Casa Corner: The ‘holidaze’ and depression

So, the “holidaze” are here and you’re not feeling really “with it.”

The holidays are supposed to be a time full of joy, cheer, parties, and family gatherings. But perhaps your family lives across the country or you’re not on the best of terms with your only sister, or this is the first holiday you’re celebrating without your longtime spouse. Maybe even with the bad economy, everyone around seems to be spending lots of money and you’re struggling to make ends meet on a small fixed income.

Caregivers, in particular, may be aware of more stress than usual. Pima Health Systems’ Family Caregiver Education and Support program acknowledges that “sometimes, the most difficult pressure to contend with is the expectations we place on ourselves ... to create the ‘Perfect Holiday.’”

Are you doing a lot of self-evaluation, feeling lonely, reflecting on past regrets and experiencing anxiety about what the future may bring? Unrealistic expectations of what the holidays should bring, fatigue from shopping and frustration with over-commercialization can lead to excessive drinking and over-eating, problems sleeping and headaches. Even after Jan. 1, some people may experience a post-holiday let down — a combination of unrealized expectations, exhaustion and getting hit with credit card bills.

Social isolation, grief and loss and financial concerns can all contribute to feeling depressed at any time of the year. With the onset of enforced “cheer,” you are likely to be more keenly aware of the contrast between how you really feel and what you are expected to be feeling. In spite of what the media promotes as the “normal” holiday emotions, it really is OK to feel sad and lonely if that’s what’s going on. The problem arises if we are persistently feeling “down” to the point where there is interference with our daily functioning.

It’s clear that the “holidaze” can easily create an environment where depression can take hold. But before you dismiss feeling down as “oh, it’s just the holidays,” consider if you were feeling this way prior to the season and if you’re still feeling badly when it’s all over.

Prevailing myth

Let’s start by exploding a prevailing myth — depression is not a normal part of the aging process. It may be common, but it is not “normal.” More than six million Americans 65 and older suffer from depression — but only 10 percent are treated for it.

According to the National Institute of Mental Health, depression is a widely under recognized and undertreated medical illness. This may be partially due to the fact that symptoms of depression in older adults are often confused with the effects of multiple illnesses and the medicines used to treat them. Also, depression often co-occurs with other serious illnesses, such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. The NIMH states that “depression can and should be treated when it co-occurs with other illnesses, for untreated depression can delay recovery from or worsen the outcome of these other illnesses.”

Depression is a true medical condition. Depression can shorten your life, help create other health problems (infections; the risk of cardiac disease; reduced ability to rehabilitate) and be a precursor to suicide. In studies of nursing home patients with physical illnesses, depression was shown to substantially increase their likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack.

Depression in the elderly is more likely to lead to suicide. Elderly white men are at greatest risk, with suicide rates in people ages 80-84 being more than twice that of the general population. The NIMH considers depression in people age 65 and older to be a major public health problem.

According to the American Psychiatric Association, women are twice as likely as men to suffer depression. Fifty percent of all families in this country are affected by depression.

Depression is a mood that persists and continues to interfere with ordinary functioning. It can range from very mild to moderate to severe symptoms. What we call the “winter doldrums” may be a case of mild depression or Seasonal Affective Disorder (SAD).

Symptoms

What are the symptoms of depression?

Empty, sad or anxious feelings.

A loss of interest in things that are normally pleasurable.

Unexplained changes in weight or appetite.

Difficulty sleeping.

Feelings of fatigue, hopelessness, pessimism, guilt or worthlessness.

Lack of concentration and forgetfulness, difficulty making decisions.

Unexplained aches and pains or digestive problems.

Many depressions start gradually and are slowly revealed through symptoms such as lack of sleep and lack of appetite. If you experience any of these symptoms for more than two weeks, talk with your doctor, call the Casa de Esperanza Care Line (625-2273), the Southern Arizona Mental Health Center (SAMHC) or the Suicide Prevention Hotline. If you feel you are in imminent danger of hurting yourself, call 911.

Barriers to treatment

Because you’re depressed, it may be difficult to get motivated to get help. If a friend, caregiver or loved one is urging you to “see your doctor” or “go to a therapist,” they are trying to get you to pay attention to yourself. On the other hand, physicians, caregivers and your family may not view your symptoms as signs of depression because they expect you to “slow down” or believe that depression is normal as we age.

Both young and older people are often ashamed of their depression, thinking that asking for help implies weakness and therefore keep it to themselves. Lack of information about treatment, including fears of being in “therapy” can hinder an individual from asking for help. The stigma surrounding depression and its treatment is a powerful one and may be shared by your family and your friends. Buying into this stigma can keep you from seeking and receiving treatment. If you believe there is no way to get help you may not tell anyone you are depressed.

There are a variety of medications available to treat depression. However, people may not be willing or able to take these medications because of side effects or cost. Having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines. It is important to discuss this subject thoroughly with your physician.

You may be self-medicating with alcohol, prescription drugs or illegal drugs. Substance abuse will interfere with effective treatment. Excessive drinking and drugging will only increase your feelings of depression. It will be necessary to deal with your dependence on these substances as well as your depression in order to feel better.

By ignoring your depression, you will find yourself having to cope with increasingly serious symptoms that could otherwise be easily treated.

Part II of The Holidaze and Depression will describe various treatments, strategies and an expanded list of resources to help you recover from and cope with depression.

Sage Bergstrom is a licensed clinical social worker with 30 years of experience. She has been the Clinical Director of Casa de Esperanza since 1999.