As we sat around the table, the issue of depression came up. We were talking about the state of the economy and the ability of young people to get into the housing market in our area. We were also talking about how many seniors we knew were finding things difficult. Jim thought that more people were depressed than ever before but were hiding their conditions. We could all see that there were many reasons to be unhappy, both for youngsters who were just starting out and for seniors who were having a hard time making ends meet. I thought it was an interesting discussion, so I came home and started to look at this issue. Here is some of what I found. The first area I looked at was people with Acquired Brain Injury as my wife had suffered this trauma, but what I found out is that in our discussion we were correct. About 6% of the general population suffer depression, but this is higher in younger and in older age groups.
Depression is more prevalent in people with Acquired or Traumatic Brain Injury. The following is taken from Coping with Depression after Traumatic (Acquired) OR Living with Brain Injury by Margaret Brown, PhD.
In the general population, we would expect that 6 people in any group of 100 experience a significant depression over the course of their lives. People who are depressed experience a loss of pleasure in things that they once found enjoyable. They typically feel sad and hopeless and have trouble getting through each day. They may feel worthless, lack self-esteem and can see nothing good in themselves. They often complain of sleeping too much or being unable to sleep, eating or drinking too much or having no appetite. People who are depressed might start some task, but then feel they can't concentrate on it or get so irritated at the first difficulty that they just stop. Depression may be experienced as unrelenting fatigue, or feeling like sleep is the only relief from the drudgery that life has become. Unlike the ups and downs we all feel from time to time as part of being human, depression typically lasts for a long time - for weeks, months or years. And, as can be seen from the description above, depression can take many forms.
One of the reasons depression "looks" different from different people is that it varies in severity from one person to the next. For example, people with relatively mild depression feel "down" most of the time, but manage to get to work or to school, and in general "keep it together." Those diagnosed with severe depression may experience such sadness, anger and "being down in the depths" that they seriously consider suicide. Depression also may "look" different because it is often mixed with anxiety, so that the person may 1 feel restless, fearful or unable to focus. Whether one has a mild depression or feels suicidal or falls somewhere in between, and no matter the "look" of depression, help should be sought. No one needs to suffer in silence.
When people experience what seems to be depression, the first step is for them to acknowledge having a problem. Next, the person needs to take steps to cope actively with depression. This means moving away from behaviours that keep depression going, such as using drugs and alcohol to "drown one's sorrows," focusing on how "bad" one is and endlessly criticising oneself or keeping one's hopes down by "hanging out" with equally negative friends. The person instead needs to accept that depression is a typical part of life for many and that it can be helped.
The next step is seeking professional help. The earlier help is sought the better, as waiting often makes things worse. And, depression can be helped.
The professional will discuss the two most common treatment approaches for depression - medications and psychotherapy. Either or both of these may be suitable in addressing the specific difficulties that one is experiencing. If medications are chosen, but the professional being seen is not an expert in prescribing and monitoring such medications, at that time the depressed person should be referred to a psychiatrist for selection and monitoring of an appropriate drug regimen
Family members and friends often are more aware of the depressed person's emotional state than he/she is. They recognise depression often before the person with it does. They can play a very important part in helping, as depression often carries with it a deep apathy that hinders depressed people from easily coping and helping themselves. They themselves are ultimately responsible for taking action, but help and encouragement from people who love them are "a good thing." Help should take the form of encouragement, not criticism or treat the person as a child. Depression is very normal after brain injury - it is a fact that can be helped, not a flaw in the person, not a sign of anything except needing to find a positive path.
The family can help by obtaining information about resources in its local area and then by encouraging the depressed person to make the phone call to set up the first appointment or, if needed, to agree to have a family member call on his/her behalf. If the depressed person is unwilling to engage in medical/psychological treatment, the family member might help by reaching out to a trusted friend, doctor or religious leader who might encourage acceptance of treatment.
Family members need, then, to support the person's therapy in positive ways. As needed, this may mean helping remember medications or helping set up a reminder system for remembering. It may mean supporting the person's getting out of the house more often. It may mean participating in family therapy or marital therapy to discuss and address problems that can only be solved as a family group. It always means providing supportive actions, without turning the adult depressed person into a child.
