• Depression
• Treating Depression
• Medications
• Turn On the Lights!
• Anxiety or Nervousness
• Relaxation and Exercise

Here is a list of the most common signs of depression. Signs vary widely among people and, sometimes, depression can hide behind a smiling face. If you have several of these for more that 2-3 weeks, talk to a nurse or doctor about them:

• An "empty" feeling; ongoing sadness and anxiety.
• Tiredness, lack of energy.
• Loss of interest or pleasure in ordinary activities that used to give pleasure.
• Sleep problems, including very early morning waking. Sleeping more or less than usual.
• Problems with eating and weight (gain or loss).
• A lot of crying or frequent feeling like crying.
• Difficulty concentrating, remembering, or making decisions.
• Feelings that the future looks grim; feeling guilty, helpless, or worthless.
• Irritability.
• Thoughts of death or suicide; a suicide attempt.

There is no single cause of depression. For some people, depression can occur with just one event. Others seem to become depressed for no clear reason.

Stressful life events will happen: children leaving home, loss of a job, or a change in relationship. In fact, during a five year period, 8 of 10 persons over the age of 70 will witness severe illness or death of a close family member or they will experience a serious illness themselves. Major depression can be avoided by developing interests or hobbies, staying involved in activities that keep the mind and body active, and staying in touch with family and friends.

The first step to getting help is to overcome any negative attitudes that stand in the way. The subject of mental health problems may still make people uncomfortable. Some believe that getting help is a sign of weakness. Relatives or friends mistakenly say that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Don't avoid help because you are afraid of how much treatment might cost. Often, the problem can be improved within weeks --not months or years -- of therapy or medications. Also, community mental health centers and many private practitioners offer treatment based on your ability to pay.

Depression is the most treatable of all mental illnesses. It can be treated with counseling, medications or, for best results, combining these two treatments.

Depending on the situation, various kinds of therapies seem to work and ease the pain of depression. There is no reason to suffer.

Several short-term (6-20 weeks) "talk therapies" have proven very useful. A licensed mental health therapist can assist people to recognize and to change unhelpful thinking patterns or improve relationships as a way to treat depression.

A very effective form of "talk treatment" focuses on the emotional difficulties that are caused by difficulties dealing with everyday events. Persons bothered by emotional issues are asked to make a list of problems. One problem is chosen. Methods for solving it are considered. After one problem is solved another is chosen. After about six sessions (4 hours of time), many patients are greatly improved.

The Chapter on Pain has a worksheet for problem solving and the Problem Solving part of HowsYourHealth is very helpful. In practice, most problems solving treatments that work for pains work for depression and anxiety -- and vice versa.

Although most types of depression are treated in a doctor's office, some patients may be referred to a mental health specialist for additional treatment.

Your doctor might also suggest that a patient use community-based programs. These include volunteer services and support groups to help deal with major changes in life such as retirement, moving, or health problems that require new coping skills and social support.

Despite their benefits, antidepressant drugs need to be used with great care. Some are best if you are too sleepy (desipramine) or not sleeping ( trazodone or amitryptyline). Some like fluoxetine (Prozac) stay in the body a long time and may be troublesome for the elderly. St. John's Wort may be as effective as some antidepressants for mild depression. Make sure you are receiving a standard dose and not mixing it with other antidepressants.

Your doctor must know about all prescribed and over-the-counter medications you already take. Also, remember to take the medication in the proper dose and on the right schedule. If you don't, the drugs may not work.

Alcohol is not treatment for depression and can make you feel more depressed. Alcohol must be avoided if your depression is to be successfully treated.

All medications can cause problems. About 3-10 persons out of 100 (3-10%) who take antidepression medicines may be so bothered by side effects of the medications that they have to stop them. Newer, more expensive antidepressants are not necessarily more effective and less likely to cause problems than the older types. Therefore, if you are given these medications, it will be very important that your doctor have close contact. Your doctor needs to be sure that you are being more helped than bothered. If possible, older persons should avoid amitriptyline, imipramine, and doxepin.

Remember that there are different types of antidepressant medications. If one type causes problems, another type may work for you.

Whichever treatment is used, your doctor will generally ask you to keep a diary of your daily activities and how you are feeling. Usually, the more you get involved in activities, the better you will do.

Remember:

• depression is not a weakness
• depression is treatable
• it can come back, but treatment will work again.

Some people regularly feel "depressed" in the winter and fine in the summer. One hour of intense light exposure in the morning seems to improve this seasonal "depression". Those who have studied this problem feel that it is very similar to "jet lag" -- except that it lasts for months. Light seems to work by keeping our internal clock synchronized with actual time.

When people are bothered by severe and frequent anxiety, they are likely to have many other problems. Often they will have troubles with their bowels, appetite, or breathing. Most often they will feel dizzy, weak and tired.

Counseling and better problem solving skills (see example in the Chapter on Pain) can be helpful for anxiety. Many people find relief with antidepressants, buspirone, and even kava extract. Probably the best method for dealing with anxiety is to learn deep muscle relaxation and breathing exercises. Yes, these simple approaches do work for stress and anxiety.

Allow yourself to stop forming words with your lips and thinking words. Think of pleasant pictures.

Other adults find anxiety and stress are reduced by regular exercise. (See Exercising)

To reduce bothersome emotions, Go TO Problem Solving.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.