Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue

 
Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Anxiety and depression
in older people

www.beyondblue.org.au   1300 22 4636
Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Urgent assistance
People who are depressed or who have anxiety may be at risk
of suicide, and if so, they need urgent help.
If you or someone you care about is in crisis and you
think immediate action is needed, call emergency
services (triple zero – 000), contact the person’s doctor or
mental health crisis service, or go to your local hospital
emergency department.
beyondblue would like to thank members of its national
reference group, blueVoices, for sharing their personal
experiences for this booklet. Their comments are quoted
throughout and their feedback has been invaluable.
Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Contents

Foreword                     4    Treatments for anxiety
                                  and depression            21
Introduction                 5
                                  Who can assist?           24
Anxiety                      6
What is anxiety?             6    Caring for someone with
                                  anxiety or depression     28
What causes anxiety?         7
Signs and symptoms of anxiety 8   Malcolm’s story           31
Types of anxiety            10    Being well and
                                  staying well              32
Depression                  12
What is depression?         12    Brian’s story             36
What causes depression?     13    References                37
Signs and symptoms
of depression               15    Join blueVoices           38

Dale’s story                18
Dementia and depression     20

                                                             3
Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Foreword

                              Mental health plays an
                              important role in the wellbeing
                              of older people. Eating well,
                              exercising and being part of a
                              community all help people to
                              lead a healthy life. Receiving
                              the appropriate support if
                              things are not going well is
                              equally important.
                              This booklet aims to provide
                              some helpful information
                              about anxiety and depression
                              for older people, their families
                              and friends. It also has positive
                              strategies for supporting older
Older people are an important people to stay mentally healthy.
part of our families,
communities and organisations
as leaders and sharers of
generational knowledge.
It is important that older
people receive the support
they need to remain fully
engaged with their families   The Hon. Jeff Kennett AC
and community life.           Founding Chairman
                              2000-2017, beyondblue

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Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Introduction

In Australia, it is estimated
                                  “Today there is so much
that 45 per cent of people will
                                   help available, so don’t put
experience a mental health
condition in their lifetime.1      up with feeling down for
                                   too long. Get help! Go to
In any one year, around            someone who can give you
1 million Australian adults
                                   an accurate diagnosis and
experience depression, and
                                   get it dealt with.”
over 2 million experience
anxiety.1                                      – Dale, 69, QLD
While anxiety and depression
are different conditions, it is   “Try to understand the ‘why’
not uncommon for them to           of it. Accept that there
occur at the same time. Over       is hope at the end of the
half of those who experience       tunnel. Accept you have to
depression also experience         do your part.”
symptoms of anxiety.1 In some
cases, one can lead to the                  – Patrick, 67, QLD
onset of the other.
Older people are at greater       “When I was young nobody
risk of developing mental          ever spoke or seemed to
health conditions because          know about mental health.
of the cumulative effect           People are so fortunate
of numerous risk factors,          these days with all the help
including chronic illness and      there is.”
isolation. However, there is no             – Carole, 72, NSW
evidence that ageing itself is
a risk factor for depression or
anxiety in later life.

                                                                  5
Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Anxiety

What is anxiety?
Anxiety is more than just
feeling stressed or worried.
While stress and anxious
feelings are a common
response to a situation where
a person feels under pressure,
it usually passes once the
stressful situation has passed,
or ‘stressor’ is removed.
Anxiety is when these anxious
feelings don’t subside – when
they are ongoing and happen
without any particular reason       We all feel anxious from
or cause. It’s a serious            time to time, but for a person
condition that makes it hard for    experiencing anxiety these
a person to cope with daily life.   feelings cannot be easily
                                    controlled.

    Anxiety is the most common mental health condition in
    Australia. On average, one in four people – one in three
    women and one in five men – will experience anxiety.1
    The precise rates of anxiety in older people are not yet
    known, however it is thought that approximately 10 per cent
    of Australians over the age of 65 experience anxiety.2

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Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
What causes anxiety?                 The most important thing
It’s often a combination of          is to recognise the signs
factors that can lead to a person    and symptoms of anxiety
developing anxiety. Risk factors     and to seek support. The
that can be associated with the      sooner you seek support,
development of anxiety include:      the sooner you can recover.
• serious physical health
  problems
                                     “Be honest with yourself.
• change in living
                                      Don’t pretend. Seek
  arrangements
                                      professional guidance
• family and relationship             and assistance and follow
  problems
                                      the strategies. Be patient
• major emotional shock               with yourself. Go with
  following a stressful or            the flow of each day. Live
  traumatic event                     one day at a time. Move
• verbal, sexual, physical or         forward in ‘baby steps’
  emotional abuse or trauma           and acknowledge that
• death or loss of a loved one        sometimes those steps will
• substance use                       see you going backwards
                                      and down a bit. Talk to
• family history
                                      people honestly and openly
• personality factors (such as        about how you feel – but do
  being a perfectionist, easily       not be a whinger or a ‘cry
  flustered, lack self-esteem or
                                      baby’. People get tired of
  want to control everything).
                                      those who do not make an
Everyone is different and             effort to help themselves.”
it’s often a combination of
factors that can contribute to a                 – Jill, 70, NSW
person developing anxiety. It’s
important to note that you can’t
always identify the cause of it or
change difficult circumstances.

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Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Signs and symptoms                  If an older person experiences
                                    physical symptoms, they should
of anxiety                          always see their doctor. Many
The symptoms of anxiety are         signs of anxiety are similar to
sometimes not all that obvious      other serious health conditions.
as they often develop gradually
and, given that we all experience    “I feel a great sense
some anxiety at some points in        of doom and gloom. I
time, it can be hard to know how      withdraw from friends
much is too much.                     and family. I don’t answer
There are many types of anxiety.      the phone or leave the
While the symptoms for each           house. I sleep a lot and
type are different, some general      stop eating. I cry and have
signs and symptoms include:           suicidal thoughts. The
                                      anxiety manifests as rapid
• hot and cold flushes
                                      heartbeats, sweating,
• racing heart                        nausea and a feeling
• tightening of the chest             almost of paralysis.”
• snowballing worries                       – Penelope, 65, NSW
• obsessive thinking and
  compulsive behaviour.

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Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Behaviour                        Thoughts
• avoiding objects or            • “I’m going crazy.”
   situations which cause        • “I can’t control myself.”
   anxiety                       • “I’m about to die.”
• urges to perform certain       • “People are judging me.”
   rituals in a bid to relieve
                                 • having upsetting
   anxiety
                                   dreams or flashbacks of
• not being assertive             a traumatic event
   (i.e. avoiding eye contact)
                                 • finding it hard to stop
• difficulty making               worrying, unwanted
   decisions                       or intrusive thoughts
• being startled easily

Feelings                         Physical symptoms
• overwhelmed                    • increased heart rate/
• fear (particularly when          racing heart
  facing certain objects,        • vomiting, nausea or pain
  situations or events)            in the stomach
• worried about physical         • muscle tension and pain
  symptoms (such as              • feeling detached from
  fearing there is an              your physical self or
  undiagnosed medical              surroundings
  problem)                       • having trouble sleeping
• dread (such as fearing         • sweating, shaking
  that something bad is
                                 • dizzy, lightheaded or
  going to happen)
                                   faint
• constantly tense or
                                 • numbness or tingling
  nervous
                                 • hot or cold flushes
• uncontrollable or
  overwhelming panic

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Anxiety and depression in older people - www.beyondblue.org.au 1300 22 4636 - Beyond Blue
Types of anxiety                   Panic disorder
                                   A person has panic
There are many types of            attacks, which are intense,
anxiety, with a range of signs     overwhelming and often involve
and symptoms. It’s important       uncontrollable feelings of
to note that the following are     anxiety combined with a range
only guides to recognising         of physical symptoms (such as
different types of anxiety. They   sweaty, shaky, increased heart
will not provide a diagnosis       rate, nauseous, dizzy, hot or
– for that you need to see a       cold flushes).
health professional.
                                   Post-traumatic stress
Generalised anxiety disorder       disorder (PTSD)
(GAD)
                                   This can happen after a person
A person feels anxious on most     experiences a traumatic
days, worrying about lots of       event (such as war, assault,
different things, over a period    accident, disaster). Symptoms
of six months or more.             can include difficulty
Obsessive compulsive               relaxing, upsetting dreams or
disorder (OCD)                     flashbacks of the event, and
                                   avoidance of anything related
A person has ongoing
                                   to the event. PTSD is diagnosed
unwanted/intrusive thoughts
                                   when a person has symptoms
and fears that cause anxiety.
                                   for at least a month.
Although the person may
acknowledge these thoughts         Social phobia
as silly, the person often finds   A person with social phobia
him or herself trying to relieve   has an intense fear of
their anxiety by carrying out      criticism, being embarrassed
certain behaviours or rituals.     or humiliated, even just in
For example, a fear of germs       everyday situations, such
and contamination can lead         as public speaking, eating
to constant washing of hands       in public, being assertive or
and clothes.                       making small talk.

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Specific phobias
                                      “It was like I was someone
A person feels very fearful about
                                       I really didn’t relate to. I
a particular object or situation
                                       was impatient, irritable,
and may go to great lengths to
avoid it, for example, having an       controlling, and difficult to
injection or travelling on a plane.    please. It often felt like the
                                       cursor was hung on my
For more information on                emotional computer.”
anxiety visit www.beyondblue.
org.au/anxiety                                      – Dale, 69, QLD

                                                                        11
Depression

What is depression?
While we all feel sad, moody
or low from time to time,
some people experience these
feelings intensely, for long
periods of time (weeks, months
or even years) and sometimes
without any apparent reason.
Depression is more than just
a low mood – it’s a serious
condition that has an impact on
both physical and mental health.

     On average, one in six people – one in five women and one
     in eight men – will experience depression at some stage of
     their lives.1
     The precise rates of depression in older people are not yet
     known, however it is thought that between 10 and 15 per cent
     of Australians over the age of 65 experience depression.2
     Rates of depression among people living in residential aged
     care facilities are believed to be much higher than the general
     population – around 35 per cent.

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What causes
depression?
While the exact cause of
depression isn’t known,
a number of things can
be associated with its
development. Generally,
depression does not result
from a single event, but from
a combination of recent events
and other longer-term or
personal factors.
Some factors that might
be associated with the
development of depression           In older people, depression and
include:                            anxiety may occur for different
• serious physical health           reasons, but physical illness
  problems                          or personal loss are common
                                    triggers.
• abusive or uncaring
  relationships
                                    “My depression was
• family history of depression       related to work stress
• past experiences                   and the after-effects of
• personality factors (e.g. self-    a physical injury. The
  critical or negative, worrying     impact was probably
  a lot, being a perfectionist)      increased by some of the
• drug and alcohol use               effects of Fibromyalgia, a
                                     chronic musculo-skeletal-
• changes in the levels or
  activity of certain chemicals      neurological condition, with
  in the brain – particularly        fatigue and sleep disorder
  serotonin, norepinephrine          as components.”
  and dopamine.                                  – Brian, 68, VIC

                                                                    13
Everyone is different and it’s
     Factors that can increase     often a combination of factors
     an older person’s risk of     that can contribute to a person
     developing depression         developing depression.
     include:
                                   It’s important to note that
     • an increase in physical     you can’t always identify the
       health problems/            cause of depression or change
       conditions such as          difficult circumstances.
       heart disease, stroke,
       Alzheimer’s disease,        The most important thing is
       cancer                      to recognise the signs and
                                   symptoms and seek support.
     • chronic pain
     • side-effects from            “I was first diagnosed with
       medications                   depression in my forties,
     • losses: relationships,        following the breakdown
       independence, work            of my relationship with
       and income, self-worth,       the father of my children.
       mobility and flexibility      However, on reflection, I
     • social isolation or           have had depression since
       loneliness                    I was a child.”
     • significant change in               – Penelope, 65, NSW
       living arrangements
       such as moving from
       living independently to a    “I experienced the death of
       care setting                  my husband and could not
     • admission to hospital         cope by myself. We had
                                     been married 53 years.
     • particular anniversaries
                                     We met when I was 16 and
       and the memories they
       evoke.                        married when I was 19, so
                                     I grew up in my marriage.
                                     After he died, I felt I had
                                     been cut in half.”
                                            – Barbara, 77, NSW

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Signs and symptoms                 experienced several of the signs
                                   and symptoms across at least
of depression                      three of the categories on the
Depression affects how people      following page.
feel about themselves. They
may lose interest in the things     “I lost motivation, found
they normally enjoy. They may        it hard to get up in the
lack energy, have difficulty         morning, lost all joy in
sleeping or sleep more than          things formerly that
usual. Some people feel              interested and fulfilled me.
irritable and some find it hard      Sad, blue, not eating, not
to concentrate. Depression           interested in life, couldn’t
makes life more difficult to
                                     care less about things that
manage from day to day.
                                     used to matter. Feelings of
An older person may be               hopelessness, deep grief,
depressed if, for more than          tired all the time, unable to
two weeks, he or she has felt        sleep… I just seemed to be
sad, down or miserable most of       existing in some kind of a
the time or has lost interest or
                                     blue fog.”
pleasure in most of his or her
usual activities, and has also                    – Jill, 70, NSW

                                                                     15
Behaviours                      Thoughts
     • general slowing down or      • indecisiveness
        restlessness                 • loss of self-esteem
     • neglect of                   • persistent suicidal
        responsibilities                thoughts
        and self-care
                                     • negative comments
     • withdrawing from family         like “I’m a failure”, “It’s
        and friends                     my fault” or “Life is not
     • decline in day-to-day           worth living”
        ability to function,         • excessive concerns about
        being confused, worried         financial situation
        and agitated
     • inability to find pleasure
        in any activity              Physical symptoms
     • behaving out of character     • sleeping more or less
     • denial of depressive            than usual
        feelings as a defence        • feeling tired all the time
        mechanism                    • slowed movement
                                     • memory problems
     Feelings                        • unexplained headaches,
                                        backache or pain
     • moodiness or irritability,
        which may present as         • digestive upsets, nausea,
        angry or aggressive             changes in bowel habits
     • sadness, hopelessness        • agitation, hand wringing,
        or emptiness                    pacing
     • overwhelmed                   • loss or change of appetite
     • worthless, guilty             • significant weight loss/
                                        gain

16
It’s important to note that
everyone experiences some of      “Depression was like being
these symptoms from time to        in a black hole and not
time and it may not necessarily    being able to climb out.
mean that the person is            A feeling of hopelessness.
depressed. Equally, not every      Unable to do anything,
person who is experiencing         unable to drive, unable to
depression will have all of        think clearly. A terrible
these symptoms.                    feeling of being alone which
Additionally, older people may     was different from being
use different language to refer    lonely.”
to their depression. Instead              – Barbara, 77, NSW
of describing ‘sadness’, for
example, they may talk about
                                  For more information on
‘their nerves’.
                                  depression visit www.
                                  beyondblue.org.au/depression

                                                               17
Dale’s story
                                 very swiftly from there
                                 because my marriage was so
                                 miserable.
                                 My talking circle has been
                                 wonderful. I belong to a
                                 group of about 20, who talk
                                 about a lot of different topics
                                 which we research. We
                                 don’t just talk. It’s not an
                                 opinion group.
                                 I really think the first place
                                 to go is to your doctor. If
                                 you’re not happy with that,
                                 beyondblue is there for you
                                 and for everybody.
                                  I often reflect with my
 It wasn’t easy to recognise
                                 husband on what life was
 my own symptoms. It all
                                 like before and what life is
 seemed to start about the
                                 like now, and for me, there’s
 time my husband finished
                                 absolutely no comparison.
 work. My husband and I
 fought every day and I cried    To watch Dale’s story, visit
 every day for a year.           www.beyondblue.org.au/
                                 olderpeople
 We called in to see my
 brother one Saturday
 afternoon. I started to cry
 and I couldn’t stop. He said
 to me, “You need some sort
 of help.” I said, “There’s no
 help available.” He suggested
 a psychiatrist and I moved

18
Dale, 69

“I just love being mentally healthy
during my retirement and I’d like to see
others be as happy as they can be
without depression.”
Older people have a lot of difficulty recognising depression because they needed to be very
strong and couldn’t show weakness. It’s not a weakness. It is an illness and you can manage it.
I often reflect what life was like before and what life is like now, and for me, there’s absolutely
no comparison. The help is there and it’s wonderful.
I can only impress upon people that what’s out there now is so much better than anything
before. So talk about it and share it with somebody.

To talk to someone today or to find out more call:

     1300 22 4636
     Watch Dale’s story online at
     beyondblue.org.au/olderpeople                                                        19
Dementia and depression

Older people with dementia
are at greater risk of
depression. Depression
is thought to affect one in
five people experiencing
dementia.3
When dementia and depression
occur at the same time it
can be difficult to distinguish
between them, because the
signs and symptoms are
similar. For example, memory
or concentration problems
can be symptoms of both
depression and dementia.        about personality or cognitive
                                changes (such as memory loss)
However, dementia and           in the person. All parties should
depression are very different   be included in healthcare
conditions that require         discussions where possible.
different responses and
treatment, so a thorough        For more information see the
assessment by a health          beyondblue Dementia, anxiety
professional is recommended. and depression fact sheet at
                                www.beyondblue.org.au/
In older people, both personal  resources
carers (such as a partner,
family member or friend) and
professional carers are a
valuable source of information

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Treatments for anxiety
and depression

Different types of anxiety and   The reality is that anxiety and
depression require different     depression conditions are
types of treatment.              unlikely to simply go away on
                                 their own. In fact, if ignored
This may include lifestyle       and left untreated, anxiety
changes (such as diet            and depression can go on for
and physical exercise) for       months, sometimes years, and
preventing and treating          can have many negative effects
mild symptoms of anxiety         on a person’s life.
or depression, through to
psychological treatment          The good news is that there is
and medical treatments for       a range of treatments, health
moderate to severe anxiety       professionals and services
and/or depression.               available to support people
                                 with depression and anxiety.

                                                              21
There are also many things that Psychological treatments can
people with these conditions    be conducted one-on-one with
can do to support themselves.   a professional, in groups, and
                                sometimes online.
Psychological                     “From the first session,
treatments                         counselling helped me
There are many types of            see through my situation,
psychological therapies that       discover strengths such
have been found to be effective    as resilience – which I
for anxiety and depression.        have always had but never
These include therapies such       perceived. Knowing I
as behaviour therapy, cognitive    have resilience enables
behaviour therapy (CBT) and        me to avoid and tackle
interpersonal therapy (IPT).       situations which may lead
Reminiscence therapy also          to a reoccurrence.”
appears to be an effective
approach to treating depression                – Brian, 68, VIC
in older people.
Psychological treatments          Medical treatments
support people with anxiety
                                  Research shows that
or depression to change
                                  psychological treatments
negative patterns of thinking
                                  are the most effective in
and improve their coping skills
                                  supporting people with
so they are better equipped
                                  anxiety. However, if symptoms
to deal with life’s stresses
                                  are severe, some medical
and conflicts. Psychological
                                  treatments may be helpful.
therapies may not only support
a person to recover, but          For moderate to severe
can also help to prevent the      depression, antidepressant
anxiety or depression from        medication may be prescribed
reoccurring.                      along with psychological
                                  treatments.

22
made by a qualified health
                                   professional, after careful
                                   assessment and consideration,
                                   and in consultation with the
                                   person concerned.

                                   “The medication made me
                                    calm. I didn’t actually know
                                    I wasn’t calm until I became
                                    calm. Then I undertook CBT
                                    with my psychiatrist who
                                    specialised in it so I could
                                    learn to live with this calm
                                    person. I never go a day
Sometimes, antidepressants          without my medication and
are prescribed when other           apply CBT to situations that
treatments have not been
                                    once would have been bad
successful or when
                                    for me.”
psychological treatments are
not possible due to the severity                – Dale, 69, QLD
of the condition or a lack of
access to the treatment.
There is a lot of misinformation    “My journey wasn’t very
about antidepressant                 pleasant having to go
medication and while there is        into clinics and given
no simple explanation as to          medication, which didn’t
how it works, it can be very         help. It was only when I
useful in the treatment of           was referred to another
moderate to severe depression        psychiatrist who found a
(and some types of anxiety).         tablet that agreed with me.
There are many different             I am still taking the same
antidepressants, and a               medication to this day.”
decision about which type to                    – Jackie, 79, VIC
use is one that needs to be

                                                                    23
Who can assist?

Different health professionals
offer different types of
                                 General Practitioners
services and treatments for      (GPs)
depression and anxiety.
                                 GPs are the best starting
                                 point for someone seeking
 “I attended counselling at      professional support. A good
  the hospital in which my       GP can:
  husband died but I knew
  I was really ill and sought    • make a diagnosis
  the advice of a psychiatrist   • check for any physical health
  and later a psychologist.”       problem or medication that
                                   may be contributing to anxiety
          – Barbara, 77, NSW       or depression
                                 • discuss available treatments

24
• work with the person to           fee. Contact your health fund
  draw up a Mental Health           to check.
  Treatment Plan so they can
  get a Medicare rebate for
  psychological treatment
                                    Psychiatrists
• provide brief counselling or, in Psychiatrists are doctors
   some cases, talking therapy     who have undergone further
                                   training to specialise in mental
• prescribe medication
                                   health. They can make medical
• refer a person to a mental       and psychiatric assessments,
   health specialist such as a     conduct medical tests,
   psychologist or psychiatrist.   provide therapy and prescribe
                                   medication. Psychiatrists often
Psychologists                      use psychological treatments
                                   and/or medication.
Psychologists are health
professionals who provide          If the depression is severe
psychological therapies. Clinical and hospital admission is
psychologists specialise in the    required, a psychiatrist will
assessment, diagnosis and          be in charge of the person’s
treatment of mental health         treatment. A referral from a GP
conditions. Psychologists and      is needed to see a psychiatrist.
clinical psychologists are not     Rebates can also be claimed
doctors and cannot prescribe       through Medicare.
medication in Australia.
It is not necessary to              Mental health nurses
have a referral from a GP           Mental health nurses are
or psychiatrist to see a            specially trained to care for
psychologist. However, a Mental     people with mental health
Health Treatment Plan from a        conditions. They work with
GP is needed to claim rebates       psychiatrists and GPs to review
through Medicare. If you have       the state of a person’s mental
private health insurance and        health and monitor their
extras cover, you may be able       medication.
to claim part of a psychologist’s

                                                                    25
They also provide people with     skills training. They also draw
information about mental health   on a range of theories and
conditions and treatment.         therapeutic approaches to
Some have training in             work holistically with people to
psychological therapies.          support their recovery and help
For a referral to a mental        them to effectively manage
health nurse who works in a       or change the situations that
general practice, ask your GP.    may contribute to mental
                                  health conditions.

Accredited Mental                 Occupational
Health Social                     therapists in
Workers                           mental health
Accredited Mental Health
Social Workers specialise         Occupational therapists in
in working with and treating      mental health help people who
mental health conditions. Some    have difficulties functioning
provide focused psychological     because of a mental health
strategies, such as CBT, IPT,     problem (such as anxiety or
relaxation training, psycho-      depression) to participate in
education and interpersonal       normal, everyday activities.

26
Some occupational therapists
can also provide focused          The cost of getting
psychological strategies.         treatment for anxiety
                                  and depression from a
                                  health professional varies.
Aboriginal and                    However, in the same
Torres Strait                     way that people can get
Islander health                   a Medicare rebate when
                                  they see a doctor, they can
workers                           also get part or all of the
Aboriginal and Torres Strait      consultation fee subsidised
Islander health workers are       when they see a mental
health workers who understand     health professional for
the health issues of Indigenous   treatment of anxiety and
people and what is needed         depression. It’s a good
to provide culturally safe and    idea to find out the cost
accessible services.              of the service and the
Some workers may have             available rebate before
undertaken training in mental     making an appointment.
health and psychological          The receptionist should
therapies. Support provided       be able to provide this
by Aboriginal and Torres Strait   information.
Islander health workers might
include, but not be limited to,   For more information, visit
case management, screening,       www.beyondblue.org.au/
assessment, referrals,            getting-support
transport to and attendance
at specialist appointments,
education, improving access to
mainstream services, advocacy,
counselling, support for family
and acute distress response.

                                                                27
Caring for someone with
anxiety or depression

The term ‘carer’ is used for a
person who supports, cares
for or looks after someone
with anxiety or depression.
Carers may be partners,
siblings, children, parents
or close friends.
While most carers say that
looking after someone is very
rewarding, it does have its
challenges. Carers have poorer
health and wellbeing than non-
carers and research shows
more than one-third of carers
experience depression.4
Being a carer can be a leading   “Find a good support
cause of their depression.        group! This is the most
Caring for, or living with,       important step. Find out
a person who experiences          about the illness and its
anxiety and/or depression         characteristics. Find out
isn’t easy. Knowing what to       what to do that works – for
do and say can be hard. It’s      yourself and the one you
not uncommon to experience        care for.”
anger, guilt or fear. On the
                                              – Barry, 71, SA
next page are some practical         (Cares for his two sons)
tips to support you while
caring for someone with
anxiety or depression and to
help you look after yourself.
28
• Let the person know if you’ve   • Encourage the person
  noticed a change in their         to face their fears with
  behaviour.                        support from their doctor/
• Spend time talking with           psychologist.
  the person about their          It would be unhelpful to:
  experiences and let them        • put pressure on the person
  know that you’re there            by telling them to “snap
  to listen without being           out of it” or “get their act
  judgmental.                       together”
• Suggest they see a doctor       • stay away or avoid them
  or health professional and/
  or help them to make an         • tell them they just need to
  appointment.                      stay busy or get out more
• Offer to go with them           • pressure them to mask how
  to the doctor or health           they’re feeling with drugs
  professional.                     and alcohol.
• Support the person to find
  information about anxiety        “For me it has been
  and depression from a             important to realise that I
  website or library.               have a life too, apart from
• Encourage them to try to get      the person I care for. That
  enough sleep, exercise and        it is not wrong to care
  eat healthy food.                 for myself, in fact, it is
• Discourage the person from        essential. To take time to
  using alcohol or other drugs      look after myself as well.
  to feel better.                   Not always easy, but very
• Encourage friends and             important to plan things to
  family members to invite          look forward to.”
  the person out and keep in                 – Patricia, 67, VIC
  touch, but don’t pressure            (Cares for her husband)
  them to participate in
  activities.

                                                                   29
It’s important for people who
are caring for someone with
                                   Take time out
anxiety or depression to also      As a family member or friend
look after themselves, both        of a person who is experiencing
physically and emotionally.        anxiety or depression, it’s
                                   important to look after yourself
 “Don’t delay in seeking           too. Make sure you give
                                   yourself time to unwind and
  counselling if you feel you
                                   do things you enjoy.
  are not coping. You not only
  need to look after yourself,
  but your welfare is vital        Talk to someone
  for the wellbeing of your        It may be helpful to talk to your
  charge.”                         friends or family members
           – Malcolm, 76, WA       about how you’re feeling in
          (Cares for his wife)     your role as a carer. If you’re
                                   having trouble coping and don’t
                                   feel comfortable talking with
Learn about anxiety                the people you know, talk to a
and depression                     counsellor.
This may help you to               For more information, see
understand why a person with       beyondblue’s Guide for carers
the condition behaves in a         at www.beyondblue.org.au/
certain way. It may also help      resources
you to separate the condition
from the person and to realise      “Reassure a friend or loved
that their mood or behaviour is      one first that you are there
not necessarily directed at you.     for them and use this
                                     fact as a launching pad
                                     to seek the right help for
                                     them. They need constant
                                     reassurance.”
                                              – Patricia, 67, VIC
                                        (Cares for her husband)

30
Malcolm’s story
                                 Finally the time came when I
                                 was called home from work
                                 because Maureen was walking
                                 around the front garden in the
                                 middle of the afternoon crying
                                 her eyes out.
                                 I don’t think postnatal
                                 depression was understood
                                 like it is now. I didn’t know
                                 that I was a carer. I realised
                                 afterwards that I had become
I met Maureen in 1956. She       one because of what I was
would have been at a ripe old    doing.
age of about 17 or something,   Building up self-esteem with
and I was a bit older. We had a someone who hasn’t got any
long engagement and finally got is very difficult. There was no
married when she turned 21.     beyondblue to say, “This is what
We’ve got two children. We      you  do. This is how you do it.”
had it rough, it meant that      It’s a lifestyle. You have to
there was no spare money         think about what you are doing
for Maureen to do anything,      all the time. You can’t just go
and things were pretty hard,     ahead and say, “I will do this.”
at least by current standards.   You gotta think, “What will be
She was isolated.                the effect on my partner if I
I not only had to work, but      do this?”
in those days, I had to go to    To watch Malcolm’s story visit
night school. I came home        www.beyondblue.org.au/
sometimes and the baby was       olderpeople
crying her eyes out because
she was colicky and Maureen
would be crying.

                                                                    31
Being well and staying well

There are many ways people        Whatever the cause, here are
can support themselves to         some simple steps that can
be well and stay well. The        support you to reduce and
practical tips below can          manage stress:
also help to promote mental       • Making major changes in your
wellbeing.                          life can be stressful at any
                                    time. If you’re feeling stressed
Reducing and                        or anxious, it’s probably
                                    a good idea to try to avoid
managing stress                     moving house or making
Stress is common in daily life,     a major financial decision.
but exposure to prolonged           Leave them to a time when
stress can start to affect your     you’re feeling better.
mental and physical health.

32
• Ongoing stress in personal
  relationships often
                                  Maintaining a
  contributes to anxiety and      healthy lifestyle
  depression. Learn how to        Eating a healthy diet, exercising
  let people know about your      regularly, getting enough sleep
  feelings so that you can        and avoiding harmful levels
  resolve personal conflicts      of alcohol and other drugs
  as they come up. Talking to     can help a person to manage
  a counsellor or psychologist    the symptoms of anxiety and
  can help you find ways to       depression.
  address your problems.
• Learn to relax. To do this,      “I stay well by working on
  you need to allocate time to      my physical health (walking
  do the things you enjoy, such     and cycling), emotional
  as exercising, meditating,        health (Mindfulness) and
  reading, gardening or             brain fitness (CogniFit plus
  listening to music.
                                    other varied activities).
• Learn to say “no”. Create a      This is an ongoing effort.
  balance between activities        I also have closer family
  or other commitments              connections and contact
  and the things you enjoy          with grandchildren. I
  doing. Don’t allow yourself
                                    immerse myself in
  to be overwhelmed by new
                                    community work related
  commitments.
                                    to health and wellbeing. I
• Include short-term coping         avoid obvious sources of
  strategies in your day, such
                                    stress, including negative
  as breathing and relaxation
                                    and nasty people. I travel
  exercises.
                                    to stimulate my brain and
                                    explore the basic things
                                    of life with a much more
                                    open mind.”
                                                – Brian, 68, VIC

                                                                   33
Eating well                         • make use of the times when
Having a mental health                you feel good to prepare
condition can make it difficult       meals ahead of time.
to eat well, but keeping things       For example if you’ve got
simple can help. Here are             energy in the morning, make
some tips:                            dinner then or cook large
                                      quantities of food and freeze it.
• keep a daily timetable and
  include food-related activities   Getting a good night’s sleep
  such as shopping, cooking
  and eating                        It’s essential to try to maintain
• learn to prepare simple           a regular sleep pattern to keep
  meals that don’t take too         well and stay well:
  much time or energy to            • try to get up at about the
  prepare – if you live on your       same time each morning
  own and aren’t eating proper      • if you’re worrying about
  meals, consider using frozen        things during the night, set
  or home-delivered dishes            aside some time for problem-
• looking for opportunities           solving during the day
  to eat with others can be         • avoid drinking caffeine after
  another way of making               4pm and try not to drink more
  mealtimes more enjoyable            than two cups of caffeine-type
                                      drinks such as coffee, strong
                                      tea, cola or energy drinks
                                      each day
                                    • avoid using alcohol to help
                                      you sleep – as the alcohol is
                                      broken down in your body,
                                      it causes you to sleep less
                                      deeply and to wake more
                                      frequently

34
• allow yourself time to wind      Here are some simple things
  down before going to bed. If     you can do:
  you are working or studying,     • invite a friend around for
  stop at least 30 minutes           coffee
  before bedtime and do
  something relaxing.              • organise a movie night
                                   • visit a neighbour
                                   • phone a friend for a chat
                                   • join a local community
                                     group or volunteer with a
                                     local charity
                                   • sign up for a course.

                                    “Important to my wellbeing
                                     are healthy diet, exercises,
                                     doing things I enjoy. I also
                                     try to manage stress and
                                     notice when I start to feel
                                     the fog creeping back. I
Staying connected                    hate exercise but it is vital!
Spending time alone can make         If I don’t walk almost every
a person feel cut off from the       day I can sink fast. I have
world.                               children and grandchildren
That’s why it’s important to         in whom I delight, and
participate in activities with       a few close friends who
family members, close friends        are understanding and
and the community – and to           supportive. My biggest
accept social invitations.           pillar is my partner. I have
                                     learned that it is not ‘weak’
Connection with other people
increases wellbeing, confidence      to ask for help.”
and opportunities to participate            – Penelope, 65, NSW
in activities.

                                                                      35
Brian’s story
                                   helped me to start to see the
                                   positives that I have in my life.
                                   One of the strongest bits of
                                   advice that I have is to be
                                   active, and that doesn’t mean
                                   you have to be out doing things
                                   all the time, there are different
                                   ways to be active.
                                   It’s a bit like a car. If you just
                                   hop in the car and drive it and
                                   don’t maintain it and get it
                                   serviced every routine period,
                                   things will go wrong and it gets
                                   worse. It’s the same with us
                                   and our bodies and our minds.
 In November 2009, I was going     What you say is I want a total
 home from work and standing       tune up and repair, and listen
 on the Collingwood railway        to the advice that comes out
 station. The thought crossed      of that. If that’s going to be
 my mind, “If I really wanted to   effective, though, you really
 get rid of myself it would be     need to have a doctor that
 good to jump there because a      you know.
 least the driver wouldn’t have
 to look” and I thought, “What     At 68, I’m striving to be the best
 the hell am I thinking?”          I can physically, emotionally,
                                   and to make sure my brain is
 So I took myself straight off the as good as it can be for as long
 next day to see my doctor who     as it can be again, you need to
 looked at me and said, “You       be active.
 need some counselling.” My
 counsellor was terrific and       To watch Brian’s story visit
 from the very first session he    www.beyondblue.org.au/
                                   olderpeople

36
“I know my weaknesses,                                   “Find a doctor and other
     we all have those, but I’ve                              health professionals you
     also found my strengths,                                 can trust, and talk frankly
     and nobody can take those                                with them. Make a decision
     away from me. Take heart,                                to be positive – reject and
     you can lead a normal life.                              avoid negative people and
     Remember there are lots                                  situations. If there is an
     of people who have the                                   obvious source or trigger
     same problems – you’re                                   for the depression or
     not alone, everyone has                                  anxiety such as your job or
     their own personal cross                                 a hostile partner, remove
     to carry, so learn to                                    yourself from the trigger
     carry yours in whichever                                 as soon as you can. Find
     way is right for you. Be                                 a new and active means
     kind to others and it                                    of contributing to your
     will be returned to you.                                 family and/or community,
    Just remember, you’re                                     one which stimulates you
     important, you are needed,                               mentally. Positive activity
     you have been put here for                               helped me immensely.
     a purpose.”                                              Prevention and early
                    – Carole, 72, NSW                         detection and action are
                                                              better, easier, less painful
                                                              and cheaper than a cure.
                                                              Seek help early.”
                                                                                 – Brian, 68, VIC

References
1
    Australian Bureau of Statistics (2008) 2007 National Survey of Mental Health and Wellbeing: Summary of
    Results (4326.0). Canberra: ABS.
2
    National Ageing Research Institute (2009). beyondblue depression in older age: a scoping study. Final Report.
    Melbourne: National Ageing Research Institute.
3
    Australian Institute of Health and Welfare (2012), Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW.
4
    Cummins, R. A., Hughes, J., Tomyn, A., Gibson, A., Woerner, J., & Lai, L. (2007). Australian Unity
    Wellbeing Index: Report 17.1 The Wellbeing of Australians – Carer Health and Wellbeing. Melbourne:
    Australian Centre on Quality of Life, School of Psychology, Deakin University.

                                                                                                             37
Being a blueVoice is so very
   important, not only to me as it
   has helped me overcome so many
   past memories and has also given
   me courage, but to those that I
   can help in some way or another.
   Christina, blueVoices member

  Join blueVoices
  Make a difference to others
  experiencing anxiety and depression

If you’ve experienced anxiety
or depression, or supported                To find out more, or register,
others through their journey, join         visit www.beyondblue.org.au/
beyondblue’s reference group and           bluevoices
online community, blueVoices.
blueVoices members provide feedback,
tell their stories and help us develop a
wide variety of beyondblue projects,
campaigns and resources.

  38
HOPE. RECOVERY. RESILIENCE. Find out more at www.beyondblue.org.au
Where to find more information
beyondblue
www.beyondblue.org.au
Learn more about anxiety, depression and suicide prevention, or talk through your
concerns with our Support Service. Our trained mental health professionals will listen,
provide information, advice and brief counselling, and point you in the right direction so
you can seek further support.
   1300 22 4636
    Email or       chat to us online at www.beyondblue.org.au/getsupport
Head to Health
headtohealth.gov.au
Head to Health can help you find free and low-cost, trusted online and phone mental
health resources.

       @beyondblue                 @beyondblue

       @beyondblueofficial               company/beyondblue

Donate online www.beyondblue.org.au/donations

© Beyond Blue Ltd. BL/0647 04/18
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