My mother has been drinking wine daily since my father died. Could she be depressed?

One risk of untreated depression is the development of comorbid substance abuse, including alcohol abuse. Alcohol and drugs make people feel better temporarily, but this effect is only temporary; as the high wears off despair can set in. After the death of a spouse or other close family member, if excessive drinking develops it is reasonable to presume that a depression is present. Alcohol abuse can often be missed in older women, particularly if it involves only consumption of wine or beer. Alcohol abuse can cause depression itself—in such circumstances recovery from the substance abuse usually leads to resolution of the depression. Often, depression precipitates the abuse of alcohol and/or drugs and thus will need to be treated to promote recovery from the substance abuse.

I have been treated for depression in the past. Can I prevent an episode in the future?

Anthony's comment:

I believe there are things you can do, such as relaxation activities of any kind, avoiding high stress situations, and engagement in physical activities.

Although many people who recover completely from a depressive episode never become depressed again, more than half of people who have been depressed will have another episode at some point in the future. The risk for future episodes increases with more episodes of depression. Although there are no specific preventive measures that can be taken, there are ways to lower the risk for recurrence, including reducing stress levels and developing problem-solving strategies. Exercise, good nutrition, and adequate sleep promote wellness, which can ward off negative effects of stress. In addition, a lack of adequate sleep can be associated with increased irritability, malaise, and poor functioning during the day, which may precipitate depression in someone who is vulnerable. Some people find that the use of relaxation techniques such as meditation or yoga reduces stress levels. Psychotherapy helps an individual develop new coping styles and insights into his or her responses to negative events. With increased self-awareness and self-esteem, there is a reduced vulnerability to situations that could precipitate depression. Also, early recognition of the signs and symptoms of depression allows for early treatment intervention, which can hasten recovery.

My mother is depressed but refuses to see anyone. What can I do?

Anthony's comment:

My mother would not seek help for what I believed was depression. She drank excessive alcohol. It wasn't until my friend's mother took my mother to an Alcoholics Anonymous meeting, where my mother was listening to other people and their stories and became scared, that she then realized she should try to take care of herself. As a result she stopped her drinking with the help of her internist. Although she never did seek mental health professional assistance, her internist was able to help her stop drinking and deal with her depression. You may have to be patient in waiting for your family member to get the help she needs and to acknowledge that there is a problem.

This can be a very complicated situation for the family members of a person who appears to be suffering from depression. Because of the stigma of mental illness many depressed persons never seek treatment. This may be based on age (older), gender (male), or ethnic and cultural identity (mental illness has a greater stigma in many cultures). An individual with close ties might want to encourage the affected person to seek treatment in any way possible. Perhaps the person will not see a psychiatrist but will agree to meet with a social worker.

Suggest a consultation first, after which treatment can be considered. Maybe the person would be willing to speak with a clergy person at his or her place of worship. One could accompany the person to his or her next family doctor or internist appointment, where he or she might be willing to have you communicate concerns to the doctor. Making an initial appointment with a mental health practitioner on behalf of the affected individual may be enough to motivate him or her to seek help, especially if you agree to attend the appointment as well. If, however, a person absolutely refuses to meet with anyone, a decision needs to be made as to potential for dangerousness to self or others. For example, if suicidal ideation is suspected, local emergency personnel can be called to take the person to the emergency room. He or she may be angry with this, but if suicide is a possibility, the risk is worth taking. Some communities have mobile crisis units available in which a team of mental health practitioners comes to the home to evaluate the person in crisis. Information about home-based mental health services for persons in crisis can usually be obtained from the community or city hospitals that sponsor such programs.

My spouse is returning from active duty overseas. What is the risk for depression?

Depending on where your spouse is stationed, the risk for depression may be no higher than the general population, or it may be significantly increased because of his or her location and assigned duties. The closer your spouse is to combat, both geographically and occupationally, the higher the potential for developing post-traumatic stress disorder and resulting alcoholism and depression. Some recent evidence has shown that the

Nearly every soldier who returns from combat will suffer from some symptoms of trauma.

highest rates of posttraumatic stress disorder and resulting depression come from soldiers who have fired on and witnessed their enemy being killed in contrast to being injured. A recent study on returning Iraqi soldiers, however, demonstrated that being fired on or ambushed did result in higher rates of posttraumatic stress disorder symptoms.

Nearly every soldier who returns from combat will suffer from some symptoms of trauma, although most will turn these experiences into constructive, character-building memories that will serve them well in their future endeavors. However, in those soldiers who continue to experience symptoms consistent with the diagnosis of posttraumatic stress disorder, the rates of depression approach 50%. The longer those symptoms persist, the more resistant to treatment they become; thus it is important that they be treated as soon as possible. This is often the tricky part, because it is hard to get a spouse returning from combat to admit to having a problem, as he or she would feel that this admits to weakness and failure as a soldier (see Question 72 for further discussion on this topic).

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