were good and lasted as long as the steroid injection.  However, when my symptoms returned once again, I chose physical therapy and REALLY worked at it.  That gave me the longest lasting results.

Depression and Heart Disease

Is there a connection?  Yes.  But is it causative – does depression cause heart disease?  Perhaps.  Three large studies (each with well over 1,000 participants) demonstrated a link but not a cause.  In the words of Dr. Mark Hamer of University College, London, “It’s really quite difficult to understand.”

Some depressed people become less active, some smoke more, some do both.  Smoking is a serious risk factor for heart disease.  Lack of exercise is another serious risk factor.  Being over-weight is another.  So, does depression exert a behavioral/secondary effect on the cardiovascular system (depression -> behavioral change -> risk factors -> heart disease) or is something else going on?

There is a well know link between depression/anxiety and an increase in the stress hormone, cortisol.  Depressed individuals have greater than normal circulating cortisol.  Excessive cortisol causes weight gain.  If this is the case, then depression has more than a behavioral/secondary effect on the cardiovascular system (depression -> increased cortisol -> weight gain risk factor -> heart disease).  This would account for the indiviuals who have heart attacks and some weight gain but no behavioral changes.

So, there is a connection between depression and heart disease.  However, it must be remembered that a connection (or correlation) does not mean a cause. 

Bottomline: do not smoke, do exercise, keep your weight within normal limits and, if you are prone to depression, get it treated.

And keep your eye out for more studies.  Heart disease is the number one cause of death in this country.


Mary Lou Bernardo, PhD, MSN

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