Saturday, March 5, 2011

Aging and Depression

Aunt Molly was remarkable in many ways.  Not only was she brilliant, witty, a great writer and wonderful company, but she was also an anomaly in her generation and her family of origin.  Despite a family history riddled with depression and alcoholism, she escaped the curse of both. Despite losing both parents while very young -- her father when she was four, her mother when she was a teenager -- and, with her older brother, my father, struggling to work her way through high school and college at UCLA in the peak of the Great Depression, Aunt Molly had a joyous spirit, a contagious love of life.  She was a career woman -- an award winning poet, a television writer and also wrote mystery fiction -- at a time when women rarely had lifelong careers. She never married or had children, but she thoroughly enjoyed making a life of her own as well as embracing us -- my brother, sister and me -- with love. She took us to the beach in the summer, made every Christmas merry and thrilled us with eclectic, no cook dinners when we stayed over at her place some weekends. When I went through a period of depression in college after the man of my dreams fell in love with someone else, she sent me a check to buy some new shoes (for Molly, new shoes were the ultimate emotional salve) and a note that said: "Now get down off your cross and get your sense of humor back."

That's why it was a shock when, shortly after her 86th birthday, my brother and I noticed some signs of depression when we visited her.  "I've lingered too long at the party," she told us.  Although she had survived the devastating loss of my parents -- my father was her only family of origin relative, my mother her best friend -- many years before, the losses were mounting now.  Most of her long-time friends were dead. Her beloved 18-year-old cat was terminally ill and her own health was beginning to fail: she had cardiac problems, disabling arthritis and a kidney problem that required a special diet, eliminating some of her favorite foods. She worried about losing her independence.  We promised to be there for her -- and we were. 

I thought of Aunt Molly this week when Ann, a woman I met at a conference, told me about her 90 year old mother languishing in a nursing home with overwhelming physical problems but a razor-sharp mind that was appalled at and depressed over her loss of control over her life.

Although studies have shown that the elderly, as a group, are somewhat immune to or are much less troubled by depression that some younger cohorts, there are life transitions that can trigger depression as one ages. 

Depression may come after losses building on losses - the loss of spouse, family of origin, too many friends. It may follow the loss of robust good health, loss of mobility, loss of options.  It may strike some after retirement, when, feeling a loss of purpose, some people get mired in depression as they puzzle over how to make life meaningful at this new stage of life.

What do you do if you have an aging relative who is showing signs of depression -- like depressed mood most days, lack of interest in things previously enjoyed, withdrawal from family or friends, even talk of not wanting to live?

Engage your loved one in life again.  That can mean visiting more often, taking him or her to movies, plays or concerts or sporting events.  It can mean frequent cards and notes just to show you care. It means not sitting there in a virtual death watch -- whatever the person's state of health -- but keeping him or her in the loop with news, stories, family gossip.  It means letting this person know, in whatever ways are meaningful, that he or she is very important to you. Let this person know the impact he or she has had on your life.  For example, I thanked Aunt Molly for all the poetry she used to write just for fun, just for me -- off the top of her head -- during a trip to the beach or during a quiet evening hanging out together. I had memorized all the poems and finally wrote them down and gave the poems to her many years later. She delighted in the poetry and also in the memories these evoked.

Urge your loved one to see a physician.  Some medical conditions, such as hypothyroidism or B-12 deficiency, can lead to depression and some medications can trigger it as well. It's important to identify or to rule out any physical conditions that may be contributing to the depression.  In the case of existing medical conditions that are causing depression by limiting his or her life in many ways, it may be helpful to explore options or resources with a physician.  There may be support groups to help or other treatments that can ease symptoms. A change of medication may alleviate symptoms as well. Also, make sure that your depressed elder is taking his or her medication correctly and on schedule.

Encourage your loved one to re-discover old passions or to try something entirely new.  Even with increasing limitations, he or she may be able to do a little gardening or needlework or enjoy another hobby of his youth.  And it can be exciting to learn something new. Some work on learning a language. Or getting involved in music, like our friend and former neighbor Orlie, who learned to play the violin and who re-discovered his love for figure skating, after his retirement.  Aunt Molly started writing again after a long hiatus and, three weeks before her death, produced an incredibly powerful poem called "Waiting".  She also decided to try something that astounded us: bingo.  Never a game player, she decided to try bingo at the local senior center just to socialize and decrease her isolation. She was surprised how much she enjoyed and began to look forward to her Thursday bingo days.

Offer emotional support and encourage him or her to stay with medications or new behavior.  Antidotes to depression -- whether medication or activity or exercise -- aren't instant cures. Anti-depressants may take six to twelve weeks to reach maximum benefit. New habits and attitudes take time.
Encourage your loved one be patient and persistent.

If depression persists, encourage your loved one to seek therapy.  There are more therapists these days who welcome older patients -- and despite the disinclination of people of the Greatest Generation to seek therapy, it can be a real help.  After a lot of hand-wringing over what others might think, my mother sought therapy during what turned out to be the last year of her life.  She found incredible comfort and insight in her work with her therapist Jim -- and she urged some of her depressed friends to get help, too.

And what if you are the one depressed? 

Depression can strike in midlife for a variety of reasons. Physical changes, like menopause, can interfere with sleep.  Your looks may change and fade -- and this can be a source of depression if your appearance has been important to you.  Your physical prowess may lessen. Your children grow from sweet childhood to sullen adolescence.  Financial pressures mount.  If you have retired recently, you may be shocked to discover that you miss the structure and sense of purpose that your working life provided.

Many of the suggestions that might work for an elder loved one could be helpful to you: to see a physician to rule out a physical reason for your depression; taking anti-depressants if appropriate; re-discovering old interests or finding new ones; seeking psychotherapy for new insights and perspectives.

For those in mid-life, exercise can make a major difference in how you feel. So can eating a healthy diet.  Taking care of yourself in these ways is enormously life-affirming.

Giving to others can also elevate your mood. Do volunteer work. Mentor someone at work. Be kind to someone you know whose life seems even worse than yours.  Make time for the friends and family members you enjoy most.

Adopt a pet. You'll not only have the joy of taking care of someone who needs you, but you will also have a gift of the unconditional love a pet can offer.

Do what you love --whether it's an old passion or something you've always wanted to try. Learning something new can keep your mind active and engaged with life.

And, while Aunt Molly's penchant for shoes as comfort objects didn't turn out to be genetic, I often think of her wonderful spirit and courage in the worst of times --  as well as her challenge to me to get down off my cross and get my sense of humor back.

A sense of humor -- the ability to laugh between one's tears -- helps immeasurably at any time of life.

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