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Mental Health Issues Throughout the Lifespan

In March 2008, our guest expert in Le Club's Ask the Expert segment was Dr. Lynne Peters, a psychiatrist working in the Women’s Mental Health Program at Women’s College Hospital.

She graduated with a degree in medicine from Dalhousie University in Halifax in 1999. She completed her specialist requirement in psychiatry at the University of Toronto in 2005.

After graduation, Lynne worked in the geriatric mental health program at the Centre for Addiction and Mental Health (CAMH) in Toronto. She gained a greater understanding of cognitive troubles including Alzheimer disease and other forms of dementia while working in this position.

At Women’s College Hospital, her primary role is to develop a new geriatric mental health program focused on reintegrating women into the community. She is also interested in mental health during the prenatal period, as well as psychiatric problems which accompany physical illnesses.

Here are Lynne’s answers to your questions on Mental Health Issues Throughout the Lifespan:

Q: I am 32 and was diagnosed with clinical depression in my late 20s. I spent several years on Zoloft and have tried, on two or three occasions, to come off of it. I am usually fine for a few months, but ultimately reach the point where I cannot cope and have to go back on it. Does this mean I will need to be on medication for the rest of my life? I have explored therapy and non-medical based intervention without any success.


A: For some people, long-term treatment with antidepressant medication is necessary – this is the case when episodes of depression have recurred several times, or when the depression has been very severe or hard to treat. This is an individual decision to make with your doctor.

Stopping antidepressant medication should be done at a time in your life when stress is as low as possible – not when moving, changing jobs, going through relationship or family changes (to name just a few stressful times in women’s lives!)

The decision to stop should be made jointly with your doctor. This is important for a few reasons: first of all, some medications are hard to stop due to withdrawal effects, and reducing the dose very gradually is necessary. Also, you need someone keeping an eye out for any early symptoms of depression that may re-emerge. Staying healthy is the number one priority. If your depression starts to come back, treating it early – before it gets bad – is important.

In your case, I wonder if you really had a full and sustained response to your treatment in the first place. It is important to be fully back to normal and then to stay on the same dose of medication that led to this recovery, for about a year, before trying to stop the medication.

Rushing things does not work, because the underlying depression is still there until it gets well treated. If you are currently taking your medication, ask yourself if you have any lingering symptoms of your original depression, even if they are mild. If so, see your doctor and consider adjusting your dose of medication, or adding in therapy again. Once you are fully better, start the clock, wait a year, and then discuss stopping with your doctor, if things in your life are low-key.

 


Q: My question is about depression in elderly women. I am wondering what pharmacological causes there may be for depression in the elderly and also what kinds of effects depression has on other body systems. Thanks.

A: Symptoms of depression occur frequently in the elderly, and need to be taken seriously. It is not normal for the elderly to be depressed! There can be many different causes, and particularly if a person appears depressed for the first time late in life, it is crucial to look for causes other than clinical depression.

You mention pharmacological causes. Some medications have been associated with symptoms of depression. I am not going to list them all because individual responses vary a lot, and the best way to figure out if a medication is causing a problem is to watch for side effects when first starting to take it (this is usually when problems appear).

An important type of side effect affects memory and alertness, sometimes mimicking depression in the elderly. These are called anticholinergic side effects and they can be caused by many different medications, including some sleeping pills, antihistamines, bladder medications and pain killers.

If a person seems confused and has a dry mouth, constipation or trouble urinating, there may be anticholinergic medications on board. In addition to causing signs of depression, these medications can also cause delirium and symptoms that mimic dementia.

Depression’s effects on other body systems are numerous. A depressed person generally does not take care of themselves well, because they lack energy and appetite, and because they may not feel like they are worth the effort. In the elderly especially, this is a serious problem.

It is easier for an elderly person to become dehydrated or malnourished, or to suffer because of neglect of other health conditions (such as not taking medications properly). A depressed elderly person will not be getting enough exercise, and this will lead to general weakness and bone and muscle loss.

In conclusion, an elderly person who appears to be depressed needs urgent medical care. They should bring all their medications with them when they see their doctor. They need effective treatment of depression (once other causes of their symptoms have been ruled out) or it can literally take years off their lives.

 



Q:
I became a mother three months ago and have been very aggressive and hysterical with the people around me. I have been seeing a psychiatrist for one month but am not noticing a lot of improvement in my behaviour. I'm sick of myself, help me!

A: Postpartum psychiatric disorders are both common and potentially very serious, both for the health of the mother and the wellbeing of her child and family. These disorders can include major depressive disorder, bipolar disorder and psychotic disorders. It is important to understand the specific diagnosis that your psychiatrist has made, and to share this information with your loved ones.

You need to ask for as much help as possible. This does not mean that you are inadequate in any way as a mother. In other cultures, it is the norm for new babies to be looked after by extended families. This will allow you to recover from this huge physical and emotional change in yourself. One of the most important things you can do for yourself is rest and sleep.

The other crucial thing right now is to make sure that your child is safe. If you have thoughts of harming the baby or yourself (you mention you have been ‘aggressive’) you need to tell someone right away. Calling 911 or going to the emergency room can get you the immediate help you need.

On the other hand, remember that these problems are usually very treatable, and the vast majority of women go on to derive great enjoyment from motherhood. It may take longer than a month for the treatment you have begun receiving to help you.

 


Q: I am 39, and generally in good health, but in the last four months my periods started to change radically. My mind started to go through all possible dark scenarios and I know stress is not improving my situation. It is actually making it worse, and this is making me more worried. I am in a circle I can't escape.

How can one cope with this, and what can be done to keep this mind focusing on the negative thoughts? I guess all the negativity comes from bad experiences (like when I had an ectopic pregnancy, or ovarian cysts) and it is hard to think one can have problems that will go away easily. 

A: It sounds completely understandable to have these sorts of worries, based on your gynecological history. Try not to judge yourself too harshly for having these fears and memories.

But – don’t let the past interfere with the present and the future. The most important thing you can do to break out of this type of worrying is to find out what is happening NOW. Start by making an appointment to see your family physician as soon as possible.

Although it is not my field of expertise, there are certainly many reasons that a woman’s menstrual cycle can change at your age – thyroid issues and perimenopausal symptoms are just two relatively non-threatening reasons that come to my mind.

If your worries don’t subside once you start to take charge of the current situation, or if they prevent you from even seeing your doctor, you may have a more serious anxiety problem such as post-traumatic stress disorder. In that case, a visit to the doctor is still in order. Make the call!

 


Q: I have had problems with depression most of my life. I am obese and I know that much of it is emotional eating. I also have problems with fixating on past hurts or failures. I am on an anti-depression medication but it does not always help. Can you suggest a kind of therapy that might help? I currently can not afford expensive therapy. I am desperate to lost weight.  

A: It can be hard to recommend a particular type of therapy without meeting you in person, to understand more about the issues that are bothering you. It also depends on what is available in your local area.

That being said, it does sound clear to me that you need to take charge of your health and your life. I wonder about cognitive behavioural therapy (CBT). This may help address the connection between your thoughts and feelings and the problematic eating behaviour. It will also take into account the issues from the past, but without dwelling on them (it sounds like this is what bogs you down).

Finding a therapist you can afford may take a little time, so start calling around. This type of therapy may be offered by psychologists, social workers, physicians and others.

There are several other things you can do while looking for a therapist. Have a physical to check on your overall health, get moderate exercise (if this is safe for you), get enough sleep and consider seeing a dietitian.

 



Q:
Is it common for women over the age of 40 to go on anti-depressants and anti-anxiety medication? And if so, are these women usually on this medication for the rest of their lives?

A: Many women over the age of 40 take medications for depression and anxiety. Several commonly prescribed antidepressants are considered to be very safe and effective for this age group.

Anxiety is sometimes treated with another class of medications called benzodiazepines. Examples include lorazepam, clonazepam and temazepam. Benzodiazepines are anti-anxiety medications that are calming but potentially sedating. They can be problematic at any age, but the older the person the greater the risk. They can lead to confusion and loss of balance, contributing to falls. They should only be used as a temporary measure, in most cases.

The length of time that a person takes an antidepressant really varies depending on individual circumstances such as the precise diagnosis, how many times it has happened and how severe the symptoms are. This should be discussed on an individual basis with one's doctor.  

 


Q: My whole family has suffered - still suffers - from suicide, and attempted suicide. Hence the topic: lifespan. We are educated, aware of the environment, and have had counselling. I wonder how influential heredity is in this disease as compared to learned behaviour?

A: There is evidence for genetic factors in psychiatric illness, and for suicidal behaviours in particular. 

However, for every individual there is always significant individual meaning attached to a family history like this. In your counselling, I hope that some time has been spent on exploring how you have been influenced by the suicides and attempted suicides of your relatives.

If a person concludes that suicide is inevitable for him or her - such that they are doomed or that there is no point in struggling when life gets hard – this can certainly increase the risk. On the other hand, the risk may be quite different for someone who concludes that they would never hurt their loved ones in the way they have been hurt.

It may also be helpful to remember that diagnosis and treatment of psychiatric illness are always improving, and stigma and barriers to help-seeking are gradually declining. 

Some of your relatives, especially in prior generations, may have had inadequately treated illness, problematic medications, or unaddressed substance use problems.

 


Q: I'm 51, and have had multiple sclerosis (MS) for 10 years. I walk with a cane and with a caregiver to hold onto on my other side. I use a scooter for longer walks. I do a great deal of MS searching on the Internet daily.

Now I notice my whole attitude on myself is mostly negative. I have less desire to see people and rarely go out of the house. I get angry so easily, and when push comes to shove, I just want to give up.

I was more positive and friendly before the last several months. I've been on antidepressants forever but wonder if I should change to a different one. There have been times I scare myself with depression. It just isn't like me. I want to be more caring and giving towards myself and others. Thanks for letting me vent.

A: It sounds like you are describing a very significant change in your mood and behaviour. You should definitely do more than vent. Make sure to see your physicians – family physician, and if recommended, psychiatrist and/or neurologist - to discuss your medication. You may need to increase the dose or - as you suggest - change to another medication (antidepressants, mood stabilizers and antipsychotic medications are all used in MS).

As I am sure you are aware (you sound well-informed about multiple sclerosis) MS is a brain illness, and psychiatric symptoms are very common. People can experience cognitive problems, mood problems and psychotic symptoms as well. It may be important to see your neurologist for an opinion on the overall management of your MS at this point, given this recent and serious increase in symptoms.


Q: Does light therapy for Seasonal Affective Disorder (SAD) work while a person is asleep? I've read that the light permeates the closed eyelids and provides equal benefit.  If so, does the length of exposure recommended change?  I've currently been told to use my light for half an hour, but while awake.

A: I could not find any information on using light therapy while asleep. Although the way light therapy works for SAD is not completely understood, most people believe that it helps to compensate for the loss in strong sunlight during the winter months, at northern latitudes.

The light helps to reset biological rhythms by stimulating your brain to produce the right levels of neurotransmitters (signalling chemicals in the brain).  To do this, the light has to reach your retina, at the back of your eyeball. Your eyes need to be open!

The recommended use is generally in the morning, with the light reaching your eyes indirectly (don’t stare right at the light). If it is used later in the day, it can interfere with sleep at night.

I wonder if your question has to do with all the demands we face, as women, in the mornings. Fitting in light therapy on top of getting kids up, fed, dressed and out and then heading to work ourselves may seem overwhelming.

If this is the case, your family needs to know that your mental health is a major priority. Figuring out a way to get this therapy might also involve your employer – could you start half an hour later, for medical reasons? Another consideration might be a light visor instead of a light box. They are a little less studied but you might want to try one for the advantage of mobility while you get your treatment.

 


Q: I am a 52 year old female and have just lost my last parent. I can't seem to stop myself from breaking down and crying uncontrollably. I am also confronted with financial problems that are making me feel even more overwhelmed. All I want to do is sleep and hope things will be better when I wake.

I find I can't summon the strength to deal effectively with the financial matters. I only have negative support from my partner which stops me from ‘laying things out on the table.’ I have tried speaking to my family doctor but don't get the message across right, as she is very dismissive of my complaints.

What can I do to get out of this rut/slump so I can start feeling more in control of myself and my life? Co-workers are supportive but I can't download on them and really don't want them to know my life history.

I lost my first parent 13 years ago and found myself just starting to get back to normal. Is this normal or am I over-sensitive?

A: It does not matter what is ‘normal’. There are huge individual and cultural variations in grieving. You know from experience that this is very difficult for you. You have lost a parent, but you don’t need to lose another thirteen years of your own life.

Bereavement is considered to have crossed the line into clinical depression when there are several symptoms of depression that are prolonged, or that are very severe or impairing. For example, it is not normal to seriously plan for suicide when mourning a loss, or to stop looking after one’s own hygiene.

I think you should see your family physician again and explain your concerns about your own health. If you are clinically depressed, medication or therapy (particularly Interpersonal Therapy) may be in order.

If you are not depressed, what you do need is support. Sometimes groups are very helpful. In Ontario, a service that can help connect you is called Bereaved Families of Ontario.

 


Q: Can a person who is type 2 bipolar work, despite all the symptoms of the illness such as anxiety, insomnia, depression, weight gain and loss two to three times a year, stress, etc.? Thank you.

A: People suffering from bipolar disorder can certainly lead full, productive lives that include meaningful work. The symptoms you are describing need to be brought under better control. Your medications need monitoring and some attention needs to be focused on figuring out what is leading to so many episodes every year.

Sometimes medications, substance use, thyroid problems or life stressors can be contributing. Limitations on work are generally those that destabilize one’s lifestyle in major ways, such as shift work, long or erratic hours, or travel across time zones.

 


Q: I’m a 50-year-old female and I’ve had an eating disorder since I was a teenager. I have sought psychological help over the years. My mental state is very disturbed and I can’t let go. Is it possible to live with an eating disorder and retain a certain amount of serenity? What should I do?

A: Please see your doctor again about this matter. There may be something going on in addition to the longstanding eating disorder. If you are depressed, for example, this may need specific treatment.

No chronic condition will go away on its own. You should look for treatment again (there may be some new approaches since you last sought help) because your quality of life is not what you want it to be.

Very likely some of the issues in your life are different now too.

Many women do reach some serenity with their bodies and their eating. Without knowing your particular eating disorder, I cannot tell you more specifically what to expect.

 

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