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Depression in Seniors is Often Unnoticed

depression uptown dallas counseling

Family members and even primary healthcare providers often mistake an older adult’s symptoms of depression as just a natural reaction to illness or an unavoidable part of the aging process. Older adults themselves often share this belief and suffer unnecessarily because they don’t understand that they could feel better with appropriate treatment.

Statistics on Mental Health and Seniors

Recent data indicate that an estimated 20.4 percent of adults aged 65 and older met criteria for a mental disorder. (Karel, Gatz & Smyer, 2012). The CDC’s 2013 report on The State of Aging and Health in America identified “addressing mental distress among older adults” as one of its primary Calls To Action needed to improve the health and well-being of older adults.  The CDC estimates:  About 25% of adults aged 65 years or older have some type of mental health problem, such as a mood disorder not associated with normal aging. Mental distress is a problem by itself, and it has been associated with unhealthy behaviors than can interfere with self-management and inhibit recovery from an illness.  

How Can we Help Change these Statistics?

Talking to seniors about their mental health can be challenging. Family members, caregivers, and even many medical professionals are not trained to assess mental disorders.  Conversations can be awkward.  Seniors are often reluctant to talk about their symptoms.  

The most common mental disorder among older adults is depression.  Depression, once diagnosed, often responds quickly to treatment.  Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. If left untreated, however, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life. 

If you suspect an older adult has depression, there is an easy, direct way to talk with them about their symptoms.  The Geriatric Depression Scale (GDS) is a reliable 15-question assessment that anyone can use.  Ask the senior to answer the following questions:

Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO

Answers in bold indicate depression. Score 1 point for each bolded answer.
A score > 5 points is suggestive of depression.
A score ≥ 10 points is almost always indicative of depression.

Source: http://www.stanford.edu/~yesavage/GDS.html
This scale is in the public domain.

Any score greater than 5  warrants a follow-up assessment by a medical professional. If your senior scores higher than 5, help them schedule an appointment to discuss the results and form a treatment plan with a healthcare provider.

If you or someone you care about is in crisis, please seek help immediately using one of the following methods:

  • Call 911
  • Visit a nearby emergency department or your health care provider’s office
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Sources: 

Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

Karel, M. J., Gatz, M. & Smyer, M. A. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67, 184-198.

Lyness JM, Noel T, Cox C, King DA, Conwell Y, Caine ED. Screening for Depression in Elderly Primary Care Patients: A Comparison of the Center for Epidemiologic Studies—Depression Scale and the Geriatric Depression Scale. Arch Intern Med. 1997;157(4):449-454. doi:10.1001/archinte.1997.00440250107012.

U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Mental Health. (2015).
Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S.
Government Printing Office.

 

 

Cognitive Behavioral Therapy and Cognitive Restructuring

CBT uptown DallasCognitive Behavioral Therapy (CBT) is based on the theory that our Thoughts, Emotions, and Behaviors all impact each other.

During therapy, the client learns how to identify distorted thinking patterns.  The client then learns the connection between distorted thinking and her emotions and behaviors.   By making changes to distorted thinking, the client experiences changes in feelings.

 

A CBT therapist teaches clients techniques to make theses changes.  Cognitive restructuring is a key technique of CBT therapy.  Dr. Aaron Beck, the founder of Cognitive Therapy, talks about cognitive restructuring techniques.

CBT Uptown Dallas Counseling

Dr. Aaron Beck, founder of CBT

Symptoms of Depression & How Talk Therapy can Help

symptoms of depressionWhile the number of suicides is at its lowest in December, the number of people who report symptoms associated with depression is at its highest.  During the holidays, many of my clients report new symptoms of depression, including:

  • Fatigue and decreased energy
  • Inability to make decisions
  • sadness or unhappiness
  • Irritability or frustration, even over small matters
  • Loss of interest or pleasure in normal activities
  • not wanting to be around other people
If you begin to experience any of the above symptoms or think you may have depression, talk therapy can be helpful, especially Cognitive Behavioral Therapy (CBT).  If you are not familiar with CBT, you can read about the basic premise for treating depression, anger, and anxiety using CBT in this Post.

One of the most common issues my clients struggle with during the holidays is that of managing expectations about people, events, and feelings. Many people have beliefs about the holidays that are simply not true, such as:

It is the best time of the year.
Everyone will show their love for everyone else.
Family will all gather together and feel only joy.
Carefully chosen presents will be appreciated.
My partner is going to give me that gift I have always wanted.
I am going to love going to 12 cocktail parties.
I have to eat and drink all that is offered.
I am going to use this family time to “fix” all our problems.
I can get by with only 4 hours of sleep.
This tree and my decorations are so fabulous, everyone will know and appreciate how hard I worked.
It is OK to stay up until 3:00am on a work day, because I have to have 4 dozen decorated cookies.
My child will not be able to survive if she does not get DaisyDoItAll Doll.
Everyone else is going to parties every night, I am only invited to one.
I lied to my friend and told her I was busy the night of her party, now I feel guilty.
Why is everyone else have such a great time, and I am miserable?  What is wrong with me?

This list goes on and on.  What are your expectations for the holiday time?  Do you share any of the above beliefs?  Your therapist may be able to help you see the connection between these unreasonable expectations and your symptoms of depression.

symptoms of depressionSome things you can try to help prevent falling into the holiday depression cycle are:
Plan ahead, make a schedule.
Only say “Yes” when you want to say “Yes”. Be okay with saying “No”.
Get your regular number of sleep hours each night.
Let go of Perfection, you can buy cookies at the store, eight strands of lights on the tree are enough.

Prepare a neutral response to conflictual situations, especially with family members.
Don’t expect anyone to behave in a way significantly different from the way they behaved last year, the holidays are not a good time to do a family “intervention” or “rescue”.
Don’t expect a partner of friend to be able to read your mind and deliver the perfect gift.
Create activities that you truly enjoy, even if they are outside your usual holiday traditions.

Challenge yourself to set realistic goals for your holiday time.  Remember, there will be things that do not go as planned.  Try to enjoy the good times.

Songs and Family

songs family happy sadNPR’s Robin Hilton posted a question asking readers to think about songs and family.  She asks them to name a song that describes your family.  So many people responded with great ideas.  Here is her Question:

Question Of The Week: What Song Describes Your Family?
by ROBIN HILTON
November 18, 2013 5:31 PM
We need some help putting together next week’s show. Thanksgiving is coming up, and for a lot of you, this means you’ll be spending some close time with family. Maybe it’s more time with family than you want. Or maybe you can’t get enough of it. Either way, it’s an opportunity to reflect on the people in our lives and how they’ve shaped who we are.  This is where you come in. Tell us about a song that describes your family. It can be a happy song or sad, a literal or not so literal one. Whatever reminds you of your family. Tell us about the song in the comments section. 

Some of my favorite responses are:
Born to be Wild
You Can’t Always get what you Want
Why Can’t we be Friends?
Wizard of Ozsongs and families

What songs describes your family?

You can read and share your own thoughts here.

Convoy of Hope – TYPHOON RESPONSE

convoy of hopeIf you are looking for a way to help the people affected by Typhoon Haiyan in the Philippines, please consider donating to Convoy of Hope.  In the video below, Hal Donaldson, president of Convoy of Hope, reports from their command center in the Philippines about the work they have already done in the community.
Convoy of hope

You can follow an up-to-the minute report of their work with the survivors on their

For other ideas on how to send your support, I also like the recommendations from the folks at Rewire Me in their post, Join Us in Helping Typhoon Haiyan Victims

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Life Goals: Are They Actually Distractions?

Your audacious life goals are fabulous. We’re proud of you for having
them. But it’s possible that those goals are designed to distract you
from the thing that’s really frightening you—the shift in daily habits
that would mean a re–invention of how you see yourself.
—Seth Godin
life goals and distraction
One of my favorite writers is Seth Godin, and I particularly this idea.  Do you think your goals are actually distractions?

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Benefits of Sleep: it Cleans your Brain.

A new study from National Institutes of Health on the benefits of sleep shows sleep may actually clean the brain. Scientists have recently discovered a process by which the brain actually flushes toxins out of spaces between cells.  We are not yet sure of the significance of this information, but it may help explain why sleep and mental health are so closely related.  A summary of the study here, explains some of the findings.

benefits of sleep

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Controlling Emotions: Is it possible?

This discussion about controlling emotions compares two different women’s reactions to the same event.

 

First Woman’s Reaction:  Take a Picture

controlling emotions

From Hannah Price’s collection, City of Brotherly Love

When photographer Hannah Price moved from Colorado to Philadelphia, she began to experience something new to her – catcalls from men on the street. After several catcalling episodes, she decided to take action.  She would either snap a photo of the man immediately; or she would talk with him about the incident, and then ask if she could make his portrait. Ms Price created a project called “City of Brotherly Love” from these photographs.

Ms Price states her project is not meant to be an aggressive rebuttal to the individuals in the photos. It is, she states, “just a way of trying to understand it. It was way for me to just deal with it on another level besides avoiding it. Sometimes it’s easier to … just respond….. you just start talking to people, you find out more about them than your initial [impression].”

To see the complete 17-photo collection, see the NPR blog post of Code Switch by Kat Chow.

Second Woman’s Reaction:  Send a Message

controlling emotions

Tatyana Fazlalizadeh’s original posters on Tompkins Ave. in Bedford-Stuyvesant, Brooklyn. (Stephen Nessen/WNYC)

Brooklyn artist Tatiana Fazlalizadeh’s response to her experiences in Brooklyn is very different from Ms. Price’s response with the photography project. She created posters with direct negative messages to the catcallers and posted them around her neighborhood.  Ms Fazlalizadeh states she can’t walk down her street without getting catcalled or harassed. “It happens almost daily to me where I get frustrated or annoyed or upset by something that someone has said to me or done to me outside on the street.”

Ms Fazlalizadeh used her posters to try and rally the neighborhood around her efforts to stop the cat-calling.  She hopes that by calling attention to the negative effects of this behavior, the men will change.

controlling emotionscontrolling emotions

Why the Difference?

Why does one woman feel okay to take photos and even have a conversation about the experience, and another woman feel anger and frustration?  Our individual responses to catcalls are a result of our thoughts about the experience. If we think: “wow, someone thinks I’m cute.”, “I still have it”, or “this is going to be a good day”, our response may be:  happiness, a big smile, a skip in our step, better posture.

If we think:  “that reminds me of my abusive former boyfriend”, “will he try to come after me?”, “they must think I am promiscuous”, our response may be:  fear, increased heart rate, hunched posture, a frown, anger.

I am not expressing approval of the long-standing phenomenon of men yelling things to women in public places.  My writing about this behavior is focused on the difference in the two responses, not a right or a wrong response.  I believe this is a perfect example of the Cognitive Model theory in action.  The theory is:
Our THOUGHTS about a SITUATION create our REACTIONS, which are EMOTIONAL and PHYSICAL.   In Cognitive Therapy, we focus on our THOUGHTS.  A few of the questions we may ask in therapy about our THOUGHTS are:
What are they? Are they true? How much do we believe them? How do we change them?  
 
Through training and practice, you can learn to control or change your thoughts that create negative reactions.  This type of training has been shown through extensive scientific testing to be an affective way to treat depression, anxiety, OCD, PTSD, and other mental health challenges.  My opinion on catcalling is that, for so many women, the experience generates extremely negative feelings; therefore, I do not like the behavior.  For further information and discussions on ending street harassment see Hollaback!.
Sources:
Stephen Nessen : Reporter, WNYC, Not Taking it Anymore: One Woman Talks Back to Street Harassers, Friday, April 19, 2013
Newshttp://www.wnyc.org/story/282239-not-taking-it-anymore-one-woman-talks-back-street-harassers/

Kat Chow, A Photographer Turns Her Lens On Men Who Catcall, October 17, 2013.

http://www.npr.org/blogs/codeswitch/2013/10/17/235413025/a-photographer-turns-her-lens-on-men-who-cat-call?utm_content=socialflow&utm_campaign=nprfacebook&utm_source=npr&utm_medium=facebook

 

Treating depression in Cancer Patients

 

treating depression in cancer patientsCecelia Gittleson writes in Memorial Sloan-Kettering‘s Cancer Center newsletter about the importance of diagnosing and treating depression in cancer patients.  She discusses sources of support for patients, survivors, and their caregivers.

Ms. Gittelson quotes a physician who specializes in the psychological treatment of people with breast cancer and their families on the importance of psychosocial support, “We’ve learned that depressed people generally do less well in the oncology setting,” explains Memorial Sloan-Kettering psychiatrist Mary Jane Massie. “This is probably due in part to the fact that because they feel bad — psychologically, physically, or both —they decide it isn’t useful to take their medications. And there can be a domino effect: They stop filling their prescriptions and may even start to miss medical appointments. But there is a lot of help available.”

I encourage anyone who is struggling with a cancer diagnosis, no matter which stage of treatment, to reach out to a mental health professionals.  Ms. Gittelson’s article and her recommendations for sources of support are here.

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Postpartum Depression: Tragic Consequences

Did Miriam Carey have Postpartum depression?

postpartum depression

From CBS News: Emergency personal help an injured person after a shooting on Capitol Hill in Washington, Thursday, Oct. 3, 2013. Police say the U.S. Capitol has been put on a security lockdown amid reports of possible shots fired outside the building. (AP Photo/ Evan Vucci) The small photo comes from what is believed to be the Facebook page of Miriam Carey, who according to multiple police sources, allegedly led authorities on a car chase near the U.S. Capitol on Oct. 3, 2013. / FACEBOOK / EVAN VUCCI/AP/FACEBOOK

We may never know whether Ms. Carey was suffering from postpartum depression when she drove from her home in Connecticut with her 1-year old daughter to Washington, DC., where she lost her life after being shot by police.  At approximately 2:00 in the afternoon on Thursday, October 3, Ms. Carey rammed her car into a temporary barrier in front of the White House, then lead officers on a chase down Pennsylvania Avenue.  Police cars surrounded Ms Carey’s car at Garfield Circle, just south of the Capitol.  Ms. Carey then rammed a Secret Service car (pictured below) in an attempt to escape.

postpartum depression

From USA Today

At this point, officers began to fire shots at Ms Carey’s car.  She then drove to Constitution Avenue before eventually stopping in the 100 block of Maryland Avenue NE, near the Hart Senate Office Building.  She fled from her car on foot and was shot and killed.  Her daughter, who had been in the backseat, was unharmed.
Ms. Carey’s mother, Idella Carey, stated her daughter had been suffering from postpartum depression and had been hospitalized once for the condition.  Other relatives stated Ms Carey believed her apartment was under surveillance and that she was being stalked by President Obama.  Amy Carey-Jones, a sister, spoke to Ms. Carey about a week ago and believed her sister was fine.
Postpartum depression can be difficult to diagnose and monitor.  It is possible Ms. Carey had a severe form of the disease, Postpartum Psychosis (PPP), a rare condition that affects only 1 or 2 women in 1000.  PPP can suddenly come out of nowhere and present any time up to one year after the birth of a baby.  Sufferers and their caregivers are usually totally unprepared with how to cope with the symptoms of this disease.
postpartum depression
Ms. Storrs recommends that family members and friends of a new mother immediately notify a healthcare professional or local emergency department if she suddenly starts showing any of the following signs:
• Acting very energetic or agitated
• Being unable to get out of bed
• Showing unusual or nonsensical behavior
• Acting fearful or paranoid
• Believing bizarre ideas, such as thinking that the baby is the devil

postpartum depression

printed with permission from deamstime

One of the most difficult aspects of PPP is that the new mother does not believe she is ill, and she will often be very resistant to treatment.   Additionally, the worldwide publicity surrounding some especially gruesome PPP outcomes (Andrea Yates drowning her 5 children in 1991) has added to the negative stigma associated with any postpartum mental illness.  Because there is so much misinformation, many new mothers with even slight symptoms can become scared and refuse to seek help.
The vast majority of women who do develop this rare illness are never a threat to themselves or their children.  Early treatment from a qualified mental health professional can have a significant impact on alleviating the symptoms and speeding the treatment of this disease.