Dear Older Self,
You have seen it happen many times. People age and sometimes become depressed. You know what it is like to see someone you care about suffer from depression. You also know what it is like to watch these same people get help with their depression late in life, whether it was through medication or therapy or some other kind of support.
One of your elderly family members, who had been withdrawn and irritable all his adult life, became more depressed as he aged. His doctor started him on antidepressants when he was in his late eighties. The change was noticeable. His chronic mental and emotional suffering seemed to be greatly reduced. After the antidepressants were started, he began to smile when he greeted you. And he began to genuinely thank you for visiting when you were ready to say good-bye. These were small things but they were significant changes for him—changes that made for a new ease and joy in being together for both of you.
You also watched as an elderly friend who had suffered the loss of a sibling and a parent when she was nine years old, and who had struggled with anxiety and depression much of her life, went to her pastor to talk about her early losses and her ongoing depression. After several helpful meetings her pastor recommended that she join the grief support group at a nearby church. She did. There she found that she was not alone in her struggles and much of her chronic depression and anxiety began to ease.
Even though it is well known that there is an increased risk for depression as people age, depression often goes unnoticed both by the people suffering from it and by health care providers. As a result lots of people do not get proper help.
One of the reasons depression tends to go unnoticed is that the signs of depression are not always what we expect. We tend to think of depression expressing itself in tears and sadness. We don’t usually expect it to be expressed and experienced as agitation, anxiety, irritability, negativity, disruption in sleep and appetite, or cognitive problems. But you have known and cared for elderly friends and family who have struggled with these “unexpected” symptoms.
Remember the elderly woman who was full of rage at everyone? Anger and irritability are often symptoms of depression. You suggested to her doctor that an antidepressant might help. And it did. An antidepressant turned out to be very helpful in relieving much of her distress. At the same time it eased her physical pain and helped her to sleep.
Or think about the man who lost his wife and was overwhelmed with depression. He was so concerned about his sudden loss of memory for names and dates that he sought the help of a counselor. With support he was able to actively grieve his loss and experience the return of his mental abilities and his energy.
Another reason depression is neglected especially in people of your age is that many of its symptoms are similar to some of the changes that we associate with aging. The cognitive changes that depression can cause, for example, are often written off to “getting old.” The low energy and social withdrawal that are symptoms of depression can also be mistaken for “normal aging”. As a result, depression can be undiagnosed and people suffer needlessly.
Dear older self, just as I encourage you not to neglect your physical well being, I encourage you not to neglect your mental health. Pay attention for signs of depression. Push back against depression as much as possible. It is not a normal or necessary part of this stage of life.
Perhaps the place to begin in practicing this kind of self care is in reviewing the signs and symptoms of depression. The signs of depression include declining energy, a decrease in concentration and memory, irritability, anxiety, agitation, lack of interest or pleasure in things that normally would be engaging, lethargy, apathy, feeling “blue,” negative thoughts about one’s self and one’s future, hopelessness, change in sleep and eating patterns, wanting to isolate, lack of grooming and paranoid thinking. Potentially, depression can lead to thoughts of wanting to die and of wanting to take one’s own life.
I know that is a long list of distressing symptoms. I also know that it is not always easy to tell the difference between depression and grief. The overlap is significant. Grief almost always looks like depression—complete with fatigue, mental fog, feeling sad, changes in sleep and eating patterns and a desire to isolate. Grief, however, typically focuses on what we have lost or on the anticipation of a loss. Depression usually does not have this kind of specific focus.
I know you will be faced with multiple losses as you grow older. You will experience losses in your health and strength. You will lose people you love. And you will probably move away from places that have been familiar. Grief is a part of living. And it is certainly a part of living long.
So you will be at risk for experiencing depression related to grief and from depression related to other changes. What I want to encourage you to remember is that experiencing depression is not a shameful thing. It is something that many people experience sometime in their life.
And I want you to remember that there is help available. You do not have to manage this on your own.
If you are able to “push back” against the symptoms of depression, do so. There are many ways to do this.
Basically, all of the symptoms of depression can lead to greater depression if we give in to them. The problem is that if we are too depressed, or too alone we may not have the energy or ability to “push back.”
To whatever degree you can, try to “push back” . For example, rather than giving in to the desire to isolate, reach out to family and friends. Rather than giving in to the desire to just stay in bed, push back by taking a shower, getting dressed and going for walk. Rather than giving in to a sense of emotional numbness, write about your feelings and talk about your feelings with a friend, minister or counselor.
If you are not able to “push back” in these ways, call your doctor and talk together about trying an antidepressant or about finding support in counseling or a group. It is quite possible that the antidepressant or the added support will give you enough energy to be able to “push back” against the depression by reaching out, getting up, exercising and expressing your feelings.
If you find yourself thinking about suicide, please tell someone immediately. Call your doctor, go to the emergency room, call a friend or minister. Talking with someone about your suicidal thoughts will be a step in getting the ongoing help and support you need.
Antidepressants, counseling, support groups, and supportive friends and family can all make a difference when you are depressed.
Dear older self, please do not neglect your mental health. Push back against depression. Get whatever help you need. Practice good self-care so you can enjoy the maximum possible quality of life and so that those who are supporting you can enjoy quality time with you.
This meditation is taken from Notes to Our Older Selves: Suggestions for Aging With Grace by Juanita Ryan and Mary Rae. You can get a copy at Amazon.com