Is this what is the future?  Mental Hospitals have come a long way since the 1980’s.  The population of mentally ill inpatients has been drastically cut; unfortunately they have been displaced and are found in jails and homeless shelters, or wandering the streets.  For some of us who are not so severe there are alternatives but does the future hold more hospitals being built in order to bring adequate care to the severely mentally ill?  Outpatient clinics can only do so much and non compliance is a number one issue.  The community residences are not the answer; there is little interaction between people with mental disorders and the surrounding community of people without a disorder.  Isolation becomes a problem with the person not having contact with anyone besides the people they share the dwelling with; case managers; doctors and therapists.  Is it better to create more hospitals again to bring better care to those in need or are hospitals the past with no further use to the mentally ill. 

Depression In Older Americans

Everyone feels the blues or sad at times.  It is a natural part of life. But when the sadness persists and interferes with everyday life, it may be depression. Depression is not a normal part of growing older. It is a serious mental illness but like heart disease or diabetes it can be treated.

Depression is a serious illness affecting approximately 15 out of every 100 adults over age 65 in the United States.  When depression occurs in late life, it sometimes can be a relapse of an earlier depression. But when it occurs for the first time in older adults, it can be brought on by another illness. When someone is already ill, depression can be both more difficult to distinguish and more difficult to bear.

Sadness associated with normal grief is different from depression. A sad or grieving person can continue to carry on with daily activities. The depressed person has symptoms that interfere with their ability to function normally for a prolonged period of time.

Depression in the elderly is not always easy to identify. It sometimes is difficult for a depressed older person to describe how they are feeling.  Older Americans come from a time when depression was not understood to be a biological disorder and medical illness.  Some elderly fear being labeled or worry that their illness will be seen as a character weakness, or a sign on senility.

Someone suffering from depression can not just "get over it." Depression is a medical illness that must be diagnosed and treated a psychiatrist. Untreated, depression may last months or even years.

Left to itself depression can; lead to disability; worsen symptoms of other illnesses; lead to premature death; result in suicide.   When it is properly diagnosed and treated, more than 80 percent of those enduring depression return to their normal life with a complete recovery.

The most common symptoms of late-life depression include:  persistent sadness; feeling slowed down; excessive worries about finances and health problems; frequent crying; feeling worthless or helpless; weight changes; pacing and restlessness; difficulty sleeping; difficulty concentrating; physical symptoms such as pain or gastrointestinal problems.   One frequent sign of depression is when people withdraw from their regular social activities.

Another important sign is that they often neglect their personal appearance, or may begin cooking and eating less. Like many illnesses, there are varying levels and types of depression. A person may not feel hopeless or helpless, but may exhibit symptoms such as difficulty sleeping, weight loss, or physical pain with no apparent explanation. This person still may be depressed.  But, those same symptoms also may be a sign of another problem; only a doctor can make the correct diagnosis.

Sometimes depression will occur for no apparent reason.  This can be because the disease often is caused by biological changes in the brain.   In older adults, there usually are reasons for the depression. As the brain and body age, natural biochemical changes take place. Changes as the result of aging, medical illnesses or genetics may put the older person at a greater risk for developing depression.

Chronic illness is the most common cause of depression in the elderly. But even when someone has a chronic illness such as arthritis, it is not natural to be depressed.

The development of depression often has a trigger.  People can pinpoint one specific event that triggered their depression, such as the death of a partner or loved one, or the loss of a job through layoff or retirement.  When a normal period of sadness or grief leads to a prolonged, intense grief then it requires medical attention.

For the older person, medical illnesses are a common trigger for depression, and often depression will worsen the symptoms of other illnesses.

Medical illnesses may hide the symptoms of depression. When a depressed person is preoccupied with physical symptoms resulting from a stroke, gastrointestinal problems, heart disease or arthritis, they may confuse the depressive symptoms with symptoms of an existing physical illness, or may ignore the symptoms.

Most depressed elderly people respond to treatment with little trouble. In fact, there are highly effective treatments for depression in late life. Common treatments include:  psychotherapy; antidepressant medications; electroconvulsive therapy.

Psychotherapy can play an important role in the treatment of depression with, or without, medication. This type of treatment is most often used alone in mild to moderate depression. There are many forms of short-term therapy that have proven to be effective.

Antidepressants work by increasing the level of neurotransmitters in the brain.  Many feelings, including pain and pleasure, are a result of the neurotransmitters' function. When the supply of neurotransmitters is imbalanced, depression may result.

A frequent reason some people do not respond to antidepressant treatment is because they do not take the medication properly. Missing doses or taking more than prescribed and so they relapse.   Stopping the medication too soon often results in a relapse of depression.

 Typically, it takes four to 12 weeks to begin seeing results from antidepressant medication. If after this period of time the depression does not subside, the patient should consult their doctor for a change in medications or dosage. Antidepressant drugs are not habit-forming or addictive.

Electroconvulsive therapy is a treatment that many people have a dread of.  ECT is a safe, fast-acting and effective treatments for severe depression. It can be life saving. For the person who has a life-threatening depression that is not responding to antidepressant medication or for the person who cannot tolerate the medication; ECT is the most effective treatment.

The treatment of depression demands patience and determination by the patient and the physician. Sometimes several different treatments must be tried before full recovery.

Suicide is more common in older people than in any other age group.  Persons over age 65 account for more than 25 percent of the nation's suicides.   Suicide attempts or severe thoughts or wishes by older adults must always be taken seriously.

It is important to remember that depression is a highly treatable condition and is not a normal part of growing older. Therefore, it is critical to understand and recognize the symptoms of the illness.   An older person who is diagnosed with depression also should know that there are professionals who specialize in treating the elderly; geriatric psychiatrists have the training to know what treatments will be better suited for an older patient.

Depression and African Americans

Clinical depression is more than life’s ups and downs.   It is normal to feel sad when a loved one dies, or when you are sick, going through a divorce, or having financial problems. But for some people the sadness does not go away, or keeps coming back. If your blues last more than a few weeks or cause a great effort to perform daily life activities, you may be suffering from clinical depression.

Clinical depression is not a personal weakness, it is a common, yet serious, medical illness. Clinical depression is an illness that affects your mood, thoughts, body and behavior. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment can help most people who have clinical depression.

Clinical depression can affect anyone; regardless of race, gender, age, creed or income. Every year more than 19 million Americans experience some type of depressive illness.  Researchers find that African Americans in are particularly at risk for mental illness. Depression deprives people of the enjoyment found in daily life and can even lead to death.  Depression is not a normal part of life for any African American, regardless of age or life situation. Depression has often been misdiagnosed in the African American community.

 The myths and stigma that about depression creates confusion, and can keep people from getting proper treatment.  The earlier treatment begins; the more effective it can be.

Many factors can contribute to clinical depression, including:  negative thinking patterns; biological and genetic factors; other medications; other illnesses; and situational issues. Some people have a number of these features seem to, while others have a single factor that can cause the illness.

 Some people become depressed for no apparent reason.  Depression is dangerous, some people attempt to cope with their negative feelings with self-medication through the abuse of alcohol or illegal drugs, and this only leads to more problems.

Clinical depression can be treated:  like other illnesses such as heart disease or diabetes, clinical depression is treatable with the help of a doctor.  Over 80 percent of people with depression can be treated successfully and achieve full recovery.

Because of cultural differences, depression symptoms may show up differently among African Americans.  If you or someone know needs help for depression the following list of symptoms may be beneficial. If you experience any of these symptoms for longer than two weeks, if you feel suicidal, or if the symptoms interfere with your daily routine, see your doctor.

A persistent sad, anxious feeling, or excessive crying; reduced appetite and weight loss or increased appetite and weight gain; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain; irritability, restlessness; decreased energy, fatigue; feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; sleeping too much or too little, waking early in the morning and are unable to go back; loss of interest or pleasure in activities, including sex; difficulty concentrating, remembering, or making decisions; thoughts of death or suicide, or suicide attempts.

The most common treatment for clinical depression is with antidepressant medication and\or psychotherapy. The choice of treatment depends on how severe the depressive symptoms are and the history of the illness. Research shows that the use of medication for more severe episodes of clinical depression is the most effective. Antidepressant medication acts on the chemicals of the brain related to depression.   Antidepressant medications are not habit-forming. It may take up to eight weeks before you notice an improvement. It is usually recommended that medications be continued for at least four to nine months after the depressive symptoms have improved. People with chronic or recurrent depression may need to stay on medication to prevent or lessen further episodes. People taking antidepressants should be monitored by a doctor to ensure the best treatment with the fewest side effects. Do not stop taking your medication without first talking with your doctor even if you feel better.

Psychotherapy: Psychotherapy can help teach better ways of handling problems by talking with a therapist. Therapy can be effective in treating clinical depression, especially depression that is less severe.

 A patient support group can be very helpful during the recovery process. Support group members share their experiences with the illness, learn coping skills. Take care of yourself. Get plenty of rest, exercise, stay away from alcohol and drugs, and eat regular, well-balanced meals.

If you don’t have insurance or can’t afford treatment, your community may have publicly-funded mental health centers or programs that charge you according to what you can afford to pay. Life can be fulfilling again! With proper diagnosis and treatment, clinical depression can be overcome. The roads that leads to recovery are in reach don’t waste your life in misery.