Seniors and depression: A growing problem

I’ve written repeatedly about the growing depression problem which is striking every age group and demographic in America. There is one area, however, that I believe is unjustly under-discussed: The problem of depression among America’s seniors.

First, a look at the facts. Depression isn’t normal. It’s not standard with aging. But many of our seniors are depressed. Over 20% of those ages 60 or up are suffer from some sort of mental or neurological disorder. 7% of all of those of the same age will suffer from depression, and another 4% from anxiety disorders.

These numbers are compounded by two trends that are largely unique to seniors. First is declining physical health. It goes without saying that health problems occur as someone gets older. This, obviously, can lead to depression.

The second is social isolation. Seniors are often more socially isolated than other age groups. Physical disability, moving families and changing social structures can lead to this isolation, and loneliness is a huge cause of depression. It’s also expensive to the general public: An AARP study found that Medicare spends about $1,600 more a year on seniors who are lonely and socially isolated than those who don’t.

What does this mean? Well, like many other areas of American society, it means that we are going to have to adjust to an aging population. The percentage of the world’s population will double over the next 31 years, with those above 60 expected to make up 22% of the world’s population by 2050 (up from 12% today). Mental health must adjust as well. There is a shortage of psychiatrists and psychologists across the board, and this shortage is even more acute in areas like geriatric psychology and psychiatry. We’ll need to develop more programs that area specific to dealing with depression in seniors, and this includes problems that specifically address the social causes of depression, like loneliness. We’ll also have to customize these programs so that they deal with the physical challenges that many of our seniors have.

This entry was inspired by a meeting I recently attended on aging in the Lehigh Valley. We all know that America is aging. But what we aren’t discussing enough is how we deal with the challenges that this aging brings. This is an area which we must address better.

Five surprising factors which are connected to depression

One of the things which I’ve learned as I’ve studied depression and mental health is that the connections to depression are stronger and more broad than any of us really are aware. I suppose this shouldn’t be that surprising: After all, nearly one in five Americans actively suffer from some sort of mental illness, and those numbers are only going up. This means that the connections with depression are tragically broader than most of us probably realize.

But, the connections with depression run deeper – and more surprising – than I think any of us are really aware.

I’ve been unpleasantly surprised at how many things are connected to depression. Here are five such items, but with a note of warning straight out of an introduction to psychology class: Correlation does not equal causation. Just because something is connected to depression doesn’t mean it causes depression. The two are connected, but that doesn’t make them causational.

1) Air pollution: Here’s an interesting one. According to a study in England, children who live in high areas of air pollution are significantly more likely to have depression than children who don’t. It is certainly possible that pollution impacts brain development and causes depression, but it’s also possible that the same societal factors which lead to someone living in a polluted area have an impact on someone’s mental health.

2) Migraines: According to the American Migraine Foundation, people who have migraines are five times more likely to develop depression than people without them. Indeed, the more frequently someone has migraines, the more likely they are to develop depression. From a causational perspective, this makes sense, of course: Chronic disorders can have a significantly negative impact on someone’s health and state of mind. But, as the American Migraine Foundation notes, the direction of the link is not clear, and it’s certainly possible that depression can cause migraines, rather than the other way around.

3) Heart disease: This one is unsurprising, but there is a connection between heart disease and depression, and it seems to run both ways. According to the University of Iowa, “While being diagnosed with heart disease or having a heart attack may increase the risk of depression, depression itself may increase the chances of developing heart disease.” In other words, this relationship seems to run both ways.

4) Neuroinflammation: I’ve written about this one before but it is worth repeating: Inflammation of the brain appear together. That’s why anti-inflammatory drugs can help fight depression. Again, the direction of the relationship is at least somewhat unclear, but treating inflammation can help treat depression.

5) Vegetarianism: Of the five items I discuss here, this is the one that took me by the most surprise. A Psychology Today article linked being a vegetarian with depression, noting that there is ample research to suggest that the two are connected. As always, however: The direction of the connection is harder to suss out, and there is evidence to suggest that the two are not connected.

I baked a cake! It wasn’t too good, I had a ton of fun, and you should do something, too

Behold! Behold! A Schloss Cake!!!

img_4252
The cake I baked: It’s Schlosstastic

What you are looking at is a red velvet hilarity. It took me about four hours to bake and was largely inspired by the Great British Bake-Off. My wife and I have been binging on it lately, and that can only end hilariously.

I’m not a complete noob at baking. I’ve baked some pretty good cookies and brownies, but a CAKE. Man, that’s a whole different level.

And how did it go? Well, poorly. Everyone LOVED the cake. No one liked the icing. Want proof? Here was the cake when I got back from work:

Cake With Icing.jpg

Now, to answer the question which may have popped into your head: Why the hell am I writing about a cake on a blog about depression?

Welp, because it was fun. And engaging, and I mean ALL ENGAGING. And that was really good for me.

Let me explain.

When I was a kid, I remember my Mom telling me that when she was down, she loved to bake. She said it was all engaging and really absorbed her attention. As an adult, I’ve found that she was completely right.

This jives with my efforts to fight depression. I’ve noticed that, the more absorbed I get in an activity, the less time I have to think about depression. Indeed, this is something I’ve written about before: The key role that rumination has in depression. This is something which has a large role in the book The Depression Cure: Fighting rumination means finding an engaging activity to absorb your attention and break the cycle of rumination.

And, let me tell you, when you bake, your attention is absorbed. Or, at least, it better be. Otherwise, your icing may suck…I mean, otherwise, things won’t come out as good. And I have to say, I really enjoyed it. I think there’s a piece of me…a very large piece…which is still a little kid. You want me to play with food AND bake something which could be very tasty? I’m in! Where do I sign up? And yes, there is a sense of pride that goes with baking. It’s kind of fun to know that I made something which is at least a little bit tasty.

Should you bake? Maybe. I mean, if it isn’t for you, don’t – but, if you want to try, I say it’s totally worth it (start with cookies, those are simpler and harder to mess up). But, if you don’t want to bake, do something else. Do something engaging, something that will swallow you whole. Do something fun. Just do something. It’s really important to beat depression.

And, as always, if you have any comments or thoughts, please let us know below!

Why the idea of a “pill for loneliness” has me nervous

I came across this article in The Guardian: Scientists are apparently working on a pill for loneliness.

The article does a great job of noting a fundamental truth about humans: We are social creatures. When we are denied social interaction with others, we become depressed and lose our ability to function. As a result of societal changes, a changing family and work structure, the increasing business of human life (and more!), humans are spending less and less time with others. We’re spending more and more time by ourselves. This has frightening implications for our ability to function as a society and as individuals.

Loneliness is bad for you. This is something which The Depression Cure concentrates on, and the Guardian article correctly notes:

Loneliness elevates our risk of developing a range of disorders, including cardiovascular disease, neurodegenerative diseases, cognitive decline, and metastatic cancer. It also weakens the immune system, making us more susceptible to infections. Left untended, even situational loneliness can ossify into a fixed state that changes brain structures and processes…

The cure, in my opinion, has to start on the individual level. We have to prioritize getting off the damn phone and spending time with others. It is very much within our ability to change our lifestyles and re-prioritize how we use our valuable time. The change won’t be easy, but it will come.

That being said, there’s a “promising” line of research creating medication which would “interfere with the ways loneliness affects the brain and body.” Initial studies have shown that the medication reduces perceptions of loneliness among those who take them.

This has me really, really itchy and uncomfortable.

Look, let me just clarify something: I am very pro-medication for treating depression. I’ve been on anti-depressants for almost half my life and I know that they have saved my life. They’ve given me an ability to function which I never would have had otherwise. Medication, combined with therapy, can give someone their life back.

But, that doesn’t mean that we should default to medication when other options are available.

I’ve taken medication for depression – along with millions of others – because traditional therapy wasn’t enough. I viewed it not as a first resort, but as a second/third one (I wouldn’t even say last because there are more intensive forms of therapy, like ECT). But the notion of someone being lonely and turning to a pill has me uncomfortable because there are less radical options which are relatively easily available. 

People who are lonely can undergo a slew of social efforts in order to meet people. Sometimes, this means making yourself attend classes or events. Other times, this means picking up the phone and calling someone in your social network and redeveloping a preexisting connection. But, more often than not, there are ways to deal with loneliness. That’s why I’m nervous here. We can’t just turn to pills to fix something when there are other solutions available.

I suspect I am not completely understanding this. There is something in the article about how taking the medication can actually help people reconnect with others – loneliness can work like depression in that it can create a “cycle” of loneliness – you get lonely and feel too “stuck” to fix it, so you don’t connect with anyone and you withdraw further from your social circle, and then you get more lonely, etc. I get that. But I fear that a pill to cure loneliness will, in the long run, just make us all more lonely.

This is one of the more controversial things I think I’ve said lately about depression and medication, so I’d be curious to hear what you have to say. Am I right or wrong? Let me know in the comments below!

What is depression?

Spoiler alert: It’s more than just sadness.

Before I begin, let me explain why I’m doing this blog entry.

If you’ve read anything about me or on this blog, you know that I regularly speak about depression, including it’s causes and potential solutions. However, one of the things which occasionally surprises me is that there is a lack of awareness about what depression really is – and how it’s so much more complex than feeling down.

I was looking at Google Trends for some ideas for a blog entry, and I came across this:

depression google trends

This is a look at searches and trends related to the phrase “depression.” The first four are not really a surprise, but it’s the fifth entry that is most interesting: “What is depression.” For something to show up this high on Google Trends, it must be something that people want to know.

Let’s try to answer that question.

In my opinion, the best way to answer this question is to turn to the experts, and specifically, the DSM-5, or Diagnostic & Statistic Manual of Mental Disorders. The DSM-5 is basically the bible for psychiatric disorders and is used to diagnose depression.

According to the DSM-5, the “formal” criteria of depression include any of the following:

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To meet the formal criteria, someone must experience at least five of these symptoms over a two week period, must have #1 or #2, and they must impair functioning or cause distress.

Why is the above information important?

Because I’m trying to make a point here: Depression is so much more than feeling sad.

There’s this misconception out there that depression – real, painful, rehabilitating depression – is simply about sadness. That it’s just a matter of feeling down. And that’s just not the case, at all. Depression is about so much more, including:

  • Losing pleasure or the ability to feel joy
  • Emotional numbness
  • Feeling sluggish and slow, like you’re moving through jello
  • Fatigue
  • Excessive feelings of worthlessness or guilt
  • Losing the ability to concentrate
  • Thinking excessively of death
  • Restlessness and losing the ability to sleep

Again, and let me emphasize this: I’m not a doctor. But I’ve been there. And I want to make sure that you can recognize symptoms of depression in yourself or others. Depression is more than just sadness, and if any of the above sounds too familiar to you or someone you love, please seek help immediately. This world is worth living in. And you should know what you are experiencing if you find yourself in this kind of pain.

A review of The Depression Cure and Therapeutic Lifestyle Change: Is beating depression REALLY that simple?

I recently finished The Depression Cure by Dr. Stephen Ilardi. It was…interesting. A unique blend of common sense, historical perspective and medical research, boiled into a six-step process which claims to be able to beat depression. My summary? A lot of merit in here, albiet maybe too simplistic. And I plan on incorporating some of what I learned into my life.

For starters, here’s the crux of the book: Depression is a disease of civilization. Ilardi argues that we’ve seen a rise in depression because of the way we have become civilized and socialized. We don’t get enough exercise, enough sunlight, enough of the right kind of food, enough sleep or enough social connections. We have broken away from the way our bodies and minds have evolved, and as a result, we’ve broken down.

Even more interesting: The book came out in 2009, well before iPhones became hugely ingrained in our lives. During that time, depression and rates of mental illness have only increased.

So what’s the cure? According to Ilardi, we need to do six things:

  • Get at least eight hours sleep.
  • Get more sunshine/natural light – including with a lightbox.
  • Improve our social connections.
  • Stop ruminating.
  • Improve our consumption of certain nutrients, like Omega-3s.
  • Get more exercise.

Ilardi claims that these steps combined – which he describes as Therapeutic Lifestyle Change – can dramatically reduce, if not outright eliminate, depression.

What does the research say? Well, that’s the thing, actually: This stuff isn’t psuedo-science. Each and everyone of the six steps above is backed up by real research which shows that these items can help reduce depression. Heck, I’ve written on many of them long before I read this book, including sleep and rumination.

How about the overall TLC package? TLC’s website provides a link which shows the effectiveness of each of these items individually, although I couldn’t find anything which evaluates the package as a whole. Still, it makes sense that they would work when used together, with the effectiveness of each individual element hopefully reinforcing each other.

My greatest issue? It just seems…too easy. Ilardi argues that, in many cases, sunshine can beat depression. I just cannot imagine it’s that simple. I also know how difficult it can be to do some of these items. When you are severely depressed, you may lose the ability to care for yourself or work towards self improvement. To his credit, Ilardi recognizes this: He breaks down each of these steps into small, easy to swallow, achievable items. He also acknowledges that there can be many causes of depression for which TLC is inadequate, including PTSD, brain damage and other medical changes.

If this is all real, I’d argue it could be a paradigm shift in depression. We wouldn’t need therapy or drugs: We’d need sleep or sunshine. It seems too easy and I’m skeptical. I’m very pro-medication (when necessary), and this book just seems to simplistic at times.

Still.

I’m going to give some of this stuff a shot, starting with the Omega 3 supplements, and I highly recognize you do the same (if you’re doing anything physical, like a lightbox or supplements, you should talk with your doctor first – I did!). At the worst, this stuff is harmless or good for you anyway. At the best…who knows.

If you’ve had any experience with TLC, please let us know in the comments below!

Access to guns means higher rates of suicide. What we can do about it is a harder question.

I recently shared this article on my Facebook page. The crux of the article is this: States with higher gun ownership have higher rates of youth suicide, and the gun ownership leads directly to more suicide. According to the article, “For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9 percent.”

This study comes in addition to the overwhelming evidence which shows that access to guns leads directly to higher rates of suicide. This isn’t just in terms of youth suicide, but for individuals across the country, regardless of age.

Why is this? While suicidal thoughts and ideation can be a long standing problem, the impulse to actually kill oneself is often a fleeting impulse. That’s why so many advocates – including me – have concentrated on means reduction when it comes to suicide: If we can get someone through that terribly difficult moment, we may be able to get them the help that they need.

Unfortunately, guns are one of the deadliest methods of suicide. If someone attempts suicide with a gun, that method will tragically “work” more than four out of five times. Gun use also explains some of the gender differences of suicide attempts vs. suicide completions: “…women are roughly three times more likely to attempt suicide, though men are around three times more likely to die from suicide.” This is, at least in part, because men are more likely to use a firearm.

While the evidence is overwhelmingly clear that there is a problem, how we address that issue is something else entirely. Like it or not, guns are overwhelmingly pervasive in America, and basic gun ownership is legally protected. Furthermore, it can be difficult for someone who favors gun control methods to advocate for reducing gun-related suicides without seeming like you are actually advocating for more gun control and to take away guns from law abiding citizens (trust me on this – I’ve run into the issue many times!). Any effort to reduce the access of suicidal people to guns has to be balanced with already existing legal protections.

So, what can we do? Many states have enacted so-called “red flag laws” which create a process by which guns can be temporarily removed from someone’s home if there is evidence which shows they can be a danger to themselves or others. Such laws can be effective in reducing suicide: According to a 2016 study of such laws in Connecticut and Indiana, “Indiana’s firearm seizure law was associated with a 7.5% reduction in firearm suicides in the ten years following its enactment, an effect specific to suicides with firearms and larger than that seen in any comparison state by chance alone. Enactment of Connecticut’s law was associated with a 1.6% reduction in firearm suicides immediately after its passage and a 13.7% reduction in firearm suicides in the post–Virginia Tech period, when enforcement of the law substantially increased.”

That’s an amazing number. And that’s a real difference.

But it doesn’t just take a law or official government action to make an impact in this regards. Take New Hampshire, where the Gun Shop Project has encouraged New Hampshire firearms instructors to “show a video about suicide prevention in their classes.” That information, coming from peers, can be powerful. I hope that research is conducted on these efforts in the future.

We have to find a way of respecting the rights of gun owners while protecting those with mental health challenges, but I do have to think there is common ground here. It is my hope we can find that space.

I’m just gonna try to make you smile for a second: Here are seven subreddits you should look at

Does the internet help with depression in the long term? Social media definitely doesn’t.

But, that’s not to say that all social media is evil. Some of it is downright wonderful.

One of the most popular social media/internet forums is Reddit. Reddit, for those of you who don’t know, is one of the longest running internet communities of…anything. And I mean anything.

For those of you who want more info, this video is a good starting point:

Reddit is made up of a series of topic discussion boards, called subreddits, that are organized around certain topics.

Now, just to be clear, like all forms of the internet, Reddit can be absolutely, positively terrible. It’s comment can be insanely abusive and it’s sleuthing “abilities” have led mobs on wild vigilante quests. Thankfully, most of these uses are rare, and if you stick to the right subreddits, you can find some amazing content, guaranteed to make you smile.

So, even if you don’t have a Reddit account (you don’t need one), here are seven subreddits which will absolutely bring a smile to your face.

  1. BeforeNAfterAdoption: Pictures of kitties, puppies and the like, before they are adopted and after. They go from beaten and beaten down to happy and playful.
  2. Aww: It’s just cute things. It’s just cute, cuddly things that will make you go AWWWWWWW.
  3. DadReflexes: If you’re a Dad (or Mom, let’s be real), you know the meaning of this phrase – you get so good at watching your kid that you reflexively can move to keep them out of trouble. These are videos and GIFs which show prime examples of Dad Reflexess saving their kids from trouble.
  4. AnimalsBeingBros: Sounds like you need some more cute animal videos! Here’s animals being friends with each other. Wish humans could get along this well.
  5. Funny: Arguably the most self-descriptive subreddit name ever. Also, yes, it really is funny.
  6. PhotoshopBattles: People will upload great pictures for the purpose of being photoshopped into amazing situations. Examples include cats being kicked in the face by other cats, police officers with two foot differences between them, and more. Words aren’t going to do it justice. Go look!
  7. UpliftingNews: The news is terribly depressing. Here’s a thread of amazing, wonderful news which shows that maybe the world isn’t going to hell in a hand basket at quite the speed it seems like it is.

Any other good subreddits to share? Let us know in the comments below!

 

Why don’t we prioritize self-care?

A good chunk of my life as a public official deals with mental illness as it impacts my constituents. One of the key issues, of course, is that far too many people have access to mental health care – some studies show that only 44% of the mentally ill actually get treatment. That’s a tragedy and a travesty, but it’s reflective of a larger issue:

We do not prioritize how we care for ourselves, or our minds.

And if you need any truer example of this, well…think of yourself. And I mean that seriously. I know everyone is different, but I bet that if you got a bad cough that you couldn’t shake, you’d go to the doctor. If you broke your arm, you run to the ER.

Now, should you run to a therapist every time you get sad? No, of course not. But I will say this: I think there are far too many people out there who simply don’t take the time to take care of themselves. And that may not mean seeking counseling. It may be as simple as taking a walk. Meditating. Building some time into your day to de-stress before your own sadness levels reach a crisis point.

Is that you? It almost certainly is. None of us – and yeah, I know this is me – adequately take care of ourselves. This is true across most sectors of society. How many of us are stressed? How many of us know we should be doing more to watch our for our emotional state of well-being, but don’t?

For example, check out this TED Talk from Guy Winch on emotional first aid, in which he discusses emotional hygiene:

Winch nails it: We know and teach remarkably little on emotional hygiene and well-being. Winch asks the question that I am asking to you now: “Why is it that our physical health is so much more important to us than our psychological health?”

One of the books on my reading list is The Depression Cure by Dr. Stephen Ilardi. The book essentially makes six recommendations for treating depression:

  • Eating more Omega-3 fatty acids
  • Engaging activity
  • Physical exercise
  • Get more sunlight
  • Strong social support network
  • Sleep

Now, serious question: How many of you looked at that and went, “Yeah, right, wouldn’t that be nice?”

I mean, I did. And wouldn’t it be nice to get more of these things?

We’ve got a long way to go in society to combat our rising rates of mental illness, depression and anxiety. Many of those changes have to happen at the cultural and governmental level. But there always has to be individual responsibility taken. And if all of us prioritized taking care of ourselves, I bet we’d be happier.

Just something to think about.

Using creative arts to combat depression

If you follow my Facebook page, you might have noticed that I posted this article the other day. It’s an NPR story about a photographer named Tara Wray who used photography to combat her depression. Said Wray:

“Just forcing myself to get out of my head and using the camera to do that is, in a way, a therapeutic tool. It’s like exercise: You don’t want to do it, you have to make yourself do it, and you feel better after you do.”

According to the story, this effort resulted in Wray launching the Too Tired Project, which bills itself as, “a photo initiative and traveling slideshow series that aims to help those struggling with depression by offering a platform for collective creative expression and community.”

Creative arts have been used to fight depression throughout history; indeed, creative arts and depression are often linked. Many of history’s greatest artists have struggled with their own demons.

So, why is it that creative arts can help people with depression?

Well, I think the quote above is at least a piece of the answer. Engaging into some other hobby – getting into a sense of flow, if you will – can get you out of your head. I firmly believe that escaping yourself is a key part of beating depression. Even if it’s for a little bit, you can trick your brain into thinking you are somewhere else, and when you “return,” things just don’t seem as bad.

Wray also notes that the arts can provide an incredible sense of relief and accomplishment: “When I’ve made what I think is a good picture, I can feel it, and everything else momentarily falls away.”

I’ll add two personal experiences. Redemption started for me during a very down period. I was struggling at work (for those of you who follow Pennsylvania politics, it was 2015 and we were just starting a rather infamous budget impasse which was very stressful). My wife had just started at a new school and she was struggling as well. As a result, I needed an escape. And thus, Redemption was born.

Second is the simple fact that it gives you an alternative perspective that is still within you – one that you can still apply to your normal life. Redemption has a few plot threads going on, but it’s core is a twenty year old named Ash, trying to deal with his inner demons, beat his depression and live his life (and save the world but that’s a whole other story!). The book features a cast of characters who help him cope.

This may be an obvious point but for the purposes of this discussion I have to make it: I wrote all of the characters. They are all my voice, my perspective and my experience. But there was something deeply therapeutic about putting that level of advice and support into another character. It reminded me, in a sense, that all the hope, words and inspiration I need are inside of me to begin with.

Creative arts – writing, drawing, photography, whatever – I think they allow you to expunge and make sense of everything ugly inside of you. They force you to think of a perspective outside of yourself. And in that sense, they can help save you.

If you have any other thoughts or experiences, I’d love to hear them.