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Keep that mental outlook healthy

© St. Petersburg Times
published May 28, 2002

I'm always fascinated with the fine-tuning of our bodies. There's no denying that our physical, emotional, mental and spiritual selves are tied in together, making for a well-orchestrated being. Things can affect any part of the orchestrated piece, but all the parts rely and react on each other.

But sometimes we need help and assistance to keep everything in tune. If one of our biological parts is not working well, we discuss it, go for help to the doctor and take the prescribed medicine. For example, many of us wear contact lenses or glasses to correct our vision. Many wear pacemakers when their hearts are not performing efficiently.

We know we can't expect heart conditions or blood pressure problems to improve without the help of medications. And when a diabetic's pancreas is not producing enough of the chemical insulin, we can't expect it to adjust or correct itself without being kept under control with insulin, diet and exercise.

Just as we can discuss these physical illnesses, we ought to be able to talk about our brain and the fact that sometimes it doesn't produce the right amount of the natural chemicals it needs.

All of us, at one time or another, have felt the blahs or been down in the dumps or blue, especially when we react to a specific incident such as having to make a change, having a bad day, being disappointed or feeling ill.

Certainly, not all of us who feel temporarily down or situationally depressed need treatment. Sometimes we can change our mood by taking a walk and exercising, visiting friends, working in the garden or doing something else we enjoy.

But when the mood we're in becomes persistent, lasting longer than two weeks, it could be that clinical depression has set in. It's then time to seek help and tell your physician about these negative feelings and how long this mood has been going on. Family caregivers and older people need to know how to recognize depression and how to get help and help themselves as well.

Depression, which stems from a biochemical process, affects people of all ages and is more common than many think it is. May is National Mental Health Month, and it is important for all of us to realize that depression affects more than 20-million people in this country and more than 6-million individuals over the age of 65.

Older people and their caregivers can suffer. Also, close to 14 percent of teenagers are affected by it and 3 percent of children under the age of 13. Frequently it is unrecognized by family and friends and is overlooked, undiagnosed and untreated by physicians.

Last month I had lunch with a friend and colleague who surprised me by saying that he had been seriously considering early retirement and had started the process. It surprised me because he had been so effective in his career and the work he had been doing.

As I listened I didn't see any enthusiasm or joy in the pronouncement of his decision. He actually looked sad. He didn't talk about making plans for his future, but actually appeared to be in the doldrums. He informed me that he wasn't feeling too well and felt he had lost interest in what he was doing and thought he had better move on. He definitely had lost his zest for life, and I was very concerned.

Over lunch for the next few weeks, he talked freely about the past year. I knew he had lost a young son to suicide, plus he had been recuperating from surgery. He came to realize that he might be making decisions born of depression and took his concern to his physician. Depression in his life was set off by a combination of loss and illness. Proper medication brought life back.

The really good news is that depression is a treatable biological disorder. This news is one of the major breakthroughs in medicine, but in order to benefit from therapy you first have to realize that you might be depressed and then seek help.

Another important piece of good news is that, contrary to popular belief, depression is not a normal, natural aspect of aging. As we age, we don't need to expect to be sad -- suffering with a helpless feeling and "not feeling like ourselves." We need to pay attention to how we feel.

When you or your loved one is depressed, you can't "get moving," "take control," "get up and do something" or "snap out of it." The depression won't go away by itself because it comes from a biochemical process we can't control. Early diagnosis is important because prolonged depression can interfere with the functioning of the immune system, causing susceptibility to infection or other illnesses. It can lead to tragedy if left untreated.

It's very important that we put aside the ignorance, denial and stigma that have persisted through the ages. Just the other day a woman told me she was on medication for depression and felt "ashamed."

I find that our individual attitude toward depression is dominated by this stigma, which can prevent people from seeking help. Older people are greatly influenced by centuries of hiding it, and the shame associated with any disorder of the brain, as if depression were a failure of will or a character deficiency. As the same woman told me, "I'm not crazy; I'm just sad!"

Fear of emotional disability continues, as if the brain were not part of our biological makeup and never needs medical attention. In addition to seeing your physician, there are many new avenues of help available.

One such program that has been in existence for five or six years is headed up by George Perlin, who supervises the partial hospitalization program at Morton Plant Hospital. It's an intensive therapy day program which runs from 9:30 a.m. to 2:30 p.m. Monday through Friday for four to six weeks.

He said, "This program is the future of psychiatry. It's completely a 100 percent voluntary program: People have to want to come to the program. They come into it because they have recognized their need for help or they have been referred by a primary physician or a psychiatrist.

"The partial hospital program is for adults of any age, 18 up to the older adult." He explained that it's a comprehensive program in which counselors work with people who are depressed, have marital or family conflict, or who are abusive, alcoholic or have a bipolar disorder. Health insurance companies are more involved with the partial hospital program because it's so much more cost effective when compared to in-patient hospital care.

"This program not only provides many benefits and advantages to insurances and managed care but to the individual, because they're able to see the psychiatrist each week, they don't have to be hospitalized, it's paid for by Medicare and other insurances, and it's a personal program of intensive therapy. There is also a followup program of after care in which the individual sees a a counselor once a week. This is different from the typical "stabilize in the hospital, get released and only see the psychiatrist once a month" routine.

"We have a highly successful program -- 95 percent do get better," Perlin said. The program measures the depression-anxiety level before the program, and it's compared upon completion.

Studies have shown that cognitive behavior therapy, which focuses on teaching coping skills and new ways to deal with stress and sadness, such as changing negative attitudes and unrealistic or highly negative ways of thinking, can be as effective as medication. It's always best to see your primary-care physician before going into treatment.

It's essential that we, as adult children, retirees, family caregivers and friends, learn how to tell whether someone is depressed. Recognize the symptoms:

You feel downhearted most of the day with a sad, empty feeling.

Your sleep patterns have changed; you have insomnia or sleep too much.

Your concentration or memory is affected.

You are experiencing a loss of appetite and loss of weight, or you overeat.

You are disturbed, irritable, very sensitive, full of worry or agitated.

You're uninterested and withdraw from activities that always gave you pleasure.

You feel unmotivated, worn out, listless, with little energy, not able to function, fatigued.

You feel worthless and have inappropriate guilt feelings.

You have multiple complaints of aches, pains, stomach problems or headaches that don't respond to treatment.

You cry excessively or have thoughts of death or suicide.

No matter our age, we must learn to talk more openly with doctor, family and friends. Open discussion of feelings and reaching out for help can turn a crisis into an opportunity for growth and perhaps save a life.

Remember, caregivers make the present moment count!

Ethel M. Sharp is executive director of Aging Matters Inc., a nonprofit network for family caregivers and elder care. You can write her in care of Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731. When seeking more information, please enclose a stamped, self-addressed envelope and include your telephone number, with area code.

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