Pine Rest Mission Statement
Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity and compassion.

Depression in Adults and Older Adults

By Suzann Ogland-Hand, PhD

Whether we typically view the glass of water as half empty or half full – whether we are normally pessimistic or optimistic – we all have times when we feel down. The causes can range from tragic, life-changing events like the loss of a spouse or the loss of job to hassles or temporary annoyances, like rain on our vacation or a disagreement with a friend. We may feel overwhelmed, hopeless, or irritable. At times, we may think nothing is going right.

These are normal feelings and thoughts we all experience. Often, these feelings and thoughts are short-lived. They may impact our behavior for a few hours or a couple of days. We recognize these thoughts and feelings are only temporary.

However, if the symptoms of depression last for two weeks or longer and interfere with our day-to-day functioning, we may have crossed into a clinical depression. This may be a “major depression” that requires treatment.

What Is Depression?
Depression is one of the most common of all behavioral health problems, affecting two out of ten Americans.

How can you tell if someone has a major depression? There are signs we can look for in ourselves and people we care about. Classic symptoms of depression fall into three categories: affective, cognitive, and behavioral.

Affective symptoms mean our current emotional state – what we call feelings. Depressed people may feel sad. Their low spirits may persist even if they hear good news or are involved in activities they used to enjoy. Some depressed people are tearful. No matter how hard they (or their loved ones) try to change their mood, they can’t overcome their blue feelings.

Cognitive symptoms mean how we think. Depressed people often have thoughts of hopelessness and worthlessness. They may find it hard to concentrate and make decisions. They may have recurring thoughts of death or suicide.

Behavioral symptoms mean a physical response like fatigue or insomnia. Some people experience changes in their appetite, sleep patterns, and sexual desire. They may have physical complaints that have no physical cause. Sometimes they withdraw from normal life activities and relationships, maybe even neglecting to take care of themselves, and spending most of the day in bed.

In some cases, people may experience disordered and disturbed thoughts with depression. They may hear voices or sounds other people don’t hear(called “auditory hallucinations”) or see images other people don’t see (“visual hallucinations”). Sometimes, people have thoughts of wishing they were dead. Some have plans of how to end their life or have tried to hurt themselves. If you or someone you care about is having thoughts like these, seek immediate help.

While symptoms of major depressive disorder are similar for younger and older adults, some subtle differences may exist. Older people with depression have more memory complaints, more self-reproach, and less guilt than younger adults. They are less likely to complain of sadness, but are more likely to report negative moods such as agitation, irritability, anxiety, and anger. Further, while anhedonia (the loss of ability to experience pleasure in activities a person used to find enjoyable) is a symptom of depression at any age, it’s especially prevalent with older people. Finally, healthy older adults often show changes in weight, sleep, appetite, and energy levels, so differentiating normal aging from depressive symptoms is challenging.

Depression Assessment
A thorough evaluation is necessary to diagnose depression. A health care professional – family physician, psychologist, social worker, or psychiatrist – makes a diagnosis of major depressive disorder. Professionals often use these three questions to help adults older than 60 decide if they would benefit from an evaluation. They may help any adult take that step.

1. Are you basically satisfied with your life?
2. Are you hopeful about the future?
3. Do you often feel downhearted or blue?

If you answered any one of these questions in the "depressed direction" (1. No, 2. No, 3. Yes), you would likely benefit from an evaluation for depression.

A thorough assessment for depression is especially important for an older adult. Many older people have chronic medical problems like hypothyroidism, hypertension, or arthritis. Sometimes, the side effects of medications they need to manage their chronic illnesses may mimic symptoms of depression. For example, if someone has level of thyroid replacement, they may feel lethargic and have low energy. In a common chronic illness like arthritis or diabetes can trigger a depression.

Further, older adults may be reluctant to discuss or admit their psychological symptoms. Effective treatments for depression have only existed in the past 50-60 years. Many elders have memories of people from their parents' and grandparents' generation who suffered silently with disabling symptoms of depression since no treatment was available.

Another factor complicating assessment is that often older adults, as well as health care providers, have biases because of a person’s age. For example, they may believe that psychiatric problems – and depression in particular – are a normal part of aging. mistakenly that depression is inevitable and can’t be treated. In fact, depression is not a normal part of aging, and treatment is available.

Once you are better from an episode of depression, you need to focus on staying well. We know that depression is a chronic health problem, meaning that once you have one episode of depression you are at risk for a future episode. It is typically within the first 6-12 months after a person recovers from an episode of depression. When you are doing really well and fully functioning again, you are at the highest risk for a relapse of depression.

That means a focus on staying well plus an understanding of the triggers that indicate another episode may be starting are very important. Applying specific strategies to your life to stay well is important if you’ve ever had even one episode of depression.

Summary
We all have times of sadness and loss. We can help ourselves handle them and possibly prevent more severe depression. Listen to your own thoughts and feelings so you know what your needs are and what changes you must make. Talk with others who care about you. Take care of yourself by continuing to be engaged in activities you enjoy. And if you – or someone you care about – shows signs of experiencing depression, get help. It’s the most important step you can take.

(Excerpted from "Today" magazine's "What is Depression?" issue. The complete magazine is available online at: http://www.pinerest.org/education/today/depression/default.asp This magazine is also available for download in pdf format here.)

Suzann Ogland-Hand earned a PhD in clinical psychology from Fuller Theological Seminary’s Graduate School of Psychology and received postdoctoral training in geropsychology at the Palo Alto VA Medical Center in California. She has been a member of the Pine Rest staff since 1996. She currently serves as the Director of Pine Rest’s Center for Senior Care and as an outpatient geropsychologist. She has researched and written extensively on behavioral health in older adults and caregivers.

Living With A Person Who Has Bipolar Disorder

By Robert Bouws, LMSW, ACSW

“What can we do to help? How can we prevent this from happening again? What is the best way to talk to them when we think something is wrong?”

These common concerns are shared by families and friends of the person with bipolar disorder when they too are impacted by the illness. Even the most concerned and well-intended have found themselves exhausted and frustrated when trying to engage and support their loved one during and after an episode of mania or depression. It is not uncommon for families and friends to distance themselves because of traumatic experiences they have endured. Some have made the decision that they can no longer be involved and have chosen to limit or discontinue their contact. The degree of involvement one chooses to accept is a decision that must be respected. For those who choose to be involved, adopting a hopeful yet realistic attitude is helpful. A commitment to learning more about the illness provides the foundation for helping people with bipolar disorder during their journey.

ENGAGING A PERSONWITH BIPOLAR DISORDER
Respecting the person yet realizing they are suffering from an illness is an important principle when interacting with a person with bipolar disorder. People who are in a state of distress and are struggling with depression or mania have an illness. They need a compassionate yet firm approach to help provide a healthy boundary they can use to regain their stability. From my experience, it is very clear that how you treat a person, especially when they are struggling, will always be remembered. Respect, compassion and patience are the cornerstones for sustaining a trusting and therapeutic relationship.

When interacting with a person with bipolar disorder, it is important to understand that verbal intervention is often ineffective. Trying to cheer someone out of a severe depression or reasoning with a person in a manic state has minimal impact. With depressed individuals, it is most helpful to validate emotions they are experiencing. Just being present with the person and near them is comforting to most depressed people. Expecting too much or placing too many demands on them can fuel feelings of inadequacy and poor self worth. By encouraging and reinforcing even small attempts at self care or achievement, they may gain some confidence. Sharing your assessment of their self care or home situation may be necessary to assure their safety and well being as neglecting basic needs is very common with the depressed person. Realistic expectations and a common sense approach to safety and basic needs are essential for the depressed patient. Patience, presence and concern about keeping open lines of communication will help develop trust and assist the person in feeling connected to the outside world. Dealing with the person in a manic state requires a different approach. Maintaining a calm exterior and speaking in a slow, relaxed tone of voice provides a necessary contrast to the loud, excited and exhilarated presence of the manic. Avoid trying to argue or reason with them. Rather, try to provide clear, simple and repeated messages to ensure your observations and input are being heard. The tendency to try to match the emotional level of the manic is an easy trap to fall into and may only lead to an escalation of emotions and even more conflict. Their view of reality is distorted and their beliefs in what is true and real are difficult to challenge or re-direct.

Distracting the person by changing the topic or re-directing their attention to an activity or topic that is less stimulating is a helpful tool. Again, respecting the intelligence and dignity of the person and realizing we are dealing with an illness is important. When a person is in their normal state, they will not act or think in this manner. It becomes a matter of weathering the storm of emotions, including the verbal abuse that is common in mania. Showing a sense of humor and sharing common experiences can also be a helpful way of engaging the manic person.

Providing solid boundaries is the most important intervention that needs to occur. Communicating what is appropriate and tolerable and what is not needs to occur as the manic has little restraint and often ignores their own safety or the safety or needs of others. Again, safety is essential and paying close attention to basic needs is as important for the manic as it is for the depressed person. Manic people exhausting activities such as walking long distances, exercising, or staying up all night cleaning or re-arranging furniture. They do not feel the need to eat, drink fluids, get enough sleep, or stay out of the hot sun. Obviously a balance of sleep and activity, good nutrition and drinking enough water is very important. Medications like Lithium require that the person drink enough water and stay nourished. Mental exhaustion can also occur when people stay on the computer for long periods or drive long distances. Behaviors such as uncontrolled spending, indiscriminate sexual behavior, or getting into physical altercations with others are unfortunately quite common with manic people and can have devastating results. Early intervention is important as families and loved ones are usually the ones who must assist in rebuilding and repairing the losses that occur.

Becoming a partner in the recovery process
Trying to establish a relationship with a person with bipolar disorder that is based on mutual respect and a sense of trust will help in establishing open lines of communication. Being able to communicate openly with each other provides the avenue for a more successful recovery.

Educating yourself in the symptoms of relapse and encouraging the person with bipolar disorder to adhere to their treatment plan are important ways to enhance the chances of a successful recovery. Ask to become part of their treatment program and to attend meetings where treatment is being discussed. Providing input to the primary care doctors, psychiatrists, counselors, and case managers who work with the person with bipolar disorder gives a more accurate and reliable picture of how things are going for them in the real world. People with bipolar disorder have a tendency to mask symptoms or to minimize the problems they may be experiencing. Having the report from the family or a friend is helpful in effective treatment.

Another way families and friends can help support recovery is in helping the person with bipolar disorder establish an environment that will support recovery. Helping with housing problems, providing transportation, assisting in getting bills paid, or giving a helping hand with things around their home are just a few examples of ways to support them in the community. Helping them establish daily goals that encourage balanced nutrition and sleep, a sense of independence, a feeling of support, and a commitment to constructive activity will provide the physical and emotional structure needed in their recovery. Encouraging the person with bipolar disorder to take advantage of the opportunities in their community that provide education and support is essential. The National Alliance for the Mentally Ill (NAMI) has educational material and support groups in the community that provide services for clients, families, and friends. They also have a web site that can be accessed for current information related to mental disorders and resources in your community. There is now a national publication, BP magazine, that is “dedicated to bringing hope, dignity, and support by providing inspiration and information about mental health issues.” Local support groups for individuals and their families provide a safe setting for sharing concerns and addressing the diverse needs of those affected by mental illness. Finally, being an advocate in your community for the mentally ill and their needs is probably the most important way families and friends can be involved. Battling the stigma and the misunderstandings about mental illness are the responsibility of every member of our society. Our communities have the responsibility to provide an environment of acceptance and understanding for the mentally ill. Being an informed and involved member of one’s community is the only way necessary change can occur.

(Excerpted from "Today" magazine's "The Ups and Downs of Bipolar Disorder" issue. The complete article is available online at: http://www.pinerest.org/education/today/bipolar/default.asp)

Robert Bouws, LMSW, ACSW has over thirty years’ experience working with the severely and persistently mentally ill in the inpatient setting. In addition to his clinical work with patients and families, he provides clinical supervision for staff and student interns on Pine Rest’s Mulder West Adult Inpatient Unit. He also serves as the Lead Case Manager on the unit and specializes in behavior management, crisis intervention and the team approach. He received an undergraduate degree from Calvin College and a Master’s degree in Social Work from Grand Valley State University.

March 3, 10, 17
Pine Rest Family Institute 'Secrets for Successful Marriage'
Pre-marital workshop taught by experienced marriage professionals for couples who want to grow their relationship in preparation for marriage. Because it is skill-based, it is a valuable addition to traditional pastoral or professional premarital counseling. 9 a.m. to noon. Cost: $95/couple. Call 616/455-5279 for more information.
For more information click here.

February 3, 2007
2007 Grand Rapids Christian Parenting Conference
The 2007 conference, themed Celebrating the Family, is planned for Saturday, February 3rd from 8:30 a.m. to 12:15 p.m. in the Richard and Helen DeVos Center for Arts and Worship, on the campus of Grand Rapids Christian High School. The conference is free of charge and open to the public. No registration is required.

Free childcare also will be available for children 0 to 8 years of age at Shawnee Park Christian Reformed Church, adjacent to the high school. Space is limited and interested persons should call 616/452-6971 by January 31, 2007 to reserve a space.
For more information click here.

February 13
'Together We Can' Community Education Series
"Take The GRRR Out Of Angerrrr," facilitated by Kym Hansen, MSW, LMSW, ACSW. 6 p.m. to 7 p.m. at Pine Rest Traverse City Clinic, 1050 Silver Drive, Traverse City. Event is free and open to the public. Space is limited so pre-registration is recommended. To register, call Pine Rest Traverse City Clinic at 231/947-2255, ext. 0.
For more information click here.

March 1, 8, 15, 22, 29
Eating Disorders Educational/Support Group
Pine Rest Christian Mental Health Services’ Northeast Clinic will continue offering a free, confidential eating disorders educational support group. This group is geared for persons with diagnosed eating disorders who are also receiving treatment from a health professional.

Facilitated by Michelle Muenzenmeyer, MA, LLP, this ongoing group meets every Thursday from 6:00 to 7:30 p.m. at the Northeast Clinic, 1700 East Beltline, NE, Suite 240.

An assessment or referral is required prior to joining the group. To schedule an assessment or for more information, interested persons should call Pine Rest’s Northeast Clinic at 616/364-1500.

Michelle Muenzenmeyer, MA, LLP, received a master’s degree in counseling psychology from Western Michigan University. She provides outpatient counseling to adolescents and adults, including individual and group therapy. She specializes in treating persons who have an eating disorder.
For more information click here.

February 6, 13, 20, 27
Anger Management For Teens
Led by Ryan LaRue, MSW, LMSW, ACSW, outpatient therapist at Pine Rest Campus Clinic. 4:15 -5:30 p.m. in the Van Andel Center on Pine Rest's main campus, 300 68th Street, SE, Grand Rapids. Open to male and female teens ages 12-17. Cost: $75/person. Call 616/222-4584 for more information or to register.
For more information click here.

March 6, 13, 20, 27
Anger Management Classes for Adults
Led by Jim Bottenhorn, MA, LLP, Director of Pine Rest’s Contact Center. 7 p.m. to 8:30 p.m. on Pine Rest's main campus, 300 68th Street, SE, Grand Rapids. Open to adults and older teens. Registration is required. Cost: $65/individual or $95/two family members. Class fee due at first class. Call 616/493-6033 for more information and to register.
For more information click here.

March 6, 13, 20, 27
Anger Management For Teens
Led by Ryan LaRue, MSW, LMSW, ACSW, outpatient therapist at Pine Rest Campus Clinic. 4:15 -5:30 p.m. in the Van Andel Center on Pine Rest's main campus, 300 68th Street, SE, Grand Rapids. Open to male and female teens ages 12-17. Cost: $75/person. Call 616/222-4584 for more information or to register.
For more information click here.

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Disclaimer

Copyright © 2007, Pine Rest Christian Mental Health Services. All rights reserved. The contents of Mental Health News & Information are for informational purposes only. The content is not intended to be a substitute for professional medical or mental health advice, diagnosis, or treatment. It cannot and should not be used as a basis for diagnosis or choice of treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical or mental health condition.