Lifting the cloud

Women are twice as likely as men to suffer from depression. And at any given time, about one million women in Canada are experiencing the illness, which is increasing in prevalence as society ages and is the most common mental health disorder in older adults.

These statistics are grim, but they don’t tell the whole story. The good news is that with appropriate treatment, most women who are clinically depressed do get better.

The concern of mental health professionals is that depression is too often under-assessed and under-treated.

“The fastest growing group is elderly women who may be especially prone to stress and depression because of their role as family caregivers,” says clinical psychologist Dr. Nasreen Khatri, clinical leader of the Mood and Related Disorders Clinic at Baycrest and an expert in cognitive behavior therapy (CBT).

Diagnosing and treating mood disorders in this ever-increasing group of caregivers, she adds, not only relieves their suffering, it also supports the critical economic and social benefit they bring to the health-care system as providers of the majority of informal dementia care.

Multiple caregiving roles, such as raising children while looking after aging parents, can also put middle-aged women at increased risk of depression. Untreated depression increases the risk of developing dementia later in life.

The earlier in the lifespan that depression is diagnosed and treated, the better, notes Dr. Khatri. In women, the illness usually begins in their twenties. “We often see it as an acute disorder like breaking your leg, but it is more like diabetes, a chronic disorder that waxes and wanes throughout life. Possibly, the more untreated, recurrent episodes of depression, the greater the risk of cognitive problems arising in later years.”

Cognitive behavior therapy an effective treatment
Patients referred to the Mood and Related Disorders Clinic at Baycrest receive cognitive behavior therapy (CBT) and other talk therapies as well as medications.

CBT is an “evidence-based, time-limited talk therapy that can help women learn about and change patterns of thinking that lead to low mood and functioning,” Dr. Khatri explains. “It is a goldstandard treatment for mood and anxiety disorders because it is as effective as medication while treatment is active, and better than medication at reducing relapse after treatment is completed.”

A groundbreaking Baycrest study of CBT as a group therapy, conducted by Dr. Khatri and colleagues, found that the treatment worked well for spousal caregivers (mostly women) of individuals with dementia. After 13 weeks of treatment, six of the 10 participants no longer met the criteria for depression and anxiety, although all 10 did at the start of the study.

Get the help you deserve
If you or a loved one is showing signs of depression, speak to your doctor, advises Dr Khatri. “If you are not feeling like your usual self, it is good to get a ‘check up from the neck up’ because we often don’t see ourselves the way others see us or the way we would see ourselves if we were well. One of the most insidious things about depression is that it tells us there is something wrong with us, that we are flawed, and in the most extreme cases, that we aren’t deserving of care and treatment.”

Photo © Pamela Moore

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