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Stress and Depression
What Is Stress?
Stress is a normal physical reaction that occurs when a person feels threatened or overwhelmed. The perception of a threat is as stressful as a real threat. The stress response narrows one’s ability to think clearly and function effectively. It can be disabling both emotionally and physically. The goal of stress management is to bring the nervous system back into balance, restoring a sense of calmness and control to the stressed individual.
Physical Effects of Stress
There have been many studies indicating that health is greatly affected by how one reacts to stressful events in life. The common finding is that the number of life changes and stress a person has experienced increases their chances of contracting a physical illness. A study by Cohen, Tyrrell, & Smith in 1993 showed that the “higher the subject’s reported level of stress, whether measured by negative life change events, perceived stress level, or negative feelings, the higher the likelihood that the subject would actually become infected with a cold.”
Many studies show that being depressed increases the risk of having a heart attack, whether or not the individual has heart disease. Long-term stress can affect the immune system as well. Most people with healthy immune systems take their resistance to disease for granted, but the most common causes of weakened immunity in healthy individuals are stress and aging. Many studies have been done on the physical stress response in the elderly, and it was found that when placed under stress, elderly people experienced loss of appetite, weight loss, a lowered lymphocyte count (which impairs immune function) and an increase in psychological distress and in serum cholesterol levels. Also, negative stress increases our body’s production of free radicals. This is because the pituitary stimulates the adrenal glands, which in turn produce the stress hormones cortisol, epinephrine, and norepinephrine. These chemical reactions set off a chain response, resulting in still more free radicals.
Methods of Preventing and Coping with Stress•
Lifestyle habits that can help avoid or manage stress include:
• Getting enough sleep: Adequate sleep fuels the mind, as well as the body. Feeling tired will increase stress because it may cause irrational thinking.
• Connecting with others and developing a support network.
• Exercising regularly: Physical activity plays a key role in preventing and reducing the effects of stress.
• Eating a balanced, nutritious diet: Well-nourished bodies are better prepared to cope with stress.
• Reducing caffeine and sugar: In excessive amounts, the temporary “highs” they provide often end in fatigue or a “crash” later.
• Not self-medicating with alcohol or drugs: While consuming alcohol or drugs may appear to alleviate stress, it is only temporary. When sober, the problems and stress will still be there. It is important not to mask the issue(s) at hand.
• Doing something for yourself everyday: It is important to take time out from the hustle and bustle of life for leisure time. Too much work is actually inefficient and can lead to burnout.
Changes in Thinking and Emotional Response to Better Handle Stress
Ways of thinking and responding that can reduce stress include:
• Having realistic expectations of one’s limits and capabilities.
• Reframing problems as opportunities.
• Maintaining a sense of humor.
• Expressing feelings rather than bottling them up.
• Not trying to control events or other people.
Compassion Fatigue
Medical professionals often suffer from a type of stress known as “compassion fatigue,” resulting from the day-to-day stress of seeing others suffering, with only limited capacity to alleviate that suffering. Compassion fatigue may result in poor job performance and plummeting self-esteem, and thus it can even drive some people who experience it out of their professions entirely. Those who suffer from compassion fatigue can also experience tension in their home lives, or even fall into clinical depression or other mental-health problems.
The signs of compassion fatigue can mimic those of post-traumatic stress disorder, including sleeplessness, irritability, anxiety, emotional withdrawal, avoidance of certain tasks, isolation from co-workers, feelings of helplessness and inadequacy. It can lead to excessive drinking or other unhealthy behavior. And vicarious stress can trigger a professional’s memories of trauma experienced first hand, causing an accumulation of symptoms that can prove debilitating. Those who experience compassion fatigue are often the best and the brightest, those endowed with a high level of sensitivity to the suffering of others.
Compassion fatigue is usually alleviated simply by acknowledging the problem and getting support. The lifestyle and mental response methods of relieving stress outlined above can also assist in relieving this type of stress.
When Is Professional Help Needed for Stress Management?
There’s a fine line between feeling stressed out while still being able to function effectively, and the debilitating, even paralyzing phenomenon of breakdown. It’s time to seek professional help if an individual:
· Feels that stress is affecting their health.
· Feels that it will never end.
· Feels so desperate that they think about quitting their job, running away, taking a drug overdose, or injuring themselves.
· Feels depressed, sad, tearful, or that life is not worth living.
· Loses appetite and finds it difficult to sleep.
· Is managing stress level by eating, sleeping, drinking alcoholic beverages, smoking, or using recreational drugs.
· Has worries, feelings and thoughts that are difficult to talk about.
· Hears voices telling them what to do.
Conclusion
Stress is inevitable in our lives as we age. As a person gets older and older, there are more stressors that appear, which can cause extreme side effects, both physically and emotionally. These effects are not to be taken lightly, since some can result in very serious health problems. If certain preventive measures are taken and certain coping methods are learned, the effects of stress can be reduced as one ages.
What Is Depression?
Depression seems to be related to an imbalance of certain chemicals in the brain. It may present solely as a major depressive disorder, or as part of a spectrum known as bipolar disorder. By definition, it cannot be secondary to physical illness or alcohol, medication or street drug use. It is not a part of the normal bereavement process.
Most of us know about the emotional symptoms of depression. But depression can cause physical symptoms, too. The signs and symptoms of depression are myriad and include:
• Poor appetite
• Weight loss
• Lack of sleep
• Memory problems
• Lack of interest
• Poor concentration
• Lack of energy
• Feeling of impending doom
• Financial problems
• Alcohol or other drug misuse – self medication
• Psychosomatic presentation
• Suicidal ideation
Treating Physical Symptoms
Many depressed people never get help, because they don’t know that their physical symptoms might be caused by depression. A lot of doctors miss the symptoms, too. Depression can cause real changes in the body, such as slowing down digestion, which can result in stomach problems. In some cases, treating depression — with therapy or medicine or both — will also resolve physical symptoms. Since pain and depression go together, sometimes easing pain may help with depression. Some antidepressants, such as Cymbalta and Effexor, may also help with chronic pain.
Depression may be a precursor to another medical disorder, such as Alzheimer’s or Parkinson’s disease. It may also be co-morbid with a disease, such as myocardial infarction, or it may follow a disorder, such as stroke. Depression is common in patients with cancer, and 80% of all cancers occur in persons older than 60 years.
Depression in the Elderly
The risk of depression in the elderly is higher than in the general population for numerous reasons, including social isolation, physical handicap, multi-pathology
and poly-pharmacy. Depression in the elderly is a hugely under-reported and under-diagnosed illness. Symptoms of depressive illness are often seen as a normal part of the aging process or as a normal response to physical illness or disability that often accompanies old age. However, depression left untreated can have significant detrimental affects on concurrent illness and general quality of life. It is estimated that 1 in 3 senior citizens living in nursing homes may be suffering from depression. Although depression is common among older people, it is not a normal part of getting older. Depression can and should be treated.
The following table describes factors and their specific statistics that may increase the risk of depression in an elderly patient.
Medical illness
Hypothyroidism (50%)
Myocardial infarction (45%)
Macular degeneration (33%)
Diabetes (8% to 28%)
Cancer (24%)
Coronary artery disease (20%)
Medications
Beta-blockers
Interferon alfa
Many anticancer drugs
Central nervous system disease
Parkinson’s disease (25% to 70%)
Alzheimer’s disease (15% to 57%)
Multiple sclerosis (27% to 54%)
Stroke (26% to 54%)
Huntington’s disease (9% to 44%)
Microvascular ischemic disease of the brain (20%)
Mini-Mental State Examination score <24
Risk of Suicide
The most serious complication of depression is the risk of suicide. Statistics show that older Americans are disproportionately likely to die by suicide.
· Although they comprise only 12 percent of the U.S. population, people aged 65 and older accounted for 16 percent of suicide deaths in 2004.
· 14.3 of every 100,000 people aged 65 and older died by suicide in 2004, higher than the rate of about 11 per 100,000 in the general population.
· Non-Hispanic white men aged 85 and older were most likely to die by suicide, with a rate of 49.8 suicide deaths per 100,000 persons.
For every 100,000 people aged 65 and older in each of the ethnic/racial groups below, the following number died by suicide in 2004:
· Non-Hispanic Whites — 15.8 per 100,000
· Asian and Pacific Islanders — 10.6 per 100,000
· Hispanics — 7.9 per 100,000
· Non-Hispanic Blacks — 5.0 per 100,000
Special Risks for Women
The female to male ratio for depression is 2.5 : 1, and women are more likely to suffer symptoms of sub-clinical depression.
Diagnosing Depression
There is no lab test to diagnose depression, which is why the healthcare professional’s observations and accurate reporting of patients’ behavior are very important. When diagnosing depression, healthcare providers look for the signs of depression mentioned earlier. They can also use “screening” tests to diagnose depression and determine its severity. Sometimes, depression is caused by or made worse by medical problems. Pain is an example of a medical condition that is associated with depression. Successful treatment of pain can decrease depression.
Some signs of depression can also be signs of infection. For example, if someone stops watching television (which he or she once enjoyed very much), the healthcare provider might want to check to see if the patient has a problem hearing or seeing. Some medications can cause depression. In these cases, the medication that causes depression can be stopped or the dosage can be decreased. In general, if no medical cause is found for the patient’s changes in behavior, and if the signs have been present for 2 weeks or more, depression may be diagnosed.
Treatment of Depression
The consequences of undiagnosed and untreated depression are substantial. Depression increases the risk for eventual development of permanent dementia, so early identification of depression is especially important in cases of reversible dementia. Persistent depression among individuals with physical dependency following a catastrophic illness is associated with failure to improve in physical functioning. Depression can probably be linked to increased medical morbidity in nursing home residents, and recent data point to increased mortality in nursing home residents with major depressive disorder.
The treatment of depression depends on several factors, such as the severity of the depression, whether or not the person is suicidal, and the person’s ability to reason and participate in conversation. For example, someone with severe depression should receive an antidepressant medication, whereas someone with mild depression may be treated successfully with non-drug therapies.
Management of depression is multi-faceted. Depending on the specific signs and symptoms and complications, therapy may include psychotherapy, drugs, electro convulsive therapy, or a combination of these. A study showed that about 80 percent of older adults with depression recovered with this kind of combined treatment and had lower recurrence rates than with psychotherapy or medication alone.
Psychotherapy – Varying modalities of psychotherapy have been shown to improve symptoms and prevent relapse if used correctly and consistently.
Drugs – Theory suggests that depression is caused by a relative lack of serotonin – the “happy hormone”, a neurotransmitter – in the brain of patients suffering from depression. Drug therapy currently centers on increasing the amount of serotonin at the terminal ends of neurons in the central nervous system.
There are many classes of drugs available for treating depression, including, most commonly, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), and in refractory cases, lithium. Studies have shown that patients aged 70 and older who became symptom-free and continued to take their medication for two more years were 60 percent less likely to relapse than those who discontinued their medications. The problem with drugs is compliance. The disease process itself may prevent patients from consistently following a drug regimen. A large part of the problem is the side effects of drug-therapy, which include dry mouth, drowsiness, dizziness and anxiety.
Electro convulsive therapy (ECT) – A long-used and feared form of treatment, this modality has a high success rate in the treatment of depression. It is reserved for patients in whom other therapies have failed or are causing unacceptable adverse effects, or in patients where a positive result is required quickly.
ECT is performed under general anesthesia or sedation. An electrical current is applied directly to the brain, resulting in a minor seizure. The exact effects of ECT on the brain are not clearly understood, but it is conjectured that it changes intra-cerebral chemistry, with positive effects on depressed individuals.
Generally a safe form of treatment, ECT may have some side effects due to the anesthesia or the treatment itself. In the first few hours, the patient may experience headache, muscle aches, nausea and confusion. There may be a transient amnesia also.
Conclusion
Depression is a serious medical disorder, with important physical and emotional consequences, including exacerbation of other disease processes and an increased risk of suicide, particularly in the elderly. However, depression can often be treated successfully, using psychotherapy, drugs, electro convulsive therapy, or a combination of all three.
