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Demystifying 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 • 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 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

Depression derived from the Latin verb deprimere, "to press down"

The Ancient Greek physician Hippocrates described as a distinct disease with particular mental and physical symptoms

Since Aristotle, melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and . The newer concept abandoned these associations Researchers theorized that depression and through the 19th century, became was caused by a chemical imbalance in more associated with women. 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 At the Chemical Level

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 , reactions to stress, and the physical drives of sleep, appetite, and sexuality

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 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 or in usual activities, plus five of the following symptoms, all occurring for at least two weeks:

– Weight change – Insomnia – Motor agitation or retardation – Fatigue – of worthlessness, – 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 • Feelings of hopelessness and helplessness • and worries • Memory problems • Lack of motivation and energy • Slowed movement and speech • • 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, , monitoring substance use

What are the treatments?

Communicating with People who are Depressed

• Demonstrate - not able to just “snap out” of it • Avoid “pep talks” • Find a balance between acknowledging emotional and projecting , 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 – 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.