Sitting alone on his couch in the early days of 2015, Robert*, a 72-year-old New York City resident, found himself overcome by feelings of isolation and depression. The holidays had been full of family, friends and regular visitors to his home. Normally he would spend this period after the holidays going out to cultural events, visiting the local community center or socializing further with friends. Because of his recent leg surgery and a worsening chronic condition, however, he was no longer able to leave the house. Now, in the cold weeks of January, Robert felt that the interesting parts of his life might be over, at least for the moment, and maybe for a long time. These hard-to-handle thoughts brought on strong feelings of depression and loneliness, as they are prone to do in many elderly individuals and their caregivers. In Robert's view, all the things he loved doing were now out of reach -- or so he thought.
Robert's situation is not uncommon among older individuals during in the months that follow the holidays. While the season's celebrations bring enjoyment to many, they can also be stressful if someone is dealing with physical or financial limitations. For those who have lost loved ones, memories of holidays past may also bring up feelings of sadness or grief that linger on long after the holidays are over and the colder weather itself can spur loneliness by making it harder to get out and see family and friends.
Fortunately for Robert, his primary care physician, concerned about his state of mind, prescribed a series of home visits by Constantine Checa, a Public Health and Behavioral Health Nurse with the Visiting Nurse Service of New York. Constantine came to Robert's home and explained that this wasn't the end of his life by any means, but simply a different phase to which he needed to adapt. Aware that pursuing intellectual interests was an important source of happiness for Robert, and knowing that he had access to an Internet connection, Constantine recommended that her patient start exploring "Ted Talks" -- a series of educational seminars presented by experts on a wide variety of topics. There is a large catalog of Ted Talks available for viewing on their website and on YouTube, and Robert dove into them with enthusiasm. This trove of information allowed him to continue learning new things and feel more connected to the outside world, despite being confined to his home. The sense of connection made a huge difference in Robert's outlook and eliminated many of his negative feelings.
In this case, Constantine's suggestion was tailored specifically to her patient, but the overarching message can be applied to anyone in a similar position: When we are feeling trapped, it's essential that we re-frame our thoughts and focus on what we can do in tough situations rather than what we can't. This is an approach you can follow yourself or implement with someone you're caring for at home.
Should you find yourself or a loved one suffering from depression this year -- especially during the winter months -- here are some basic approaches recommended by my clinical colleagues at Partners in Care and VNSNY to help break the grip of the winter blues.
1. Do Something Different
Feelings of depression and isolation related to your age or medical condition can be a vicious cycle. You feel isolated and sad because you aren't doing anything -- which in turn takes away your motivation to try anything new. Often, the first step in breaking this cycle is to simply do something different. This could be literally anything that shifts you out of the thought pattern that says "I can't" or "There's nothing I can do." Your chosen activity might be specific to your interests or those of the person you care for, as with Robert and his Ted Talks. Would the depressed person enjoy writing letters to family members? Calling friends and chatting? Singing along to old records? Would teaching them to use the Internet and explore social sites like Facebook help? Some medications can add to depression as well. If you think that might be the case for you, speak with your physician to see if alternative medications could help.
All of these ideas apply to those in the position of caregiver as well, for this role can also leave people feeling isolated and depressed in the winter months. Even something as simple as playing music on the radio and watching a movie on TV can make a difference in a depressed person's mood. If the person you're caring for expresses a reluctance to try new things, try framing it in these terms: "I know you don't want to do anything, but you've already tried that and you still feel depressed -- so why don't we try spending a few minutes doing something new?"
2. Humans Are Social Beings, So Get Out There
If you or your loved one are able to leave the house, then getting out and socializing can play an important part in overcoming seasonal or long-term depression. Human beings are social creatures, so look for activities that will take you out into the community: Going to church or synagogue, spending time at a community center, shopping or visiting with friends, or attending concerts or talks are all great ways to get out of the house. You might also try volunteering, since helping those in need can often take your mind off your own troubles.
If you have difficulty getting around town, inquire whether community or religious organizations have a transportation assistance program or a visitors program that sends church or synagogue members into the home. Hosting card games or get-togethers at home can also help alleviate feelings of isolation. Once you decide what you or your loved one would enjoy doing, try to make it a routine, giving you something to look forward to each and every week!
3. Reach Out For Help If Necessary
If the above steps don't work, it's time to seek help. When depression persists longer than a couple of weeks you'll need to reach out to a counselor, psychotherapist or other mental health professional. Prolonged depression and the stress it places on the body is a serious matter that requires medical assistance. Your primary physician, visiting nurse or social worker can help you and your family locate the appropriate resources to help you or your loved one combat depression.
The bottom line is that if you find yourself feeling depressed, you can't expect your condition to resolve itself -- you need to do something about it!
Below are some additional links regarding depression, including one more specifically aimed at helping those with disabilities.
*Patient's name changed to protect privacy