Anxiety and depression are among the most common conditions treated by physicians. When I was in my training years ago, depression was called “the common cold” of geriatric medicine. Interestingly, the prevalence of these conditions is quite high in the general population as well. Age-related issues such as retirement, loss of a spouse, change in living environment, and medical problems can trigger adverse effects on mood. Most of us will occasionally get “down in the dumps” or transiently stressed, but if the symptoms persist, professional help is necessary. The good news is that help is available!
I welcome your questions related to anxiety, stress, and depression.
Q: Steve, OK - Are the antidepression medications good in decreasing pain?
A: Dr. O'Neil - Yes, some are. Drugs like Elavil have been used in low dose to reduce nerve pain from Diabetes. Another effective anit-depressant called Effexor has also been used for nerve pain. We have to be careful with some drugs like Elavil in the elderly due to potential side effects.
Q: Camilla, PA - Mom is 83 and her husband (Dad) passed away a little more than a month ago. She is now staying with me and my husband and has some health issues. I can not always tell if she is griving or depressed or has health issues (a small infection and COPD). She just sleeps, doesn't want to go out and hardly eats. My question is... when she said "I just dont' want to live anymore, maybe I shoudl die too" what should my response be ?
A: Dr. O'Neil - I would suggest that you speak with your moms' doctor and get a referral to a psychologist or psychiatrist-clearly she needs some help dealing with her grief. I really think it is a good idea for anyone who has lost a spouse to have grief counseling especially during the first 3-6 months after the loss.
Q: Dom, FL - With acupunture being more and more accepted by the medical profession as a form of relief when will Medicare start recognizing it for a covered medical expense? Chiropractic at one time was in a similar situation but now Medicare accepts it with certain limits.
A: Dr. O'Neil - The Center for Medicare and Medicaid Services bases their funding on the findings of research and efficacy. I am confident at some point in the future, Medicare will recognize accupuncture as a legitimate procedure and eligible for reimbursement for certain conditions.
Q: Amanda, FL - Can depression be genetic?
A: Dr. O'Neil - Yes, there has been evidence that depression may run in famlies. Many physicians feel there may be a biochemical basis for depression.
Q: Lauren, TN - I read that some people reported feeling less depressed if they ate Brazil Nuts each day. Is it possible that this actually works?
A: Dr. O'Neil - We do know that nuts have certain health benefits because they are high in Omega 3 fatty acids and proteins. Many physicians now recommend the Mediterranean diet along with a handful of mixed nuts. Also a good source of vitamins-there is some evidence that Vitamin D may have a positive effect on mood. Good sources of Vitamin D are fifteen minutes of sunshine, milk products, and fish.
Q: Kim, AZ - Some reports seem to link recurring depression to dementia later in life. Is there a connection, and why?
A: Dr. O'Neil - There is no evidence that Depression per se causes dementia. However, some people that are depressed may have the same signs and symptoms of dementia-there may be memory impairment, etc. An evaluation is important to make a proper diagnosis.
Q: Ken, NJ - I heard playing video games is good for your brain but I get tense as the game speeds up. Is this type of stress bad for me?
A: Dr. O'Neil - Transient situational stress is not physically harmful in most cases. Chronic stress is what we need to avoid. So keep playing!
Q: Carolyn, MA - My child went from being an achiever to doing nothing. What makes a child between the ages of 12-14 get depressed?
A: Dr. O'Neil - There may be a multitude of reasons why an adolescent may get depressed. First, an appropriate physical examination to exclude any medical causes would be very important. Adolescence itself is an unsettling time with hormonal, psychological, and social changes occurring. Teens sometimes experiment with drugs, alcohol, or sex which can have some adverse effects. Make sure your child is evaluated by a professional.
Q: Sarah, IL - Many seniors seem unwilling to discuss depression or taking anti-depressant medications - any suggestions for getting the conversation started?
A: Dr. O'Neil - Yes-I often approach this from a "wellness" perspective. A question to ask is "Do you feel happy most of the time"? If the answer is no, then the next question should be, "Why not"? Many older adults consider depression a weakness, reassuring them that this is a common problem and very treatable is important.
Q: Neil, MA - How does someone know when they're depressed?
A: Dr. O'Neil - Great question Neil! Depression in older adults can be difficult to diagnose since crying spells or feeling down in the dumps may not be common. Complaints such as tiredness, memory difficulties, and headaches may predominate—which of course can be seen with other medical conditions. Doctors use screening questions such as the Geriatric Depression Scale to determine if depression is present. Occasionally other tests may need to be done if another disease process is suspected.
Q: Judy, MA - What can I do to help someone close to me who is battling depression?
A: Dr. O'Neil - Being a good listener is important, encouraging your friend to stay socially engaged, physically active, seek professional care are all important steps to take in being supportive to someone who is depressed. Learn all you can about depression and proper management.
Q: Anna, IL - What is biochemical depression?
A. Dr. O'Neil - Anna-we know that in some cases, depression is related to depletion of certain brain chemicals such as serotonin, in fact one of the classes of anti depressants we use to treat depression, inhibits the break down of serotonin. These drugs include Prozac, Zoloft, Paxil, and Effexor.
Q: Holly, WI - As we age, what are some things we can incorporate in our lifestyle to stave off depression later in life?
A: Dr. O'Neil - Great question Holly! There are certain things that we have control over-such as our lifestyle. It is shown that regular physical activity can increase endorphins, which is not only a pain reliever, but a "feel good" hormone. In addition, exercise can help preserve the brain levels of serotonin. Getting a good nights sleep is important, a well-balanced diet can ensure that we are getting adequate levels of Vitamin D, also continue with social engagement and interaction with others, spiritual lives can help provide a sense of hope and comfort. Volunteering can heighten our sense of purpose and meaning.
Q: Rita, NY - My mother is 85 and appears to me to have symptoms of depression but she refuses to admit it. And even if she did admit it she has always had the conviction that meds are not the answer and would never knowingly take anything for it. Any suggestions?
A: Dr. O'Neil - Rita-your mother is not unusual. Some cases of depression may respond to individual or group counseling, exercise, and social activities. Regular exercise has been shown to have a favorable effect on brain chemicals that can help alleviate depressive symptoms. However, more severe depression is associated with biochemical disturbances in the brain and thus nearly always requires treatment with medications.
Q: Bridget, AL - How can talking to someone possibly help you to get over being depressed?
A: Dr. O'Neil - Sometimes mild cases of depression may respond to talking with friends and family. However, nearly all cases of severe and chronic depression require professional intervention.
Q: Anna, IL - When I feel really stressed out, what can I do to relax?
A: Dr. O'Neil - Here are some good “stress busters.” Do regular physical activity such as walking, swimming, and bicycling. Nature walks and beach walks can be very calming. Eat a well-balanced diet. Limit consumption of alcoholic beverages. Take time to meditate and be grateful. Stay socially engaged. Join or start a humor club. Maintain a positive attitude. Practice positive self-talk. Do something to help others—it helps take the mind of our own problems.
Q: Maria, OH - Several friends of mine would have sudden crying spells for months after they had heart surgery. Is that depression or something else?
A: Dr. O'Neil - Spells of depression can be quite common after heart surgery or other major sugeries or illnesses. Dealing with something that makes us confront our own mortality can be difficult. If crying spells are persistent or associated with other symptoms of depression are present, a professional should be consulted.
Q: Harriet, MO - Is it dangerous to ask a depressed friend if they're thinking about suicide?
A: Dr. O'Neil - The highest rates of suicide are still in older adults, especially in Caucasian men who are divorced, seperated, or live alone. Severe depression is the leading cause. I would suggest that you get your depressed friend to a medical professional who can ask the appropriate questions to determine risk and treatment.
Q: Cora, RI - I don't like most of the treatments for depression. If I can function is it harmful to me to just live with my depression when it gets bad?
A: Dr. O'Neil - Cora, there is some evidence that chronic depression may have some harmful health consequences, however if the spells that you have are short-lived, then I would encourage you to initiate the lifestyle actions as I have mentioned in the previous answers(exercise, social engagement, etc).
Q: Anna, IL - What is bi-polar disorder? Is it regressive?
A: Dr. O'Neil - Bipolar disorder was previously known as "Manic-Depression". During the manic phase, the individual may have hyperactivity, grandios delusions, racing thoughts, sleep deprivation etc. The manic stage is then followed by depression state. Bipolar disorder requires life long medication.
Q: Martha, VT - I get depressed just about every February. My friends tell me I need to snap out of it. Any advice on what I can say to them without it sounding like I'm whining?
A: Dr. O'Neil - Martha, I see you are from Vermont-since this is happening in February, might this be Seasonal Affective Disorder? This may respond to light therapy. You may want to discuss this with your doctor as simple treatments are often very effective.
Q: Millie, OK - My doctor put me on a new drug for my blood pressure. Now for the first time ever I've been depressed. The drug is the only thing that's different. Is it possible that the drug is making me feel like this?
A: Dr. O'Neil - Yes. There are a number of drugs that can have an effect on mood. It is important to let you doctor know about this and perhaps an alternative medication could be considered.
Q: Anna, IL - Does bi-polar illness affect cognition negatively? Does it affect hormones?
A: Dr. O'Neil - Because Bipolar Disorder is often associated with sleep deprivation, it can affect concentration, memory, and focus. However, with appropriate treatment, cognitive status should be normal.
Q: Brenda, UT - When my best friend is depressed she listens to sad music and watches sad movies. Should I try to get her to do happier things?
A: Dr. O'Neil - Yes, try to get your friend out to interact with others socially, go for walks and get more physically active. And if she is feeling down, practice positive self-talk. You may want to recommend a book to your friend, by Dr. Shad Helmstetter, called "What To Say When You Talk To Yourself".
Q: Sara, IL - Is Shock Treatment still done?
A: Dr. O'Neil - Electroconvulsive therapy (ECT), better known as shock treatment, is actually a very effective treatment for major depression with success rates approaching 90%. Despite its detractors, ECT is relatively safe. In severely depressed persons where medical therapy has failed or not been satisfactory or when suicide risk is high, ECT is the treatment of choice since serious consequences could result from waiting several weeks for medications to take effect.
Q: Dorothy, IL - Can medications cause depression?
A: Dr. O'Neil - Some medicines such as digitalis, beta blockers such as propanolol, and tranquilizers such as Valium have been associated with depressive symptoms. If a medicine is suspected of causing these symptoms, it should be carefully withdrawn and an alternative found. Valium is one of many medicines that should seldom if ever be used in older adults since it frequently causes undesirable side effects.
Conclusion: Dr. O'Neil - Thank you so much for the wonderful questions today. I hope you found this information on mental health issues helpful. I look forward to being with you on May 14th at noon CDT for the blog focused on "Nutrition-Food for Thought".
Best wishes for an Optimum Life!
Dr. Kevin