Overcoming Loneliness in Later-Life Depression

At 80, Agnes was struggling with depression for the first time. She could handle the moments when she felt “blue” or “down.” She could understand that moving into her new apartment was a change, and that change could be stressful. She could even accept that she was forgetting more things, more often, than usual.

But what she could not stand, just could not get used to, was the loneliness. She thought she’d been through the worst after her husband died, but this was different. Her daughter lived only 10 minutes away, her new neighbors seemed nice enough, but still she felt so completely alone. And the more she told herself how fortunate she was, how grateful she should be for her family and her health, how others had it much worse, … the more deeply lonely she felt.

So what is loneliness exactly? Being lonely is similar to being alone, apart from others, but it is also very different. Think of being alone: Isn't it possible to picture a situation when you’d feel OK being alone, maybe even peaceful? Perhaps you'd be knitting a sweater, or walking along a waterfront, or reading a good book. Some people find solitude helps them think clearly and creatively, without distraction.

Now think of being lonely. Isn’t there a completely different tone to your thinking? Loneliness stems from one’s perception of loss, or absence; wanting someone (perhaps someone special) around and not being able to have that. In that sense, some people describe feeling lonely even when they’re around other people, yearning to connect at a meaningful level but being unable to do so.

Loneliness, of course, is a natural part of being human in our imperfect world, in the same way that sadness and grief are normal, expected responses to life’s losses. Older people tend to experience more of these losses, simply by living longer—loved ones die or move away, physical health declines, homes get sold, dreams drift beyond reach. And the fast-paced, youth-oriented nature of our world makes meeting new people difficult for anyone not comfortable with the internet, let alone for people who are depressed.

The kind of loneliness associated with depression is the loneliness that doesn’t ever seem to go away, and is not necessarily affected by whether or not we’re surrounded by people. It may feel like it follows you around, like a dark cloud. Loneliness may begin as a cause of depression, or it may develop later as a symptom. Regardless of how it starts, loneliness is neither natural nor healthy to feel for any extended period of time, nor is it necessary, given proper attention and treatment.

For Agnes, holidays proved especially lonely. Of course she looked forward to being with her family, and to celebrating with her church community. But the depression seemed to sap so much of her energy and get-up-and-go that her usual preparations wore her out just thinking about them. And partway into the festivities themselves, she found that she couldn’t enjoy being with her loved ones at all. She simply stopped putting on a happy face for the occasion, and really wasn’t present anymore. Instead, she had begun dreading the moment when everyone went home, when she'd be alone again.

Depression works like a thief. It steals away your ability to take comfort from the people who love you, to really hold on to their love and keep it warm inside you. It steals away your connections, isolating you from your loved ones, from your neighbors, even from your God. It steals away your identity, your sense of self, making you feel different from other people. "Nobody else could possibly feel so sad/lonely/empty." And so ashamed of your differentness that it's hard to be with other people and imagine that they might want to be with you.

But there are ways to take back your life from the depression, and to ease your loneliness. The first step is to understand that you’re not “crazy.” Depression is a real illness; it is not a normal part of aging. Every year, approximately two million Americans 65 and older experience some form of depression. Other people do feel some of the same feelings that you do; some people might understand what you’re feeling and thinking.

The second step is to realize that loneliness is a real part of depression—just like waking up at 2:00 in the morning, struggling with your memory, and feeling negative or angry about everything. Loneliness is related to low self-esteem and a negative sense of yourself and your future.

Becoming clear that you are not “crazy” should help turn down the volume on the obsessively self-conscious voice that often plays in depressed persons’ heads. Also helpful is learning to be comfortable in your own skin, and learning to be a good friend to yourself. You might consider taking up practices that increase your ability to be “present” in your life and in your body, rather than stuck in your head and your thoughts, practices such as mindfulness meditation or yoga.

This is also a good time to assess your relationships and your social life in general. Do you have at least one or two good friends, people you can trust? Do you have occasion to be with other people working on a common project, such as volunteering at a soup kitchen or cleaning up a local park? What are some interests that you might like to share with other people, perhaps through a book group, knitting class, spiritual community, or neighborhood improvement project?

Resources abound to help you understand both depression and loneliness. To learn how other people have experienced and coped with loneliness specifically, search your library or the internet. You’ll discover books, stories, poetry, and artwork spanning hundreds of years (at least)—and witness just how universal the presence of loneliness has been in human existence.

If you find that your self-help efforts do not provide enough relief for your depression and/or loneliness, please seek professional help. Many psychologists, clinical social workers, and counselors provide psychotherapy designed both to help you learn to be at peace with yourself and to encourage the development of truly meaningful personal and social connections. Some clinicians also teach classes in mindfulness meditation and other alternative healing practices. In those cases where depressive symptoms are particularly severe or long-lasting, antidepressant medication combined with psychotherapy has been shown to be beneficial, sometimes even life-saving.

How is depression assessed and treated?

by Dr. Bob Campbell
Everyone gets sad or feels down now and then. For the most part, this sadness is not depression; it’s just the normal sadness of life. Grief over the death of a loved one is also not depression, although if prolonged normal grief can become depression. What is depression then? Depression is a much more serious condition than the usual sadness or grief; it can be extremely debilitating, and can even lead to suicidal thoughts or attempts. Depression is also surprisingly common – more than 16% of people in the U.S. will get it at least once in their lifetime (Kessler, 2003) – and there have been many famous people who have suffered with it, including Billy Joel, Woody Allen, and the author William Styron, who called it “darkness visible.”
Someone who is depressed often exhibits symptoms such as low energy, changes in sleep habits, significant mood shifts, loss of interest in activities usually enjoyed, hopelessness, or a change in appetite and body weight (up or down). These symptoms commonly cause missed work, low productivity, and relationship difficulties.
The good news is that depression can be effectively treated, and individuals can get better. It may seem straightforward to recognize depression, but it is best assessed by a professional, so that the most appropriate treatment can be initiated. Antidepressant medications have often been prescribed for people who don’t need them, resulting in significant side effects.
Once depression is diagnosed, it can be treated in a variety of ways. Talk therapy has proven to be quite effective for many people, and comes in various types, including cognitive-behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), psychodynamic therapy, Adlerian therapy, and existential therapy. All of these treatment methods are available at Willow, and can be discussed with your therapist. For more severe levels of depression, antidepressant medication may be needed. Research has shown that most severe depressions respond best to a combination of medication and psychotherapy. Rare treatment-resistant depressions can also be treated with electro-convulsive therapy (ECT), which is administered in a hospital, and which has become much more refined and safe over the last several years.

The bottom line is that depression is serious, but can be treated effectively. At Willow, we are committed to providing you with the latest evidence-based treatments to bring hope and joy back into your life.

(For more detailed information, see Kessler, R.C. et al. (2003) 'The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R)', Journal of the American Medical Association 289 (23): 3095-3105.)

Ho, Ho, Holiday Pounds!

How to keep winter weight to a minimum.

by Dr. Sandra G. Carey

It is not uncommon to gain some weight during the winter months, and a few extra pounds can even be healthy. The cold weather and winds of winter calls for insulation from body fat, which may keep us warm and strengthen the immune system. However, holiday parties and family gatherings, which provide ample opportunity to indulge in the goodness of the season, may lead to unwanted pounds. Below are some ideas for enjoying the many festive occasions this season while minimizing extra weight.

• Eat a light meal or snack before going to a party



This will decrease feelings of hunger and limit sugar cravings, lessening the likelihood of overindulging on cookies and cakes.



• Wait 20 minutes before going back for seconds at holiday meals



This amount of time gives the body a chance to register what you have eaten. If you are still hungry after 20 minutes, please enjoy a second helping, but if you do not feel hungry refrain from extra helpings to keep extra pounds at bay.



• Remember: “The feast is in the first bite.”



Take time to give full attention to what you are eating. Explore the textures, tastes, and smells of the food you eat by chewing slowly and thoroughly. This will slow down the time it takes to eat, and helps avoid that “stuffed” feeling. This mindful approach to eating can also bring awareness to the love and time it took to prepare the food and may increase your sense of thankfulness and joy.



• Increase movement during the day



Winter weather may inhibit your desire to get outside and be active, so create new opportunities to keep the blood and calories flowing through your body. Take the stairs up to the office, or park towards the end of a parking lot, when safe, to add in a few extra steps to your day. Add some stretching or isometric (contracting muscles while standing still) to your work breaks or after a meal.

Be well!

Basic Guidelines for Good Digestion

• Eat in a relaxed environment and an attentive manner
  
  • Stress impacts the body’s ability to digest nutrients
  
  
• Chew food completely before swallowing
  
  • Poorly chewed food is not digested well
    
  • Nutrients are not available to the body if food is not digested
    
  • Partially chewed food particles can compromise intestinal health and be attacked as a foreign object by cells, lowering the immune system
  
  
• Include raw foods (uncooked) into your diet
  
  • The enzymes present in raw foods aids digestion
    
  • Eat warming foods to help aid digestion, such as Ginger and Curry
  
  
• Avoid substances that hinder digestive health
  
  • These include:
    
    • Cigarettes
      
    • Caffeine
      
    • Alcohol
      
    • Pesticides on foods
      
    • Antibiotics
  
  
• Exercise
  
  • This stimulates digestive organs
  
  
• Drink plenty of water throughout the day
  
  • Water helps digestion and elimination
  
  

References

• Bartholomey, Paula. Hawthorn University, 603.1 Lecture Series, Whitehorn, CA, 2006.
  
• Lipski, Elizabeth. Digestive Wellness 3rd ed. Los Angeles, CA: McGraw Hill/Contemporary Books, 2004
  

Nutrient-Rich Snacks, Beverages, and Desserts

by Dr. Sandra G. Carey

Food is the fuel necessary for our body to run well, and what we eat directly affects the way we feel physically and emotionally. Every person has unique dietary needs based on genetics, environment, and lifestyle. Listed below are several suggestions for supplying your body with fuel that will provide the body with nourishment and please the palate. Enjoy discovering what you like best!

Nutrient-Rich Snacks

• Choose snacks that feature whole, natural ingredients and avoid white flours, refined sugars, or hydrogenated vegetable oils.




• Whole foods will provide the body with consistent energy while processed foods can lead to depletion of energy, decreased mood, and may lead to certain diseases of the heart and digestive system.


• Sprouted Nuts and Seeds




• Sprouting (soaked in water overnight) helps the nuts to be easier to digest and increase availability of nutrients


• Healthy nuts can include almonds, pecans, walnuts, peanuts, and cashews




• Hummus and whole grain or sprouted breads and crackers




• The protein and fat found in hummus helps repair and build muscles and increases concentration


• Sprouted grains increase the content of vitamin c, and several B vitamins and helps with absorption of calcium, magnesium, iron, copper, and zinc.







Beverages



• Make water your beverage of choice each day




• Our body is made up mostly of water and our body needs it to thrive at all times and more so during stress and illness


• Mineral water can increase additional benefits of hydration by adding nutrients to the body




• Avoid sodas, especially those with artificial sweeteners
  
  
  
  • Phosphoric acid in soft drinks blocks absorption of calcium and magnesium
  
  
  • Artificial sweeteners, like aspartame, are neurotoxins and break down into poison in the body
  
  
  
  
• Include Herbal Teas




• Provides nutrients and has soothing qualities


• Does not contain caffeine, which negatively impacts digestive health





• Avoid drinking beverages with meals


• Interrupts the digestive process







Desserts
Choose desserts that contain natural sweeteners, fruit, whole grains, cream, and butter




• Natural sweeteners help control a dip or spike in blood sugar, stabilizing mood and physical energy.


• Avoid drinks, like diet sodas, that contain artificial sweeteners


• Aspartame breaks down into methanol, a known poison


• May cause dizziness, visual impairment, severe muscle aches, numbing of extremities, pancreatitis, seizures and depression


• Phosphoric acid in soft drinks blocks absorption of calcium and magnesium contributing to fractured bones in children and osteoporosis in adults and a compromised immune system

References:

• Bartholomy, P. (2008) Micronutrients and Water. Hawthorn University Lecture Series, Micronutrients.


• Bland, J. S. & Beenum, S H. Geenetic Nutritioneering. Lincolnwood: Keats Publishing.


• Fallon, S. (1999). Nourishing Traditions. Washington DC: New Trends Publishing, Inc.


• Margel, D. L. (20005). The Nutrient Dense Eating Plan. Laguna Beach: Basic Health Publications, Inc.

Project Renewment Group

The book Project Renewment, published in 2008, has caught my imagination--not so much for the book itself, but for the possibilities it stirs up for me. Two women wrote the book--Bernice Bratter, a licensed Marriage & Family Therapist and advocate for women & aging; and Helen Dennis, an expert on aging, employment, & retirement--after developing a new model for career women looking for an alternative to the traditional forms of retirement. Project Renewment began as one small group in California, connecting women close to retirement or recently retired, and has grown into a movement of sorts with groups continuing across the country. The authors describe the concept as "a combination of retirement and renewal," suggesting "optimism and opportunity, growth and self-discovery." It's really about women learning together, from each other and from themselves, to make the coming years abundant with life, passion, and purpose.

My vision is to start the process in the Chicago area, with the first group beginning September 21, a Monday night at 7:00, in our Park Ridge offices. We will meet together for 4 weeks, processing some of the book topics together (including "Who am I without my business card? What if he retires first? What is productivity anyway? Why do I feel guilty reading a book at 3:00 p.m. on a Tuesday? How do I feel about not earning another dollar?"). We will also bring in other relevant resources as needed or desired by group members--from books, movies, and news sources. This is not a "therapy group"; but it is not a traditional "support group" either. It is a new creation developed by and for career women, building on the strengths and processes that already have aided women in their professional lives. My hope is that group members will find sufficient support and inspiration to continue meeting on a longer-term, monthly basis, as highlighted in the Project Renewment model.

If this process catches your imagination as well, please contact me before this group fills up (we're limiting the first group to six women). Reach me by phone at the Willow Wellness Center at (847) 318-8200 or email at lcampbell@willowwellness.com. Thanks.

Diversity of Faith Traditions

Our staff consultation group has been talking about spirituality and religion, and how faith issues impact both our clients' lives and psychotherapy, and it occurred to me to make a list of all the different faith traditions we've welcomed here at Willow in the last 4 years. I was amazed at the diversity, especially because we practice in a suburban area that on the surface seems anything but diverse. Take a look (in alphabetical order), though know that we've left out a couple very small religions in the interest of protecting our clients' confidentiality, as well as many people who consider themselves "spiritual but not religious":

• Episcopal Church
  
• Evangelical Christian Churches (non-denominational)
  
• Evangelical Lutheran Church of America (ELCA)
  
• Greek Orthodox Church
  
• Jainism
  
• Jehovah's Witness
  
• Jewish (Orthodox, Reformed, cultural)
  
• Lutheran Church--Missouri Synod
  
• Muslim
  
• Presbyterian Church
  
• Roman Catholic Church
  
• Salvation Army
  
• Seventh-day Adventist
  
• United Methodist Church
  
• Unity
  
• Wisconsin Evangelical Lutheran Synod