Give a Caregiver a Break

A recent local news broadcast featured a local man who is a full-time caregiver for his wife, who is in the advanced stages of a chronic illness. Each year, he attends an Ohio State football game (a huge deal in this area) with his adult son. A volunteer from an association that supports the illness (in this case, multiple sclerosis) stays with the man's wife to facilitate his attendance at the football game.

I liked that the news covered such an event: it spotlighted an important issue that most people don't think much about. People who care for ill partners, parents, other family members or friends desperately need a break. Studies have shown that the stress level for these folks, both emotional and physical, is off the charts. In a research article from The Ohio State University, Janice Kiecolt-Glaser, a nationally-known authority on caregiver stress, says that caregiver's life spans are actually shortened by the stress they experience.

“Caregivers showed the same kind of patterns present in the study of mothers of
chronically ill kids,” Glaser said, adding that the changes the team saw
amounted to a shortened lifespan of four to eight years. "We
believe that the changes in these immune cells represent the whole cell
population in the body, suggesting that all the body's cells have aged that same
amount.”

How can caregivers take care of themselves? In an AARP article, Managing the Stress of Caregiving, the following tips are offered:

"Take Care of Your Health

• Eat nutritious meals. Don't give in to stress-driven urges for sweets or drink too much alcohol.


• Get enough sleep. If you are kept up at night, try a nap during the day to make up some sleep.


• Exercise regularly, even if it means finding someone else to provide care while you walk or go to exercise class.


• Get regular medical checkups. If you have any symptoms of depression (extreme sadness, trouble concentrating, apathy, hopelessness, thoughts about death), see a doctor right away. Depression is an illness that can, and should, be treated.

Involve Others

• Make a list of jobs you need help with. They could include household chores, home repair or maintenance, driving, paying bills, finding information on services you need. Maybe it's simply giving you a break by staying with Mom while you get away for awhile. Ask friends, neighbors and other family members if they could give some time to helping out.

Maintain Social Contacts

• Isolation increases stress. Having fun, laughing, and focusing on something besides your problems helps you keep your emotional balance."

What about taking a much-needed break? There are services that provide respite for caregivers. Adult day-care centers can provide care during the week for patients. Volunteers at church organizations will offer to visit and give the caregiver a break. According to a recent Wall Street Journal article, More Resources Help Caregivers Help Themselves, an estimated 45 million people care for a loved one. The article states that new evidence is showing that caregivers can better manage if they are given access to resources, such as "counseling sessions, in-home skills training, support groups and assistance juggling care responsibilities."

It makes sense that the strain of caregiving is especially difficult during the holidays. With everyone busy and celebrating, the usual resources may be unavailable. The WSJ article offers a list of Web sites for organizations that can help:

National Family Caregivers Association

National Alliance for Caregiving

Family Caregiver Alliance

AARP

What can you do to help out a caregiver? Offer to give them a break by arranging someone to stay with the patient while you take them to lunch or out shopping for holiday gifts. Or stay with the patient yourself to allow the cargegiver a well-deserved day off. It's important to ask specifically what you can do. A vague offer "to help" isn't really helpful. There is probably a long list of things you can do.

So extend an offer to a caregiver. Your assistance will be invaluable.

Relapse Prevention - Not Just for Alcoholics

Relapse prevention is one of the most important aspects of addiction treatment. Most newly-recovering patients are so confident that they will never use again that they don't always take it seriously. It's often not until after they relapse that they see the signs in retrospect.

Terence T. Gorski is a leading addictions expert. On his Web site, he lists a comprehensive, 9-step relapse prevention program. One of the key elements is "warning sign management," which is a list a patient makes of his/her particular warning signs and a strategy to address them.

I don't believe we should limit relapse prevention to addiction. I work with all kinds of patients, especially this time of year, on how to manage their symptoms so they don't relapse. For instance, with a hectic schedule, some depressed patients forget to take their medication. Couples who are trying out new, healthier behaviors often "throw out the rule book" while focusing on their holiday plans. People who have problematic eating issues are often tempted to forgo their treatment plans when presented with so many unhealthy food options.

Earlier this month, I posted an old AA-based, relapse tool, HALT. It's a reminder not to get too Hungry, Angry, Lonely or Tired over the holidays. The following is kind of an addendum to HALT.

1. Identify your "triggers." Are yours crowds or unfamiliar social situations? Being in places with your credit cards where you will overspend? Watching your baby sister play out her princess role yet again?

2. Write down your triggers and how you will address them. Having a very specific plan for each of your triggers will re-direct you to the thinking/logical response instead of the emotional/reactive response.

3. If at all possible, Avoid. Try to avoid the triggers on your list if possible.

4. Use your support systems. Wrestling with your "demons" alone is tough. Make a list of people who you can call or visit when you feel "unsafe" and tempted to ignore your relapse prevention plan.

Now, go work on your own plan.

Is "Cyber Monday" Fueling Your Shopping Addiction?

In the U.S., "Black Friday" has traditionally been the shopping day after Thanksgiving on which retailers have their highest sales."Cyber Monday," a recent name given to the Monday after Thanksgiving, is a high-traffic day for online shopping. I admit when I started writing this post, I had to pop onto Amazon.com to see if there were any irresistible deals!

Most people joke about the "shop 'til you drop" mentality or "retail therapy" and we're all familiar with the stereotypical woman shopper who cruises the malls, her fist crammed with credit cards. But compulsive shopping behaviors do exist and can be very damaging.

Not Every Behavior is an Addiction

As an substance abuse/dependence specialist, I tire of anything and everything being labeled an "addiction." I would prefer to discuss some of these compulsive behaviors as problematic by degrees. Most of us experience a "high" when we buy something new for ourselves or find the perfect gift. There are definite addictive qualities to serious compulsive shopping. But is it accurate to compare a moderate shopping habit to a heroin addiction? What do other experts have to say?

WebMd.com addresses the difference between a harmless pastime and problem behavior in the article, "Shopping Spree or Addiction?" "Compulsive shopping and spending are defined as inappropriate, excessive, and out of control," says Donald Black, M.D., professor of psychiatry at University of Iowa College of Medicine.

According to Addictions.org, the compulsive spending cycle mimics that of other addictive cycles,

"Because they lose their ability to buy within their means they are constantly in financial trouble and often dogged by collection agencies. When the "high" of shopping dissipates they are left with the guilt and shame so characteristic of the addiction cycle. The guilt and shame may contain the urge
for a short while but ultimately it leads to the need to alleviate the bad feelings through another bout of spending."

Take the Self-Test

If you have concerns that your shopping behavior is becoming problematic, take the following Self-Test at Addicted.com.

My own professional criteria for any compulsive behavior becoming unhealthy is a simple question, "Is the behavior causing problems for you or anyone else?" If you answer "yes," then you might want to consider getting some help.

Getting Help

Start by looking in your local phone book under "Addiction" " to find treatment centers that can help answer your specific questions. 12-Step or Alcoholics Anonymous groups have resources for most addictive behaviors. Do a Web search on "addiction" or "compulsive behaviors."

But keep in mind, the majority of people who enjoy shopping at this time of year do not have addictive, potentially problematic behaviors.

Holiday Stress-Reduction Tips - Listen to the Real Experts

With Thanksgiving behind us, now we are in the sprint towards Hanukkah, Christmas, Boxing Day, Kwanzaa, New Year's, etc. Take a deeeep breath.

I spent Thanksgiving at a neighbor's where I was able to eat other people's favorite foods and watch family dynamics with an objective eye. It was very enjoyable. But I noticed the conversation inevitably turned to a panicked, "I have so much to do before _____!"

A recent article in the Baltimore Sun, Taking a holiday from the Holiday Stresses, takes a bit of a different approach to the topic. Reporter Meredith Cohn cautions us to be aware of where the stress-reduction tips are coming from and be discriminating when reading advice from so-called "experts." She quotes Thomas J. Capo, a psychology lecturer at the University of Maryland,

"I'd say the No. 1 concern is that you want to be able to discriminate good
advice from the rest of it, most of which tends to be bogus. In order to qualify
as 'good advice,' it needs to be backed by good science, rather than
'testimonials' or so-called 'common sense."

Cohn also spoke with Mark Gorkin, the StressDoc, who points out (somewhat tongue-in-cheek), "Holiday blues is that feeling of loss or sadness that you have over the holiday when, for whatever reason, you can't be with those people who have been or are special and significant. And holiday stress is...when you have to be with some of those people!"

Gorkin, a licensed clinical social worker, author of "Practice Safe Stress" and motivational speaker (The Stress Doc) - who is an expert, elaborates further on holiday stress in his classic holiday article "Four F's of Holiday Friction."

"Here are 'The Four 'F's of Holiday Friction: Fantasies, Family, Food and Finances.'

1. Fantasies. First, the idyllic image of the holidays portrayed by the media seems so out of touch with reality, it's enough to make you overload on eggnog (with or without the alcohol).Another pressure is the internalized memories we carry around. I recall my friend Linda, a single parent at the time, berating herself because she couldn't keep up with the holidays - the cooking, the shopping, the house decorations, etc. - the way her mother had. Of course, Linda's mom did not work outside the home. I also recall Linda observing that, as a successful professional, she now has the money but lacks the time for the season. Previously, when she wasn't working, she had plenty of time and no money: The "Holiday Catch-22."And, finally, this season turns most of us into sentimental jelly fish, just waiting to get entangled in the arms of that "true love." Hey, I'm not saying that Mr. or Ms. Holiday Hopeful is as possible or as real as Santa Claus. (My motto: "I no longer count on nor discount any possibility.") Just don't let childhood longings and memories and voices transform you into a frantic, salivating, love-crazed inner child.The key to managing this friction: gently embrace, don't cling, to magical memories. Discover a blend of magical realism that helps you balance love, work and play in the present.

2. Family. There are so many permutations in families these days, it's got to get a bit confusing. For separated families, a poignant question: which parent (or grandparents) will we be with for Thanksgiving, for Christmas, for New Years? I vividly remember an eight year old's lament: "Why can't we just be one family again?"Another common family issue is when a holiday gathering turns into a competitive arena for sibling rivalry, along with a desire for long-standing recognition and approval. And if you find in these family therapy sessions, I mean holiday reunions, that you can't resist trying to change the attitude and behavior of the parent (sibling or child) that "makes you crazy," patterns which have resisted influence attempts for decades...maybe there's only one solution. Have you thought about getting far out of town for the holidays?

3. Food. The holidays turn most of us into bingeaholics. Running helter skelter, not stopping for lunch, overdosing on the cookies and chocolate that a colleague has brought to work. And discipline at a party is a contradiction in terms. This caloric chaos is not surprising considering the biggest role model of the holidays looks like he hasn't met a single gram of fat in two hundred years that he doesn't love. Hey, Santa Claus hasn't been doing his aerobic workouts either. But wait...Appoint a designated nagger, who will gently remind you when you are overdoing it. Don't chat hovering around the buffet table. Take reasonable portions and move away. Now replace food with some food for thought. And face it, no matter what you do, or don't do, you are likely to add some pounds on the holidays. So go to the malls and walk briskly for thirty minutes before you start the shopping splurge. You'll spend less and, probably, will eat less as well.

4. Finances. The holidays heighten our monetary consciousness -- from the end of the year financial and psychological accounting (did we meet our financial/family security and career goals?) to the never-ending list of holiday gifts. And as the great Russian novelist, Dostoevsky, noted: "Consciousness is depression!" For the first issue, seek a budget counselor, a CPA, a career counselor or even a mental health specialist. For the last, "just say no" to your child's "toy lust." Give your child choices; explain why there are limits. Try this holiday mantra: "Presence not just presents." This season, invest time, not just money. For big families, be creative. Divide up the gift list with other relatives. You shouldn't have to buy something for everyone. Making a gift definitely adds a personal touch. And, finally, don't overlook a very important person. Get a special gift for yourself.So the holidays may be a stressful time; a time of feelings of loss and sadness. But with a little higher power humor it also, can be a source of creative expression and sharing."

So when everyone from your neighbor, the TV news anchor and your mother offers tips on reducing holiday stress, be selective and seek out the experts.

Have a safe, sane and restful Thanksgiving!

TXT HELTH NFO 2 U?

What if your doctor or dentist sent you a text message on your mobile phone to remind you of your appointment? Sent you test results? What if the health department sent you a message warning of STDs and reminding you to wear a condom? Sound far fetched? It's happening now.




A Wall Street Journal article, don't 4get ur pills: Text Messaging for Health, discusses the new practice of text messaging health information to patients via cellphones. It is argued that it is a better means to deliver information to patients than leaving messages on their voice mail and unlike email, doesn't need an email device.

"In England, women have received text reminders to take their birth-control
pills. In Australia, texting helped AIDS patients adhere to complicated drug
regimens."

According to the WSJ article, most programs that deliver text messages don't cost anything other than what phone plans are already charging for texting.


The Web site, Technology, Health and Development has pulled together some really interesting research on many of the available phone messaging programs now available world-wide.


As a mental health clinician, I have mixed feelings about such readily accessible health information for patients. On the one hand, I applaud the ease and efficiency of it. But I have serious reservations about patient privacy.

What do you think? Does the benefit outweigh privacy concerns? Let me know.

Myth of Holiday Suicides Perpetuated By the Media

Most of us have a common belief that people with depression have a difficult time during the holidays. I can only speak to what I've seen in my therapy practice - patients with a depressive disorder often struggle more with symptoms during the holidays, but it isn't always the case. What about suicide? We often read in the news that the number of suicides increases during the holiday season. But not only have studies proved that to be an inaccuracy, the media is now acknowledging that they have been in error.

I first saw this reported in the Wall Street Journal Health Blog. Shirley S. Wang reports,

"Between late ‘99 and early ‘06 more than 40% of newspaper stories that reported on suicide during the holidays perpetuated the myth that the holiday season led to a rise in the suicide rate, according to an analysis released yesterday by the Annenberg Public Policy Center of the University of Pennsylvania."

According to a NYU Medical Center article, True or False: Depression and Suicide Rates Rise During the Holiday Season, the opposite is true: Suicide rates actually drop in the winter months and rise in the spring.

Another organization, Suicide and Mental Health Association International (SMHAI) has an in-depth report on the press's reporting inaccuracies.

It is heartening, however, that the press is acknowledging it's role in perpetuating this myth. In a particularly astute opinion piece from 2005, USA Today's DeWayne Wickman chides his colleagues for linking the suicide of a famous football coach's son to the Christmas holiday.

This does not mean that we all shouldn't be more watchful of those we care about who display depression symptoms this time of year. It is simply a reminder that when it comes to mental health, the media often gets it wrong and that we should do more of our own research when we see these headlines.

Choose Not to Star in Your Dysfunctional Family's Holiday Drama

"Family relationships" is always a loaded topic. But during the holidays, it's foremost in our minds. We all play a role in our family. What is your role? And can you choose not to play it this year?

Family Systems

Many theoretical concepts are used in the practice of family therapy. One of the most common is family systems therapy. This is based on the theory that the family is the identified patient and examines the relationships and communication patterns within the family. A comprehensive look at this theory can be read at Serendip.com.

Family Roles

Out of family systems theory, grew an examination of the roles within families with addiction issues. In such dysfunctional families, children often take on a role, such as "scapegoat," "hero child," or "lost child." Scapegoat is fairly self-explanatory. The family, due to denial, is unable to address the real problem - the alcoholic or addict's use, so they blame another family member. This is usually the child who gets into trouble at school or with the law. The hero child is the one getting good grades, never in trouble, etc. The family can point to this child and say, "there's nothing wrong with THIS family!" The lost child is often the quiet one who sits in the corner playing with toys. Without help for the family, all these children are at risk for health and mental health issues.

Claudia Black, PhD, MSW, a pioneer author and lecturer on recovery and family addiction is an excellent resource. I highly recommend her workbook, "Repeat After Me," which has exercises to break dysfunctional family roles.

In a less clinical examination, most of us have a role in our family. Sometimes it's the older brother who always takes charge, the care-taking sister who "knows what's best" for everyone or the "baby," who just by virtue of being the youngest, gets all the attention. What about "slacker brother who can't keep a job" or "thrice-divorced sister who can't keep a man?" The latter is extreme, but the general idea is universal.

Choose to Step Out of Your Role

It might not be fair to label each other this way, but sometimes it's more comfortable for our family members to see us in these familiar roles. But that doesn't mean you have to assume or play that role forever. Your family may have an adjustment period, but they will have to adapt to your new role.

Healthy families can joke about their family roles. Being open and direct about your role and expressing your feelings can help your family have a better understanding of how dysfunctional it can be. One of my favorite movies is a comedic examination of family roles - "Home for the Holidays" Rent or borrow it this season.

Set Realistic Expectations for the Holidays

Last week I posted the first in a series about surviving the holidays. We are almost on the eve of Thanksgiving in the U.S., so let's talk about keeping our expectations for the holidays on a realistic level.

We are all victims of every media-driven image of Happy Holidays - from cherished old movies, holiday music CDs that every artist seems to release, holiday-themed magazine articles to our own family and friend's ideas of the perfect gathering.

Although it may sound like the "glass is half empty" mentality, I try to keep my expectations for the holidays quite low. I hope to see people I care about, have some extra time with my spouse, pick out some fun gifts and enjoy seasonal foods. Beyond that, I don't expect much. If some special things happen, I'm pleasantly surprised.

The following is a handout I usually give to patients this time of year. Years ago, I started passing them out to newly-recovering patients in drug and alcohol treatment. As the holidays are key times for relapse, it serves as a reminder about "acceptance." Acceptance of our family relationships and ourselves as less than perfect beings. The author is anonymous.

Holidays

Holiday time is here: so is the challenge to treat one another with grace and to remember the importance of the connections between us.

It isn't easy, so here are a few rules:

• Take very good care of yourself so you aren't stressed out or crabby.


• Don't expect or attempt perfection; settle for anything short of a disaster.


• Don't ask if the pies are homemade.


• Don't correct or criticize anyone.


• Choose to be happy, not right.


• Don't care who gets the credit for whatever.


• Avoid competition and comparison; don't keep score.


• Give up playing martyr or victim.


• When in doubt, keep quiet.


• Remember, very few things are important.

Then thank everyone for staying alive so you can love or hate them for another year. Your family may not be perfect, but they're yours!

Strategies for Surviving the Holidays - H.A.L.T.

As we head into the holiday season, I'm going to post a series of "survival" tips. You are probably very familiar with the stress-reduction suggestions that usually appear everywhere this time of year. But hopefully, these will serve as a reminder.

So what is H.A.L.T.?

HALT is an acronym that serves as a relapse-prevention tool people in early recovery from alcohol and drug addiction have in their repertoire. It's a handy reminder of behaviors/states of minds/situations that are triggers to relapse. But it doesn't just apply to addiction, it can work for all of us.

H - Don't Get Too Hungry

Hunger can be a trigger to drink or use. But how many of us starve ourselves in anticipation of a holiday event and then binge when we get there?

A - Don't Get Angry

When we aren't in control of our emotions, it can lead to unhealthy and/or nonproductive behaviors.

L - Be Careful of Being Lonely

Isolation and social withdrawal is often a precursor to relapse. It is also a symptom of depression and some types of anxiety. Spend time with people who support you.

T - Don't Be Too Tired

Be careful of wearing yourself out. Most of us can make bad decisions when we are overly tired.

HALT is a simple tool, but an easy way to remember some very effective means of self-care during the holidays.

Using Your Personal Power - You Can Learn to Be Assertive

Saying "no" and setting limits doesn't come easily to most people. It becomes especially difficult during the holiday season as we try to make everyone around us happy, often at the expense of our own well-being. How can we take better care of ourselves? Women, in particular, have a very hard time being assertive. We are socialized at a young age to defer to others. For years in my therapy and substance abuse counseling practice, I've led women's groups. A topic I always cover is assertiveness and I believe it's a skill we can all learn.

What is the definition of "assertive?" It comes from the root asserio, which means "to step forward." Most dictionary resources I looked at included the word aggressive. But I feel that "aggressive" is a totally different concept. The definition that seems most appropriate is, "describes someone who behaves confidently and is not frightened to say what they want or believe." Assertiveness is a way to express your personal power. A handout I give members of my women's groups is:

Personal Power

is your ability

to get what you want

in ways that maintain

respect and dignity

for yourself

and others

What's the difference between Assertive and Aggressive?

Unfortunately, the two words are often interchangeable in our society. Aggression also means that you express yourself and ask for what you want, but it often violates the rights of others. Picture someone getting in your face to make their point in an argument. More extreme forms of aggression include physical threats and harm.

What about Passive?
Merriam-Webster defines passive as, "acted upon by an external agency" and "receptive to outside impressions or influences." In the slang vernacular, you might be referred to as a "doormat." Deferring to others or compromising are often necessary in relationships. But if you are passive to the point that none of your needs are met, then it isn't healthy.

Take an Assertiveness Quiz
I really like this quiz at the Leadersdirect Web site. This site is obviously addressing this issue in the work environment. Human resource departments often have assertiveness training workshops for their employees. But the training and principles can apply to personal interactions, too.

Learning to be more assertive
Becoming more assertive takes practice. I have patients do role plays with me or each other in group in order to apply assertiveness to situations they encounter. One I use often is the following:

Role-play a family member asking you to come to a family function:

Family member: "We're having a birthday party for
Susie Friday night and we hope you'll be there."

You: Well, it's nice of you to include us, but we
have a dinner planned with Barb's boss."

Family member: "You can't miss this party! She
only turns 35 once!"

You: "Mom, there will be other big events that we
will plan on celebrating with the family. But with our schedules, we need to
plan ahead. Sorry, but we have this commitment."

Family member: "I understand and we'll miss you
and will be thinking about you."

I like this example because it is a situation we all find ourselves in. Pressure from family is hard to take because it plays on our guilt and all those childhood tapes playing in our heads about obligation and being "good."

More ways to practice assertiveness
At Coping.org, there is a very thorough listing of assertive "rights" and many exercises for Improving Assertive Behavior. Take some time to check out how you can begin to take better care of yourself by becoming more assertive.

What Topics Interest You? Let Us Know!

As Talia mentioned when she posted her "month-away" notice, we'd love to hear what topics you'd like us to cover.

With that in mind, I thought I'd list my areas of expertise and interest to jump-start the process.

Mental Health/Wellness

• Mood disorders - depression and anxiety


• Stress Management - job-related stress, anger management, school stress and lifestyle issues


• Family relationships - parenting, couples' issues, dysfunctional family concerns


• Women's Issues - Gender-specific issues for women


• Work/Family/Personal Life balance

Substance Abuse/Dependency

• Adults, adolescents struggling with chemical abuse/dependency


• Treatment options - Spectrum of care available


• Family members of substance abusers and substance dependent people


• Women's issues - issues specific to women in addiction and recovery


• Celebrities and addiction/treatment/recovery

Related Topics/General Interest

• Healthy/Unhealthy Lifestyle Trends


• Relaxation and Leisure


• Pets


• Media portrayal/reporting of the above

So there are many, many things listed about which I can share my expertise and experiences. Please leave me a comment or two about your areas of interest. And if you don't see an area that interests you, let me know. I'll try hit on those topics while covering the blog this month.

I look forward to hearing from you!

Depression in Older Adults - How is it Different?

"Doesn't everyone get depressed as they get older?" It's a common misconception that becoming depressed is a natural part of the aging process. This and other age-specific beliefs often result in depression going under-diagnosed and untreated in this population.

I encountered this in my own life when I asked my mother if she was depressed awhile after my father died. I was concerned that she might need medication. Her response was, "I'm not depressed, I'm just unhappy." Although I found her answer confusing, it underscored to me that there are profound differences in her generation's concept of depression. We of the Dr. Phil/talk show/self-help book generation just assume everyone understands and shares our belief system about mental illness. Because depression is so common in older adults and their high risk of suicide, it's important for us to understand the signs and symptoms. According to NAMI (National Alliance on Mental Illness), depression affects as many as 6.5 million of the 35 million adults 65 and older and that older white males have the highest suicide rate in the U.S.

How do symptoms differ in older adults?

In addition to the usual depressive symptoms of lethargy, sadness, feelings of hopelessness, older people often have memory deficits, confusion and social withdrawal and they may even experience hallucinations or delusions. Often, these symptoms are misdiagnosed as dementia. It is also very difficult to gauge things like social withdrawal as many older adults live alone and may have mobility difficulties that restrict socializing.

Social/Cultural differences

It's important to also factor in that this generation grew up in a culture that doesn't support sharing "personal" things with strangers, may view depression as a "weakness" or believe that focusing too much on oneself is "selfish." This makes recognizing depression in older adults more challenging as they may not share their symptoms with you. Often older people will complain about physical ailments repeatedly. Recognize that this may be their way of seeking attention for depressive symptoms that they can't articulate.

Treatment options

Fortunately, depression in older adults is very treatable. Unfortunately, suggesting therapy may not be the best way to engage these patients in treatment. Starting with a family physician is what I call a "back door" approach. If the doctor has a trusting relationship with the patient, they may be more likely to see therapy as a way to get better if the doctor recommends it.

Antidepressants are often affective for treating older adult depression. But there are risks not evident in younger populations. WebMD discusses some of these concerns, such as the risk of side effects and other reactions with other medications the older patient may be taking. Also, some of the older types of antidepressants, such as imipramine and amitriptyline can be dangerously over-sedating or cause a drastic drop in blood pressure. It is often a good idea to have the patient referred to a psychiatrist who is skilled in medicating geriatric patients.

Older adults can also benefit from psychotherapy, support groups and informal peer-social groups.

What can you do to help a family member or friend who has been diagnosed with depression?

Make an extra effort to visit, call and spend time with them. If you are a family member, ask if they will sign a release so you can have contact with their doctor if needed. Assure them that this is simply to offer all the support you can, not to "pry" into their business.

Check out local resources like a local hospital, mental health facility or senior center to educate yourself on what is available in their community. Encourage them to participate in therapy or support groups, etc. and help facilitate getting them transportation if needed.