How blue are you?

by Women's Brain Health Initiative:It’s been over two weeks since you’ve felt like yourself – loss of appetite, erratic sleep patterns, unable to concentrate and even the things you like to do, aren’t giving you any enjoyment.  You can’t put your finger on it, but you hear yourself using words like glum, miserable, unhappy – basically down.  What’s going on and what should you be doing about it?The Women’s Brain Health Initiative recently sat down with Dr. Nasreen Khatri, a registered clinical psychologist who specializes in the assessment, treatment and research of mood and anxiety disorders to discuss issues of depression and the aging brain.Dr. Khatri began our interview by getting me up to speed on some of the facts we all need to know about depression, women and aging. 

1. A history of untreated depression in mid-life and beyond doubles the chances of developing dementia later in life.
2. Women are diagnosed twice as often with depression compared to men.
3. Women are twice as likely to have dementia than men.
4. Depression is usually a chronic disorder more like diabetes, than an acute episodic problem, such as breaking your leg.
5. Depression starts in the mid-twenties for women and tends to wax and wane throughout life.
6. Depression exacerbates chronic physical health disorders, such as hypertension and diabetes.
7. As a population ages (as is the case in Canada), the number of depressed people increases.
8. The highest suicide completion rate occurs in adults over 65.

“Depression is a combination of many symptoms,” said Dr. Khatri.  “Changes in physical health, cognition and mood all point to something going on.  Depression in a 30 year-old woman can present itself as being upset, sad and crying with no real understanding of where this is coming from.  In a 70 year-old woman, it can present as memory complaints.”What should we be looking for if we are concerned that ‘something’ is going on?See your doctor.  Get a physical.  Make sure that there are no physical changes caused by low iron or change in thyroid function, issues that have symptoms that can mimic depression.  Ensure that you have your hormone levels checked as well to rule out hormonal fluctuations caused by pre-, peri- or post-menopause.If your doctor doesn’t find anything physical, you should then have a mood assessment – what Dr. Khatri calls “A Check Up from the Neck Up.”A mood assessment will detect your depression, help identify lifestyle and environmental factors contributing to your illness, and provide a rational basis for the development a treatment plan.What options do you have if you are diagnosed with depression?There are various anti-depressant drugs on the market that your physician can prescribe.  However, for older adults, medications can take longer to provide a therapeutic affect; most elderly have complex medical conditions, which may contradict the use of antidepressant drugs; and side effect profiles may be intolerable for some elderly individuals.On the other hand, Cognitive Behaviour Therapy (CBT) is a psychotherapeutic approach addressing emotions, behaviors and cognitive processes.  It is a structured, evidence-based time-limited psychotherapy that is the gold standard treatment for treating depression.  It is especially helpful with older adults because their depression involves cognitive dysfunction that CBT can address.  Also there are no drug interactions, side effect profiles or wait times for therapeutic effects to ‘kick in’ as there may be with drug treatments.“Because CBT is a more targeted treatment,” says Khatri.  “it is the gift that keeps on giving.  CBT is a self-management program that allows the individual to become her own therapist over time.   Studies have shown that patients with depression who are treated with drugs are twice as likely to relapse within 12 months than patients who engage in Cognitive Behaviour Therapy.  CBT is cost-effective; improves mood, cognitive functioning and problem-solving skills; and, cuts relapse rates.  And because it helps improve cognition, it may help to stave off dementia.”Which relates to the very first thing that Dr. Khatri told me - a history of untreated depression in mid-life and beyond doubles the chances of developing dementia later in life.  What else can we do to counteract the impact of depression on our cognition?How many studies does it take to convince you that moderate exercise will make you happier? If you need one more reason to start being more physically active, professors from the University of Toronto have compiled and analyzed over 26 years’ worth of scientific research which concludes that even moderate levels of physical activity—like walking for 20-30 minutes a day—can ward off depression in people of all ages.Make sure to talk to your doctor about the best exercises for you - those that will have the greatest impact on your brain.  Neuroscientists now know that we can regrow our hippocampus – the part of the brain that regulates memory.  What’s good for your heart is good for your brain, which means that cardio exercises, the one that makes you sweat, will help you to retain memory and can be another preventive measure for declining cognition.Another interesting factoid is that we all tend to hold onto negative memories – so it’s important not only what you remember, but how you remember it.  One of the benefits of exercise is that it makes us feel good about ourselves, improves outlook as well as general health – all a good thing.Dr. Khatri wants us to remember that untreated depression in women is one of the most burdensome worldwide.  The impact of this crisis will be felt at every level of society and within every age group.  Because women fulfill the role of wife, mother and caregiver, we can’t afford to breakdown.  Although we have no current cure for dementia, we can help prevent cognitive decline as we age.“You can always change your mind,” says Dr. Khatri.Source: