Demystifying Depression in the Older Adult: A Closer Look at Depression and Suicide

Catholic Health Association of British Columbia

October 2013

Why focus on Depression?

• To increase knowledge and understanding

of Depression and Suicide

• To decrease preventable suffering

• To enhance communication techniques

with those suffering with Depression

• To help support the people in our

communities

Why focus on Depression?

Why focus on Depression?

By 2020, Depression will become the 2nd

leading cause of disability

(trailing after heart disease) Reference: World Health Organization, 2012

Why is depression important?

• Common problem in the older adult

• The symptoms of depression may affect every aspect of life

• Too many depressed people fail to recognize the symptoms of depression

• Most depressive illnesses can be treated

• High suicide rate in older adult males

The History of Depression

Since Aristotle, melancholia had been

associated with men of learning and

intellectual brilliance, a hazard of

contemplation and creativity. The newer

concept abandoned these associations

and through the 19th century, became

more associated with women.

Depression derived from the Latin verb

deprimere, "to press down"

The Ancient Greek physician Hippocrates

described melancholia as a distinct

disease with particular mental and physical

symptoms

Researchers theorized that depression

was caused by a chemical imbalance in

neurotransmitters in the brain, a theory

based on observations made in the 1950s

of the effects of reserpine and isoniazid in

altering monoamine neurotransmitter levels

and affecting depressive symptoms

Of approx. 30 neurotransmitters identified, researchers discovered

associations between clinical depression and serotonin,

norepinephrine, and dopamine.

Antidepressants influence the overall balance of these three

neurotransmitters within structures of the brain that regulate

emotion, reactions to stress, and the physical drives of sleep,

appetite, and sexuality

At the Chemical Level

Prevalence of Depression in Canada

• Youth: – > 250,000 (6.5% of people 15-24 years old) experience major

depression every year

• Older adults: – Under recognized, difficult to diagnose (dementia, age-related

changes)

• Women: – diagnosed twice as often as in men

• People with chronic illness: – 1/3 with physical illness (diabetes, heart disease)

• People with substance abuse problems: – direct link between depression and substance use. Lower brain

activity – make you feel even more depressed

• People from different cultures

A Gift to Our Community

• Archbishop of Vancouver

Raymond Roussin

• Episcopacy: 2004-2009

• Motto: Steadfast in Faith

What is Depression?

• DSM-V (Diagnostic and Statistical Manual May 2013):

– Classifies disorders based on observation (social science)

– No definitive lab test confirms the diagnosis (e.g. disease)

• Formerly classified under Mood disorders

• 2013: separate category

– Major Depressive Disorder (MDD) – one or more

periods of major depression

Vincent van Gogh's

1890 painting

Sorrowing old man

('At Eternity's Gate')

Criteria for Major Depression

• Depressed mood and/or loss of interest or pleasure in usual activities, plus five of the following symptoms, all occurring for at least two weeks:

– Weight change

– Insomnia

– Motor agitation or retardation

– Fatigue

– Feelings of worthlessness, guilt

– Decreased ability to think

– Suicidal thoughts or attempts

Could I have depression?

Do I have Depression?

Clinical Presentation of Depression

• Unexplained or aggravated aches and pains

• Feelings of hopelessness and helplessness

• Anxiety and worries

• Memory problems

• Lack of motivation and energy

• Slowed movement and speech

• Irritability

• Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)

What are the treatments?

Medical Therapy

• Medications e.g. anti-depressants

• ECT (Electroconvulsive Therapy)

• Cognitive Behaviour Therapy (CBT)

• Interpersonal Therapy (IPT)

• Light Therapy (Seasonal Affective Disorder)

Psychosocial Interventions

• Supportive listening/socialization

• Self Help: – exercise, eating well, managing stress, spirituality,

monitoring substance use

What are the treatments?

Communicating with People

who are Depressed

• Demonstrate empathy - not able to just “snap out” of it

• Avoid “pep talks”

• Find a balance between acknowledging emotional pain and projecting hope, warmth, and caring

• Offer easy, limited choices and options

• Gently remind the person of past and present achievements

• Offer to arrange activities of short duration that are of interest to the person

• Encourage the person to seek and maintain social contact

Is there a link?

• Link between suicide

rates and professions?

• Some research:

– dentists, physicians,

EMTs, priests

– Access to lethal means;

knowledge on how to

successfully end their life

• Research varies for

different professionals

Is there a link?

SAD PERSONS:

Risk Factors for Suicide

S – Sex

A – Age

D – Depression

P – Previous Attempt

E – Ethanol

R – Rational Losses

S – Solitude

O – Organized Plan

N – No spouse

S – Sickness

What can I do to help?

Communication Interventions for

Suicidal Ideation

• Establish rapport by listening to content and emotion –

validate their feelings and don’t distract

• Ask direct questions re: thoughts/plans

• Phone for help: family, 911, (1-800-SUICIDE)

• Explore their resiliency factors: “seeds of hope”

– Meaning and purpose in life

– Sense of hope or optimism

– Religious practice

– Social network and support

– Positive help-seeking behaviours

– Engagement in activities of personal interest

What resources exist for me?

• BC Partners for Mental Health and

Addictions:

– www.heretohelp.bc.ca

• HealthLink BC:

– 811 (nurse or pharmacist), non-emergency

• Mood Disorders Association of BC:

– www.mdabc.net or 604-873-0103

• BC Crisis Line:

– 310-6789 (do not add 604 or 250…) 24 hours

a day to talk to someone (no busy signal)

Any questions?

On behalf of the Catholic Health Association of BC:

Thank you for participating in today’s session.