Psychiatrist Discusses Depression, Stress, and Grief

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Since May is Mental Health Month, I decided to change the format this time in order to post this very informative article written by a psychiatrist just for this blog.

Psychiatrist Discusses Depression, Stress, and Grief

By Meitra Doty, MD, UT Southwestern Department of Psychiatry

It can be very difficult to differentiate between normal “stress,” normal grief, and clinical depression.  The feelings and signs can overlap significantly, and it can be difficult to know when it is time to seek help from your doctor. Counseling can help any of these, and medication can help with depression and also may help when the stress or grief becomes overwhelming.

People may not realize that even though their loved one has not yet passed away, you, as their caregiver and loved one, may already be going through the grieving process.  Sometimes simply realizing that you are grieving can make what you are going through easier to cope with.

Some of the overlap between grief, stress, and depression are the following:  trouble with sleeping, changes in appetite, feeling easily overwhelmed, and losing interest in your usual activities.  Grief can come in waves, while stress and depression tend to be steady.  Grief can make you wish you were dead sometimes, so that you can be with the loved one you lost, but you would not be having thoughts of ending your life.  In depression, sometimes you can become so hopeless that you wish you were dead to end your suffering, or even have thoughts of taking your own life.  Feelings of wanting to end you own life are not normal, and treatment of depression can help alleviate those dangerous thoughts.

Treatment with medication can be very helpful and very safe.  Many people fear it may cause them to become “addicted” or “dependent” on the medication.  Or they fear it will change their personality or behavior.  Antidepressant medication is usually quite safe for most people and has very few side effects, if any.  It simply helps reduce the symptoms and helps you feel back to your normal self.  Like medication for any other illness, just because you need the medication to help your symptoms does not mean you are now addicted or dependent.  

I often hear people refer to how they’re feeling as “situational depression”; meaning they believe if it weren’t for the obvious stressor in their life, they would be feeling fine.  That may be so, but again there is a difference between the normal stress in one’s life and the symptoms of depression negatively impacting one’s day to day functioning.  A doctor can help you figure out if you need further treatment, and which treatment would help you the most.

Some feel that counseling wouldn’t help, because talking about it doesn’t make the problem go away.  This is true, your situation itself may not change much.  But a professional counselor can help you navigate all the painful and sometimes confusing feelings a person has, and help you adjust to the problems and stress in your life that may not be going away any time soon.

A caregiver’s job can be lonely and unappreciated at times.  Recognizing that you need a break is the easy part, but actually making time for yourself can be difficult due to feelings of obligation, guilt, or worrying that others helping out can’t do it as well as you can. However, taking care of yourself is as important as caring for your loved one.  Oftentimes, if you are the caregiver, it is because you have always been the rock of the family and the responsibility of taking care of your loved one seemed to be your natural role.  Don’t forget that others in the family may not recognize when you are needing a break.  They see you as the strong, tireless one, and they may be assuming you will ask for help when you need it.  Many times I have patients who have an incredibly difficult time asking for help, and would rather take the burden on themselves than reach out to others.   This isn’t fair to you, the loved one you’re caring for, or the others in your life who still need you in other capacities. Taking small breaks, delegating responsibilities, and holding others accountable even for small tasks can relieve more of your stress than you may realize.

When the time comes to let go of your loved one, most of us expect to feel sad and miss our loved one, but we don’t expect all the feelings of guilt, anger, relief, and other uncomfortable thoughts and emotions that occur after our loved one passes away. We may not have had a chance to reconcile certain issues with our loved one.  We may be relieved that their struggle and our own struggle is over, and this can make a person feel very guilty.  There are many mixed emotions when we suffer a loss, and few people actually express these feelings so we’re not sure what’s normal or acceptable to feel.  We also may have a lot of anger or resentment towards others in the family who we feel didn’t do their part in caring for the loved one, or we may feel angry at the medical providers for not doing more to help or save our loved one.  

You may be familiar with the “stages of grief.”  There is a reason that these stages are well known and accepted as factual, so expect to go through these stages to some degree.  Allow yourself time to go through these stages, and realize that each person grieves in their own way.  You may not be going through the stages at the same time as others, and sometimes this can cause conflict or resentment.  Sometimes you must step outside of your own pain to recognize what others are going through, and realize that you can’t rush the process for them or for you.  Grief counseling or standard counseling can help you through this phase, and as mentioned earlier, treatment from your doctor may be helpful as well.

Prayer

Lord, give us Your peace and hope during our periods of suffering and despair. Help us to know that You are always with us. Keep us close to You, and You will turn our brokenness into wholeness. You are the ultimate healer.

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A Critical Care Doctor Discusses End of Life Issues

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Ryan Brown, M.D., a Critical Care doctor at Vanderbilt Medical Center, offers some excellent advice for caregivers. First, he says having an explicit plan beforehand takes away a lot of stress when the patient is in the Intensive Care Unit. When that plan isn’t in place, he sees a lot of dissent between family members, as well as guilt if they don’t do everything possible. The goal is to be the patient’s voice if they can’t tell you what they want. He also recommends that for elderly patients, a gerontologist should be a part of the discussion beforehand since they can be very helpful and can take a lot of stress off of the caregiver.

Dr. Brown says, “Caregivers need to think about what should we do versus what can we do. Do you want to prolong life if the patient is truly suffering or do we want to make them comfortable and let nature take its course? Death is part of life, and the beauty of death is that God is calling them home.”

Dr. Brown says there is no need to fear death, and his hope is that the caregiver doesn’t feel guilty when the patient does die. Also, he emphasizes that there is so much doctors can do to make the patient comfortable now, and Hospice is a huge help in allowing the patient to die at home versus the hospital. He believes that God doesn’t want us to suffer at the end of life when there are ways to help. Dr. Brown has watched many people die comfortably.

He says caregiving is a difficult job with a lot of burnout. It is very important for the caregiver to take care of their own health. These days since most people live longer and die of chronic diseases such as heart disease and cancer, the caregiver’s role can go on for a long time. Dr. Brown typically sees caregivers at the end of their patient’s lives, but the gerontologist sees them throughout the process. He says it’s also very important for caregivers to establish a trusting relationship with the patient’s doctors to fully utilize their experience.

What Helps?

  • Have a plan of action while the patient is still lucid and share the plan with all family members.
  • Talk with your gerontologist about different scenarios.
  • Trust your doctors.
  • Do not fear death.

Scripture Verse

John 3:16 For God so loved the world that he gave his only Son, so that everyone who believes in Him may not perish but may have eternal life.

Prayer

Lord, bless these special healers who are doing Your work here on earth. Give them strength and faith to take the best care possible of their patients. Help them to be an aid to the caregivers as they face difficult end of life decisions. Help us to remember that God calls all of us home as death is a part of life. Death is not to be feared, especially since our stories will end well.

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