Coping With Suicide and Depression: A Guide for Caregivers
By: AGING ARKANSAS newspaper
Caring for an older family member or friend presents many challenges. A concern shared by many caregivers is depression, often leading to talk of suicide.
It is not unusual for both the patient and caregiver to suffer from depression or suicidal thoughts. Illness, pain, frustration and worry provide a “breeding ground” for prolonged sadness. And in fact, it is not an abnormal response to feel sad when caring for someone you love who may never recover or never be the person he or she once was.
But when sadness goes on and on and life seems hopeless, then serious or clinical depression may be the cause. Depression can make you feel exhausted, worthless, helpless and hopeless. Such feelings make some people want to give up. It is important to realize that these negative feelings are part of the illness and will fade as treatment begins to take effect. The good news is, 80% of people with depression can be cured and the symptoms can be prevented from returning.
Caregiving is a challenging job that requires good health, energy and stamina. Don’t let depression rob you of your emotional, mental and physical health.
Get a thorough examination by your doctor. Depression can be caused by several illnesses and until the illness is treated, the depression will not go away. Help is available but you have to ask.
Growing Older Doesn’t Cause Depression
By Robert Mount
Despite what some people may think, it isn’t “normal” to feel depressed all the time simply because you’re getting older. In fact, according to the National Institute of Mental Health, most older people feel satisfied with their lives.
However, among people 65 and older, anywhere from 3% to 15% suffer from something called clinical depression, a whole body disorder or illness than can be serious and even lead to suicide.
Clinical depression is far more than a down mood or even the normal period of depression following the loss of a loved one. The difference is a matter of degree and duration. When a depressed mood continues, without interruption for several months, the person may be suffering from clinical depression.
Fortunately, nearly 80% of these people can be treated successfully with medications, psychotherapy or a combination of both, but only if their illness is diagnosed.
Depression Can Have Many Causes
Illness
One of the causes that can bring on or aggravate depression, particularly among older people, is a long-term or sudden illness. Strokes, certain types of cancer, diabetes, Parkinson’s disease and hormonal disorders are examples of such illnesses.
Medications
Another source of depressive symptoms can be the side effects of certain prescribed medications, such as some of the drugs used to treat high blood pressure and arthritis. In addition, when two or more drugs are taken together, they sometimes interact in unexpected ways. It’s so important that your doctor know all the types and dosages of medicine you are taking.
Genetics
Family history, genetics and personality make some people especially vulnerable to depression. The children of depressed parents, people with a certain biological make-up and those with low self-esteem or an extreme dependency on others are more likely to suffer serious depression.
Biochemical
Biochemical factors or brain chemistry is a significant factor in depression. For example, people with major depressive illness typically have too little or too much of certain brain chemicals, called neurotransmitters.
Significant loss
The loss of a loved one, divorce, a change of residence, money problems, a major change in life pattern or any kind of loss can trigger depression. Sadness and grief are normal responses, but if someone you know has had four or more symptoms of depression for months, professional help may be needed.
Other causes
Substance abuse occurs in about a third of people with any type of depressive disorder.
Persons with certain characteristics---negative thinking, low self-esteem, a sense of having little control over life events and proneness to excessive worrying---are more likely to develop depression.
Treatment Options
People in need of help for their clinical depression are often their own worst enemy. They think that depression will go away by itself, or that they’re too old to get help or that asking for help is a sign of weakness. They’re mistaken. Even a seriously depressed person can be treated successfully, often in only a few weeks and return to a happier and more fulfilling life.
The most commonly used treatments for depression are antidepressant medication, psychotherapy or a combination of the two. Which of these is best for you depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, one or both of these treatments may be useful, while in severe or incapacitating depression, medication is generally recommended as a first step. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the opportunity to learn more effective ways of handling problems.
Medications
The medications used to treat depression include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), serotonin reuptake inhibitors (SRIs), and bupropion. Each acts on different chemical pathways of the brain related to moods. Antidepressant medications are not habit-forming. To be effective, medications must be taken for at least four to six months (in a first episode), carefully following the doctor’s instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects.
Psychotherapy
“Talking” therapies help patients gain insight and resolve problems through verbal give-and-take with the therapist. “Behavioral” therapies help patients learn new behaviors that lead to more satisfaction in life and “unlearn” counter-productive behaviors. “Interpersonal” therapy works to change interpersonal relationships that cause depression. “Cognitive-Behavioral” therapy helps change negative styles of thinking and behaving that may contribute to the depression. (See “Counseling Can Help” on page______)
Exercise
Exercise may be very helpful when used in conjunction with other therapies. It changes the brain chemistry; increases blood flow to the brain and improves physical functioning. Exercise also helps people sleep better, feel better and handle stress better. Studies have shown that when exercise is added to drug therapy, it greatly enhances the success and limits the return of depression.
Other treatments
Avoiding isolation is important to treating elderly depression.
Spirituality can also be helpful by maintaining hope and decreasing isolation. Studies have shown that prayer has a strong physiological effect on the body.
Despite the unfavorable publicity electro convulsive therapy (ECT) has received, there are situations where it is medically justified: those who are at high risk for suicide or with psychotic agitation, severe weight loss or physical debilitation due to other physical illness. ECT may also be recommended for persons who cannot take or do not respond to medication.
Counseling Can Help
One of the most effective treatments for depression is a combination of medications and counseling.
Many older people have attitudes or beliefs that prevent them from getting counseling or psychotherapy. Many refuse to see a counselor because they fear it is a sign of personal or moral weakness. They think psychotherapy is only for people with serious mental illness or who have “gone crazy.” Still others believe there is a negative stigma or shame attached to anything dealing with mental illness. Others mistakenly think depression will go away by itself. Many older people with depression believe they are too old to get treatment.
All of these attitudes are myths that prevent people from getting help for a real illness that can be treated.
Where to start?
Talking to your family physician is the best place to start. Most people have a level of comfort and trust with their doctor. Studies have shown that people are much more likely to be diagnosed with depression or anxiety by their doctor than by a mental health professional.
Before deciding to seek counseling, it is a good idea to ask for a consultation to discuss the situation and decide, with the counselor, if therapy is needed.
What a counselor can do
There are many types of mental health counselors licensed to provide therapy: psychiatrist, psychologist, clinical social worker, pastoral counselor, psychiatric nurse and marriage or family counselor.
These trained professionals cannot read minds nor can they magically solve your problems. What they do is listen and, together with the patient, try to find solutions to the problem. They may provide information, offer ideas on getting along with others, help think through decisions or suggest community services. Only a psychiatrist (medical doctor with special training in mental illnesses) can prescribe medications. (Your family physician may also prescribe medications or he or she may refer you to a psychiatrist for the medications.)
There are many types of counseling. A therapist may treat you as an individual or as a couple or treat the whole family. Counseling can be specialized such as for depression or alcohol or drug abuse or for marital problems. Group therapy or self-help groups may be suggested.
Who needs counseling?
Therapy may be indicated if a person exhibits major changes in behavior such as:
-withdrawing or refusing to participate in normal activities
-being too anxious or panicked to participate in daily activities
-displaying sudden outbursts of anger without cause
-hearing or seeing things that aren’t there
-increasing use of alcohol or drugs
-having constant feelings of sadness or disappointment
-wishing to be dead or expressing suicidal thoughts
Only a trained professional can diagnose and determine the need for treatment.
What does counseling cost?
This varies considerably. It is important to find out about the cost because fees are based on a number of factors. Medicare covers some outpatient treatment and some insurance policies include mental health benefits.
Finding counseling services
Call your local community mental health center, your local Area Agency on Aging (toll-free numbers on pages 22 to 25), a local crisis hotline or your local hospital. Talk to your doctor or clergy. Look in the Yellow Pages under counselors, mental health services or physicians’ listings for psychiatrists or psychologists.
Depression Linked To Stroke
People who experience symptoms of depression are at an increased risk of developing stroke, suggest the results of a two-decade study conducted by the Centers for Disease Control and Prevention (CDC).
There was a 73% increase in stroke risk among study participants with high levels of depression. The CDC also found a 25% increase in stroke risk associated with moderate levels of depression,
The relationship of stroke risk and high depression also varied by race and gender. There was a 68% increase for white men, a 52% increase for white women and a 160% increase for African Americans.
“The suggestion of an increasingly strong relationship between level of depressive symptoms and stroke indicates that reducing depression may be important for everyone, not just those whose symptoms may have clinical implications,” said lead author Bruce S. Jonas, ScM, PhD, of the CDC’s National Center for Health Statistics.
The increased risk of stroke for individuals with symptoms of depression persisted even after controlling for other stroke risk factors including age, gender, race, education, smoking status, body mass index, alcohol use, physical activity, serum cholesterol level, systolic blood pressure, history of diabetes and history of heart disease.
The exact way depression may increase stroke risk is not understood, noted the researchers. Previous research suggests depression’s effect on the nervous or immune systems may play a role. Depression may also increase the risk of diseases such as hypertension, that in turn increase stroke risk.
Depression Different for Seniors
People over 65 have a higher rate of depression than the general population, according to Dr. C. G. Gottfries, a Swedish expert on depression in the elderly. About 5% to 8% of the total population has depression, but this figure rises to 12% to 15% in people over 65. Depression peaks during the years before retirement, declines during the first decade of retirement and then increases again after 75, according to Gottfries. Elderly patients often fail to report depressed mood, thinking it is merely an inevitable consequence of aging.
Anxiety is reported by about 15% of elderly people, a rate similar to that of depression in that age group. There is a high rate of anxiety in elderly patients with major depressive disorder, whereas in younger severely-depressed patients anxiety is not pronounced. Gottfries says anxiety is one of the key differences between the depression symptoms of young and old. He says there may be a depression-anxiety syndrome that is unique to older people.
Physical symptoms are probably the major feature of depression in the elderly, according to Gottfries. These may include a generalized weakness (asthenia), headache, palpitations, pain (generalized or at a specific site), dizziness, labored breathing (dyspnea) and gastrointestinal disorders including constipation.
Another key difference in depression for those over 65 is cognitive (ability to know or perceive) impairment. In older people, cognitive impairment that is induced by depression is more obvious because they may already have some impairment caused by aging or degenerative illnesses. It is rarely seen in younger depressed people because they have greater reserves of cognitive capacity. Cognitive impairment with depression is often referred to as pseudodementia or depression with dementia. In this respect, insight is important; demented patients lack such insight.
Older depressives also have a higher level of hallucinations and hypochondria (abnormal anxiety over one’s health, often with imaginary illnesses.)
Reasons for depression in seniors
There are a number of potential explanations for depression in elderly people. First, there are the normal aging process changes:
Both serotonin and nor-adrenaline are reduced in the aging brain. These regulate mood, along with dopamine levels that also change with age.
Diseases common in older people form another group of conditions in which depression can appear: heart attacks, chronic lung disease, arthritis, hypothyroidism and vitamin B-12 or folate deficiency.
Hypothyroidism has symptoms similar to depression and this condition is easily missed. But antidepressants won’t work in this case.
Vitamin B-12 deficiency is common in those who don’t eat well and many older people suffer from malnutrition. Some drugs interfere with the body’s ability to absorb B-12. For example, if the patient is taking Prilosec, vitamin B-12 will not be absorbed well.
Estrogen deficiency, such as the natural decline at menopause, can also cause depression.
Depression is very common in people with dementia. Studies have shown that treating the depression actually can improve the patient’s ability to perform normal daily activities.
Cancer patients are frequently victims of depression. Some cancerous tumors secrete a substance that cause changes in mood and the side effects from treatment can be devastating emotionally, mentally, as well as physically.
The following drugs have been linked clinically with depression in elderly people: beta blockers, other antihypertensives, digoxin, L-dopa, steroids, benzodiazepines, barbiturates and major tranquilizers.
Finally, life events in the elderly, particularly serious financial or health problems, can have a major influence on the emergence of depression.
Seniors’ Depression Not Treated
Most of the nearly two million elderly Americans who suffer from severe depression are not treated, according to the National Institute of Mental Health.
Left untreated, depression has major implications for older people, whose rates of suicide were more than five times the national average.
“Depression often goes undetected because few people recognize that it is a real, common and diagnosable illness that can be effectively treated,” said Michael Faenza, president and CEO of the National Mental Health Association.
Over all, 19 million Americans experience depression each year, but the nation’s senior citizens are the hardest hit. Only 10% of the elderly with depression receive treatment, Faenza said.
“The elderly represent a population where the hidden symptoms of depression can unfortunately be even further hidden behind other illnesses that commonly occur with increasing age,” Faenza said.
Symptoms of Depression and Mania
Depression
-Persistent sad, anxious, or “empty” mood
-Loss of interest or pleasure in activities, including sex
-Feeling of hopelessness, helplessness
-Sleeping too much or too little, early-morning awakening
-Appetite loss or weight loss or overeating and weight gain
-Decreased energy, fatigue, feeling “slowed down”
-Thoughts of death or suicide or suicide attempts
-Restlessness, irritability
-Difficulty concentrating, remembering or making decisions
-Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders or chronic pain
Mania
-Abnormally elevated mood
-Irritability
-Severe insomnia
-Grandiose notions
-Increased talking
-Racing thoughts
-Increased activity, including sexual activity
-Markedly increased energy
-Poor judgment that leads to risk-taking behavior
-Inappropriate social behavior
A thorough diagnostic evaluation is needed if five or more of these symptoms persist for more than two weeks or if they interfere with daily activities or
family life. An evaluation involves a complete physical checkup and
information-gathering on family health history.
Depression Can Be Life Threatening
Depression is a serious illness that often leads to premature death. Suicide is one result of untreated depression and is particularly common among elderly people. Among people over 75, for example, 60 to 75% of suicides have diagnosable depression.
More than 80% of people who are depressed respond quickly and positively to treatment. However, in a survey of over 1,200 U.S. men and women, nearly two out of three people with depression reported waiting at least four years before seeking treatment. Common barriers to treatment include denial, shame, lack of money or insurance and fear.
Advice for Caregivers About Suicide
Living with a person who is severely depressed or is expressing suicidal thoughts creates fear and feelings of helplessness for the caregiver. Many of us feel that if we only try harder, do more, love more that we can make “it better.” But this is a time to get help from a mental health professional.
Caregivers may also benefit by attending a support group or getting one-on-one counseling. This can help you understand the limitations for helping and to share your feelings with others. It is essential to be able to separate yourself from your loved one’s wanting to die, you should understand that you can hold them, but not save them. Even mental health professionals cannot take the responsibility for preventing a suicide.
It is essential that caregivers take warnings seriously and get help as soon as possible. Treatment for depression or hospitalization of the suicidal person to prevent them harming themselves is usually successful. Caregivers and family members need to work closely with the mental health system to become educated about treatments and expectations for the future.
Getting a mental health referral
Contact your insurance company. If you do not have insurance, contact your local suicide hotline. In an emergency, call the police or 911.
What You Can Do
-Accept and listen. Listen but do not lecture. Accept what is said and take it very seriously. Individuals may use various terms or express themselves in muddled ways, about taking their own life, such as: I wish I could go to sleep and never wake up; I want to see my mother again; The family would be better off without me; I can’t live any longer without...
-Talk openly and honestly. There is stigma and shame attached to suicide and your loved one needs to know they can talk to you openly. This will also help you determine if they have a plan so you can pass the information on to their mental health professional.
-Do not preach or moralize. Suicidal people know already that killing themselves is considered wrong by society’s standards; they do not need to hear it from a loved one.
-Talk about feelings and focus on the person and the problem. Talking about feelings with a suicidal person lets them know that someone understands the pain they are in, the hopelessness and helplessness that they feel.
-Help the person focus on solutions. Talk about how they have coped in the past. Help them increase their understanding of the alternatives to suicide. Evaluate and talk about what is needed to improve the situation.
-Follow-up. Do not try to handle the situation on your own! Seek professional mental health help. Ongoing treatment is essential. Learn the signs and symptoms of relapse and what you can do and what your loved one must do.
-Remember special occasions. If your loved one has made attempts on special dates (birthdays, anniversaries, etc.), tell the mental health professional and arrange for family or friends to provide social support.
-Take care of yourself and deal with your own feelings.
Interventions for critical times
-Verbally contract with your loved one (both make a promise) to talk if he or she is feeling suicidal. Or the contract can be to call a mental health professional, police or suicide hotline (1-800-SUICIDE) if they are thinking of killing themselves.
-If there is a firearm in the house, get rid of it. Many police and sheriff offices will secure weapons. You will still own it and can access it, but law enforcement will house it for you.
-If overdosing on medication is a concern, lock it up. If you do not have a locked closet, buy a locked cash box and hide it out of reach.
Caregiver Support
Caring for someone who is feeling hopeless and is suicidal, in addition to his or her other needs, can be overwhelming. The stresses of caregiving cause mental and physical distress ranging from severe anxiety and depression to debilitating aches and illnesses. These feelings spring from the strain of never knowing what may happen. The strain becomes commonplace and makes it very difficult to maintain normalcy in life for your loved ones and yourself. One caregiver describes it as “walking on eggs all the time,” another says “No matter how hard I try, I can’t go back to what life was before.” Get in touch with your feelings---they are normal. Talk to other caregivers, they understand.
Remember local Crisis Lines and Samaritan Hotlines have someone you can talk to 24 hours a day, seven days a week.
Reprinted with permission of Family Caring, Inc. d/b/a Boomerang. Provider, product and third party service referrals are suggested based upon apparent needs. These suggestions are not recommendations nor are they direct or implied endorsements and are not intended to replace clinical advice or health care professional services. Copyright Boomerang 2001.
Warning Signs of Suicide
Suicide attempts are cries for help and extreme expressions of helplessness. Seventy percent of all the people who have talked with someone about killing themselves actually make an attempt. Eighty percent of people, who complete the attempt, have given warning signs to the people around them.
The following are some of the symptoms to look for in a suicidal person. These may also be symptoms of depression, which is commonly associated with suicide:
-Sleeping more or less than usual
-Eating more or less than usual
-Very tired and slowed down
-Having persistent headaches, stomach aches or chronic pain
The following feelings are also closely associated with suicidal ideation:
-Talking about being guilty or worthless
-Expressing that no one loves him or her or life is not worth living
-Feeling restless or irritable
-Expressing that they do not enjoy things the way they used to
In studies of death by suicide, researchers have found the following criteria can put a person at higher risk for suicide:
-Previous suicide attempts
-Family history of suicide, abuse or violence
-White male over 60
-Little or no support system, particularly of family or friends
-Severe life stressors and feeling helpless about a situation
-Alcohol, medication or drug abuse
-Owning a firearm
Websites About Suicide
American Association of Suicidology www.suicidology.org
American Foundation for Suicide www.afsp.org
Substance Abuse and Mental Health Services Administration www.samhsa.gov
The National Association for the Mentally Ill www.nami.org
Crisis Hotlines nationwide www.metanoia.org
E-mail chatting with a counselor and telephone numbers for Samaritans Befrienders International worldwide. www.befrienders.org
Websites for the Suicidal Person
www.metanoia.org Lists telephone numbers for crisis lines nationwide
www.befrienders.org Provides email chatting with a counselor and telephone numbers for Samaritans Befrienders International
www.yellowribbon.org For children and teenagers
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