Thursday, September 11, 2014

What NOT to say to a caregiver

You hear it all and usually you wish you didn't. You would love for family member and friends to understand how some comments sound incredibly insensitive. To help, a list of ten things...
1. “You know what you should do?”
 2. “Why don’t you just get some help?”
 3. “Why are you so tired? You don’t go anywhere.”
4. “Why are you so tired? You don’t have a job.”

Wednesday, September 10, 2014

Five things Canadians get wrong about the health system

Five things Canadians get wrong about the health system

How our health system should be reformed, and in what measures, is nothing short of a national pastime in Canada

1. Doctors are self-employed, not government employees
2. Canada has 15 different health care systems
3. Funded health care services are not provided equally across the country
4. User fees charged to patients are not permitted
5. Canada does not truly have a “single payer” system meaning a significant portion of Canadian health care comes from both public and private financing

Sunday, September 7, 2014

Best practices for caring for people with dementia symptoms

 I've had my fair share of clients, not to mention my late father, who had dementia. Dad's was due to his brain tumour, but symptoms vary by the individual, and by the cause of the dementia symptoms. For we must remember that dementia is a SYMPTOM.
In terms of their physical and medical, it does matter what is the cause of their dementia.
In terms of their social and emotional care, it does not and we must remember a number of things.

Firstly, you simply cannot understand the world in which they live. You must listen to them. For this reason, the newest notions from professionals tell us that we must buy in to their world and their stories. It really hit home for me when listening to This American Life's segment entitled Magic Words. If you haven't listened to a podcast, you really should!

It is up to the caregiver to adapt and change to the needs of the care recipient. This will save you grief. For just as a new parent must adapt to a diagnosis of a disability in a child, caregivers must adapt to the diagnosis in a loved one since they are unable to control their biopsychosocial symptoms. This is crucial. Your hopes and dreams must change, as well. We must change the way we frame our lives, Framing Our Happiness and Our Attitudes.

What is ironic for me is that my son, the actor, told me about this show, which led me to this idea. I'd Yes, and' makes to a conversation with an adult child and granddaughter, towards a family member with dementia symptoms.
suggest listening to the show, as they have audiotape of the mother and you can listen to the difference a simple, '

 Act Two

Producer Chana Joffe-Walt talks to a woman named Karen Stobbe and her husband Mondy about a plan they've recently enacted in their family. Karen's mother lives with them and she has dementia. Karen and Mondy are actors and they stumbled upon a skill they have that is incredibly useful in communicating with Karen's mother – improv. (20 minutes)
Karen Stobbe offers workshops "" on how to use the tools of improv with people who have dementia. 


Here is the program taught at the four pilot facilities.
WORKSHOP 1 - Understanding the World of Alzheimer's
WORKSHOP 2 - Non Verbal Communication
WORKSHOP 3 - Verbal Communication
WORKSHOP 4 - Listening Skills
WORKSHOP 5 - Tools for Behaviors
WORKSHOP 6 - Tools for Caregiving

It is a brilliant strategy for those who face a loved one who forgets who they are, or forgets early memories, or forgets that you are their daughter, wife or carer. You cannot argue with them, as their brain is functioning differently.

Essentially, good carers must be open-ended with them, and do as they do in Improv: do not shut down the scene. "You're wrong." or "It didn't happen that way."

In good Improv you acknowledge the statement and say, "Yes And ..." There is much to support this in the acting world, Yes And   is a tool that keeps the drama unfolding, rather than ending the scene.

This is how we can interact with someone who is not living in the here and now, but in their own world. We do it with toddlers. We can do it with people with whom we have a history as long as we leave our own egos aside. It is fruitless to argue when faced with these dementia symptoms, as much as we want everything to be 'normal', it is not.

Dr. Phil talk about the Right Fight, in which couple seek to convince the other that they are right and you are wrong. The argument continues for hours, weeks, years. This is what happens with many caregivers. It leads to frustration, anger and a sense of failure. When working with young children, I learned to prune information and ideas from them, using questions, and it makes for a satisfying conversation.

I instinctively used this skill when my late father used to sit in his wheelchair, bang on the table in It's all gone to hell!" This from a man who never swore or got angry with me. I acknowledged that he was right. Rather than shaming him for his language, I used to simply agree with him. "Yes, Dad. It's all gone to hell. Now, do you want some veggies or meat right now?" I spent many an hour feeding him after he lost the ability to use a knife and fork. We spent a lot of time in this reversed relationship.
front of him and yell that "


"Tell me more about that time in your life."
"What was that like for you?"
"Why do you think it is like that?"
"What will we do about this?"

Friday, September 5, 2014

Dying with dignity –it's complex

I am terribly disconcerted with the government interference with marijuana laws. Many of my clients would benefit from this drug. There are physicians who are afraid of this drug.

On the other hand, the Dying With Dignity movement is lobbying to allow physician-assisted deaths.

Each case, each life is unique and precious. I have seen people who have taken joy from the love and the care loved ones are providing – that is both the caregiver and the care recipient.

We have been fighting physicians to provide individual, patient-centred care for many years. it all seems topsy-turvy to me, however, when we are faced with stories such as this one...

  1. Toronto hospital illegally imposed 'do-not-resuscitate' order ...
    2 days ago - In a case that dramatizes the debate over who has ultimate power in such cases – doctors or patients’ families — Ms. Wawrzyniak said she had only just learned that the “full code” response to emergencies she had requested on her father’s behalf had been over-ruled by a do-not-resuscitate (DNR) order, which meant CPR would not be attempted during cardiac arrest.

Monday, September 1, 2014

Assisted suicide isn’t the only dignified way to go – most of us die with dignity

Assisted suicide isn’t the only dignified way to go
We come into this world helpless, and most of us have gone out of it that way. It makes us human.

Too many interventions make the patient worse
I'm pretty much fed up with those who are weighing in on this debate.
Yes, if you are in intolerable, unmanaged pain, due to a terminal illness.
Most of us do not fit this category.

Dr. Donald Low surely hit a new low with his terrible video. With one eyelid taped open, he was bemoaning the fact that he was unable to end his life. He didn't want the embarrassment of having someone help him to the toilet. I find that most of my clients accept the help they require with dignity and grace.

And I've had some pretty ill clients. As with pediatrics and geriatrics, we need some help along the way. There is dignity in accepting help gracefully. My client with ALS, who used her iPad keyboard to type her words. She wasn't ready to end her life. Her husband showed much grace in seeing to her every need. I felt such a reward in helping her PSW clean her up and get her back form her commode to her wheelchair.

There are diseases with long trajectories. Cancer has a very varied trajectory, long or short, depending upon its stage. The period of time gives family and friends time to pregrieve. It gives the person time to prepare for the end-of-life. Most of us die with dignity.

Monday, August 25, 2014

A professional weighs in on feeding tubes, dementia, and EOL

I have written on this topic before. When End of Life comes, the body knows what to do. It shuts down slowly, part by part.

A person with dementia, who experiences many pneumonias, and chokes while eating, is at risk. Aspiration pneumonia, and the ensuing antibiotics, is hard on someone dying.
A feed tube adds a difficult surgery, with complex care, as brain function slows down.
But contrary to popular belief, a feeding tube does not prolong life in a patient with dementia. It actually increases suffering. A stomach full of mechanically pumped artificial calories puts pressure on an already fragile digestive system, increasing the chance of pushing stomach contents up into the lungs. And surgically implanted tubes are a setup for complications: dislodgments, bleeding and infections that can result in pain, hospital admissions and the use of arm restraints in already confused patients.

But maybe most important, the medicalization of food deprives the dying of some of the last remnants of the human experience: taste, smell, touch and connection to loved one.

Sunday, August 24, 2014

Baby boomers fear future health-care costs

Those opinion polls are just awful. We're living longer and we're living healthier lives. These scare tactics are ridiculous, especially when it is the Canadian Medical Association (CMA) who paid for the poll. We have volunteers, such as those delivering Meals on Wheels, who are living long, healthy, meaningful lives. Media only reports of those who are abused or fall through the cracks.

What is the answer?

Firstly, we must take responsibility for ourselves. Eat well; exercise mind, body and spirit; participate; volunteer; everything in moderation; demand accountable physicians. Ours have been fabulous throughout our journey confronting cancer.

It's high time physicians took responsibility for wait times, inability to get appointments with medical staff, uncooperative physicians, physicians who screen potential patients, physicians who are few and far between at homes, and the lack of care in LTC. It's also time we stopped opinion polls and simply reported data.

It's shameful for the CMA to point fingers at The System, when many (but not all) in the CMA are part of the problem.

A strong majority of Canadians aged 45 and older are anxious about their financial future and their ability to pay for uninsured prescription drugs and other health expenses, a new poll finds. Eight in 10 aren't convinced they will be able to find or afford a decent home or long-term care should they need it, according to the Canadian Medical Association's annual "report card" on health. 

The Ipsos-Reid poll of 1,000 Canadians aged 45 and older was released Monday to coincide with the opening of the CMA's annual meeting in Ottawa.

  • 81 % of those polled said they are worried about the quality of health care they can expect when they're older
  • 60% have little faith hospitals and long-term care facilities have the resources even now to handle the needs of a rapidly greying population, or that there will be enough services to help seniors live at home longer. 
Baby boomers fear future health-care costs
Six in 10 have little faith hospitals and long-term care facilities have the ... But the proportion of health dollars spent on seniors' care has budged little ...

Seniors care is the paramount health care issue of our time, says the new Canadian Medical Association President Dr.�Chris Simpson.

Saturday, August 23, 2014

PART XXV: Food intolerance test results

Hubby is determined to get into as good shape as he can to better confront his cancer disease trajectory.
He works out regularly.
I was concerned with his stomach issues.

Our Naturopath has been fabulous.
We've learned to incorporate items like quinoa and couscous. Unfortunately, hubby doesn't like any of these things!

It's not good news – the test results, as hubby is sensitive to dairy, eggs, yeast, kidney beans, spelt, casein, whey, and this means a whole new attack for menus. It means vegan bread, and none of those multi-grain breads we love, and limiting the times we eat out.
He lost 6kg on the cleansing diet, intended to get him off sulphates and other items. That was a good thing.

Thanks to all who have been asking.
Deep breath.
Dr. Jen is amazing!
I took copious notes on the iPad, which is very helpful. I type quickly, and captured a lot of information.

I suspected hubby had food intolerances when he was having stomach issues, on top of having cancer and taking his cancer treatments. The drugs are merciless.  They ruin your gut. I've been on prednisone for my Poison Ivy bout. I'm looking at my issues, too.

Now we know foods to avoid.
Yes, a bit of a shock. We shall regroup and create a plan. Thank goodness for our local Foodsmiths, with their organic, vegan foods; on-line shopping; vitamin supplements, protein shakes, dairy-free products; as well as well-trained and informed staff, who've been supportive during his cleansing diet. Ever onward.

Extensive report
Next, we'll have to manage to figure out how to create balance, and reintroduce particular foods that are NOT on his intolerance list. It was an excellent report, with many things we could learn.

For example, they recommend a 4-day cycled menu. Don't have any foods repeated within the four days. For us, this will be a challenge, as habits die hard. They have quinoa breakfast flakes, much like oatmeal.

Replacing bread means doing things like using lettuce leaves as wraps, eating rice products: they make great pastas, and rice cakes, which can act as a substrate.
Our consult
Our local store does have quinoa bread, which are made without yeast, eggs and dairy. This was a challenge to find!
A friend suggested in lieu of yeast, you can combine baking powder and lemon juice.
He's to stay on the probiotics and glutamine.

Another possibility is a candida fungal infection. There is an on-line test for this. Also, some suggest a spit test. Candida grows in the gut. Hubby's gut has been leaking, and this is why he has been uncomfortable. The cleansing diet was to give him time to heal his gut.
"The main difficulty with testing for Candida is that everyone has it! It is not the presence of Candida Albicans that is a problem, rather is is the overgrowth of Candida that gives you all those nasty symptoms."
If you search: you'll find for-profit sites, including a questionnaire. It's posted by someone who has written a book, which isn't exactly confidence building.
Here are some tests you can do at home:

Friday, August 22, 2014

How to Manage the Offers of Assistance During Cancer Treatment

Too much help? It may seem like an odd problem to have, but it can happen. Robin McGee, author of “The Cancer Olympics,” has been through it before. In this video she explains how to manage all the offers of assistance during cancer treatment

Tuesday, August 12, 2014

Biopsychosocial Factors in Adult Depression

Biopsychosocial Factors in Adult Depression and
Implications for Counselling Practice
Jennifer Jilks, B.A., B.Ed., M.Ed.

July 6, 2007


This paper develops a framework around the history of major depressive disorder. It examines the history and theories of this disease, also known as unipolar disorder. It develops a theory of the implications for clients, client's families, employers and counsellors to create an understanding of the disorder, to better understand the physiological responses and psychosocial consequences of this mental health issue. It examines the impact of depression and demonstrates the necessity of identifying and treating it early. The conclusion examines ideas for further research and the impact of technology on this field including research in the areas of cognitive therapy, technology and early identification.


Major depressive disorder is one of the most common mood disorders (Pezawas, 2005; Pinel, 2007; Sigelman & Rider, 2006). Diagnostic and statistical manual of mental disorders (DSMV-IV, 1994 ) provides a quantitative analysis for major depressive disorder and includes a check list with a weighting factor. Pinel (2007) refers to major depressive disorder as unipolar disorder to differentiate it from bipolar disorder, in which the patient experiences activities of extreme overconfidence, impulsivity, distractibility, and high energy, as well as bouts of depression.
The consequences of unipolar disorder leads to an impact on the social, emotional and socioeconomic lives of clients. This paper strives to create a modern response to an age-old disorder, based on the latest research from biology, psychology and sociological sources. It points to the importance of the counsellor to have a holistic understanding and an integrative approach to the treatment of this disorder.
Fink et al (2007) and Shorter (2006). call for a renaming of this disorder for the publication of DSMV-V by melancholia. This will differentiate the disorder from its various subgroups and will aid in identification and treatment of the disorder. It is clearly identifiable by its psychcomotor disturbance, psychotic and non-psychotic disorders and neuroendocrine markers. To enable more disorder-specific research,
Treatment in the past 60 years has been wide and varied and has included pharmocuetical, psychotherapy, and electroconvulsive therapy (ECT) . Taylor (2005) finds ECT a useful and underused therapy on carefully selected patients, i.e. those resistant to drug therapy, the elderly, or during pregnancy.

Theoretical Perspectives

Treatments for depression in the past have ranged from physical treatments for apparent physiological disturbances such as purging, bleeding and blistering, to surgery to remove the theoretical cause of the disease.
Galton’s heritability of families and twins in the 1860’s opened the door to more scientific explorations of this disorder. Freud’s psychosocial theories developed from his 1895 work on synapses and neuroplasticity (Doidge, 2007), Freud tied his research to his early work on neurology (Doidge, 2007). With Philippe Pinel’s more humane approach, rather than locking away the mentally ill (Making the World, 2004), theorists recognized social or psychological distresses, and studies of temperament, body types and emotional patterns in the 1940’s demanded further biopsychosocial research (Friedman & Schustack 2006). Eysenck’s brain-based model or personality in the 1960’s, evolutionary personality psychology in the 1990’s (Friedman & Schustack 2006), and the study of genetic bases of individual behaviour patterns in the present have led to a wide array of attitudes, etiologies and treatments for depression (Pinel, 2007; Sigelman & Rider, 2006).
Freud felt that depression is a reaction to inner guilt and self-criticism, which can be traced back to early childhood loss (Friedman & Schustack 2006), Currently, Doidge’s work (2007) supports Freud’s connection between the physiological, the psychological and the emotional consequences of this disorder. Doidge (2007) examines the plasticity of the brain and, how, through psychotherapy, cites research to demonstrate how the amount of flow of blood in the brain can be changed in the early years and brain cells can be rewired in the prefrontal cortex to rewire the brain’s circuitry and improve the biopschyosocial reaction to stress. He advocates for the counsellor to help the client reframe her thinking to move forward. Attitude and perception is formed in early years, but can be changed in adulthood.

Literature Review

Literature Review: Biological Factors

Physical symptoms of depression include fatigue, sleep issues, tremours, cognitive deficits and can be masked by other physical, social and emotional issues. Depression is a serious, life-debilitating mental health issue. It is a silent disease which crosses developmental ages and stages (Straugh, 2003; Sigelman & Rider, 2006), but becomes more evident during the biological changes associated with adolescence. Straugh (2003) points to the research from the National Institute in Washington in which rates for major depression rise beginning in puberty. Interpersonal stress, establishing a sexual identity, in addition to hormone levels and biological reactions to stress, leading to a preponderance for stress reaction (Sigelman & Rider, 2006) . It is at this stage that the brain is developing brain cells and refining brain structures, creating and pruning dendrites in preparation for adulthood (Nunley, 2003).
Cells in the central nervous system control mood, eating, sleep, pain and thinking. When a person is under stress, their body reacts with the fight or flight response and, like adrenaline, the body becomes flooded with serotonin (Hariri et al, 2002; Nunley, 2003). Neurotransmitters are responsible for sending signals across the synapses between cells and throughout the body. Under stress the synapse is flooded with serotonin and noradrenalin as the organism pumps in these chemicals to aid in its response. Treatment for depression included three types of anti-depressants: tricyclics, monoamine oxidase inhibitors and tretracyclics (selective serotonin-reuptake inhibitors or SSRIs). These drugs increased the amount of norepinephrine and serotonins, which increased serotonic transmission. They provide the physician with drugs that not only have an effect on physical symptoms in patients but affect emotional changes to perceptions of self-esteem, fear of failure, excessive sensitivity to criticism, and the inability to experience pleasure (Bosker et al, 2004; Pinel, 2007).
Current research, with the help of functional Magnetic Resonance Imaging (fMRI), demonstrates that as the brain cells attempts to communicate with each other, putting chemicals into the synapses, neurotransmitters, such as dopamine or serotonin, trigger the neighbouring cells to fire. The body can re-use these chemicals and the re-uptake mechanisms would allow absorption of the serotonins. The new drugs such as the norepinephrines Paxil or Zoloft, shut off the re-uptake inhibitors allowing serotonin levels to return to normal neuronal firing rates. Selective serotonin reuptake inhibitors (SSRIs) Only 25% of patients (Pinel, 2007) are helped with monoamine agonists and this theory supports the necessity of counseling interventions (Szigethy et al, 2002).
Historically patients have been subjected to various drugs such as monoamine inhibitors (Pinel, 2007; Bosker et al, 2004). Some of these drugs have been shown to increase the risk of strokes (Pinel, 2007). Other symptoms include Blurred vision, hallucinations, hypertension, dizziness, fatigue, nausea, and anxiety.
Stress can create changes in the brain that have a lifelong impact, and leave the patient without critical brain cell functioning (Doidge, 2007). The drugs target the dysfunctioning monamine neurotransmitter circuits in the central nervous system, serotonin and norepinephrine, but frequently patients do not respond until 3-5 weeks of regular use. Neremoff (2002) found that after 6-8 weeks, only 35-45% of patients managed to reach premorbid levels of functioning. The balance of patients did not respond or failed to respond adequately to chemical treatment.
During depression autonomic functioning is impaired and sympathetic arousal contributes to increase cardiovascular risks (Karavidas et al, 2007). Biofeedback was been shown to be effective in relieving this symptom. The therapeutic benefits of exercise (Balkin et al, 2007) continue to reflect a complex relationship between wellness and the physiological benefits of a holistic therapy. This study questions whether participating in exercise is evidence of a cure, or a benefit of choosing to become involved in these studies.
Depression not attributable to a particular cause is called endogenous depression. Pezawas et al, (2005) and Hariri et al, (2002) identified a functional polymorphism in the human serotonin transporter that appears in cell activity during depression. Studies have found links between physiological responses in the prefrontal cortex and the amygdala. There are ranges from underactivity of monoamine oxidase inhibitors and norepinephrine. This, in conjunction with individual tempermental differences, creates the difference between normal and abnormal behaviour. Some patients in autopsy indicate a proliferation of serotonin receptors. Paul et al, (2004) finds an association between folic acid deficiency, but cites inconsistencies in methods of measurement and findings appear inconclusive. Folic acid and the relationship between mood disorders has been identified as significant factor, but more research is required.
Pinel (2007) supports the theory that brain damage is an underlying cause or effect of depression, which can be measured quite clearly. Depressed patients cannot experience pleasure (anhedonia), as evidenced in the mesotelencephalic dopamine system. Genetics add to the susceptibility of a patient and their ability to face depression, with stressful life events triggering a bout with depression. Pezawas et al, (2005) found a genetic susceptibility demonstrated by neuroimaging with subjects demonstrating anxiety, and emotional reactivity in response to fear.
Kendler, et al (1995) estimated heritability factors, based on twin research, at 41 to 46%. Pezawas et al, (2005) reported a 70% heritability factor. Researchers cannot agree, due to the inability to separate biological factors from psychosocial factors.
As the brain creates dopamine, in response to pleasure, the brain, if faced with excessive production of mimicked dopamine from the alcohol or drugs, naturally decreases its production and the patient has difficulty seeking the same pleasurable feeling with the same amounts of artificial sources. The brain removes and reduces dopamine receptor sites. Alcohol and drug abuse contribute chemically to the effects of depression. Not only does the patient need increasing amounts of unnatural substances to feel pleasure, but reduces available receptors (Nunley, 2003).
Ill-health is another factor in a diagnosis of depression. Akechi, et al, (2001) found that 12.8% of referred cancer patients were diagnosed with major depression. 51.4 % had suicidal ideations. Biological, psychological, and social factors influence depression. Morley et al, (2004) advises against genetic screening due to the ineffectiveness of such measures. Many variables influence the development of unipolar disorder.
As with all medications, there can be side effects which preclude the patient from following doctor’s orders. Nausea, difficulties falling asleep, feeling sleepy or dizzy, yawning, diarrhea, constipation, increased sweating and sexual disturbances. Other reported side effects include unspecific symptoms like a clogged or running nose, decreased appetite, fatigue and a mild fever (iCan, 2007).

Literature Review: Psychosocial Factors

Depression is categorized by its etiology: medical conditions, postpartum depression, premenstrual depression, and seasonal affective disorder, for example, all result in depressive symptoms. Reactive depression is the response to an extremely negative experience: bereavement, job loss, miscarriage (Scheidt et al, 2007), rape. Depression can be brought on by an extreme response to life’s normal passages (moving, a new job, childbirth, bereavement). Depression can occur during the entire adult stage of life, but it is more frequently diagnosed in early adulthood with new challenges faced by those just beginning their path to adulthood and less frequently in late adulthood as a healthy adult adjusts to life in society (Sigelman & Rider, 2006).
The client is said to have this disorder if he or she is reporting five of the following symptoms, including the first and second. Depressed mood, greatly decreased interest or pleasure in activities, significant weight changes, insomnia or oversleeping, psychomotor agitation or sluggishness, fatigue and loss of energy, feelings of worthlessness or guilt, concentration issues or indecisiveness, suicidal ideations or attempts. It is characterized by persistent symptoms, experienced over two week, as differentiated by mild feelings of depression, which do not affect daily life, social interactions, work or personal hygiene (American Psychiatric Association, 1994)..
Kagan’s work (CBC, 2007) included the study children. He found that with novelty they will demonstrate cautiousness. He concluded that temperamental traits cause a reaction to new experiences demonstrating introversion or extrovert tendencies. The amygdala reacts to unexpected and ambiguous events and the client associates this with fear. He classified 60 % of the children he studied as high reactive, the other 40% as low reactive. Low reactives didn’t move, cry or generate the same amount of stress symptoms in response to new things. He found that less than 5% changed temperaments. Being classified as high reactive doesn’t guarantee that you’ll be a fearful, high risk adolescent but it demonstrates a preponderance for social reactions and the powerful inbuilt need to protect oneself in society.
Unfortunately, media reports abound with drug warnings, especially for teenagers, regarding the risks of taking such chemotherapies (U.S. F.D.A., 2004) and the consequences of abuse. Clients should be monitored since side effects associated with taking more than the recommended doses of SSRIs, for example, could include dizziness, shaking, agitation, drowsiness, reduced consciousness, seizures, heart racing, slowed breathing, and vomiting.
Depression is a disorder that strikes all socioeconomic stratas. Somers, et al (2006) in a review of the literature on anxiety disorders found that between 1980 and 2004 4.2 % of the population in Italy, 9.2 % in Korea, 28.7 % in Switzerland. Mulholland, (2005) cites a rate of depression of 8 per cent for men and 12 per cent for women in the U.K., while stating that another unidentified group of patients likely suffer in silence. Reaction to stress can be seen in the preponderance of those who commit murder-suicides (Kumar et al, 2006).
Workplace stress (Jilks, 2003), unemployment (Comino et al, 2007) and stressful life events (Kendler, 1997) are factors in the presentation of clients with unipolar depression. Suicide rates in Canada soared during the depression and suicide rates for males are about four times that for males. (Statistics Canada, 2005). Gender statistics found that more women are diagnosed and treated with this disorder. U.K. statistics show that about 80% of women who have received treatment for depression commit suicide (Mulholland, 2005). Only 50% of men fall into this category. Of the men who committed suicide, two-thirds demonstrated themselves mentally ill and 20% have alcoholism. The Canadian Mental Health Association (CMHA, 2006) finds a prevalence higher amongst, for example, Inuit, Native groups, particular age groups. Suicide accounts for 24 % of deaths of 15-24 year old and 16 % of 16 – 44 year olds. 73% of hospital admissions for attempted suicide are for 15 – 24 year olds. (CMHA, 2006)
Likierman (2003) examines postpartum depression and cites such factors as extreme financial, social and emotional issues during this stage of life, especially in the event of marital difficulties. In the event of such a debilitating disorder, which has a profound effect on the whole person, an integrative approach is to be addressed.
Avis (2003), in an attempt to determine the answer to the question of depression as it relates to perimenopause and menopause concluded that these factors do not cause depression. The stage of life in which a woman finds herself: empty-nest syndrome (or adult children returning home), ailing parents, and other life passages, can cause a depressive reaction unrelated to the changing hormones (estrogen and progesterone). She felt that most studies examined patients, rather than the general population, and many women do not suffer from depression during menopause. Further examination found that the length of menopause and more than 27 months of symptoms (hot flashes, night sweats and menstrual problems) resulted in an increased likelihood of depression due to the effects of the symptoms, rather than the condition itself.
Depression can be related to particular medical interventions, such as cancer treatments (Capuron, et al, 2002) and open-heart surgery, and brain injury. The elderly are at risk due to life-changing circumstances, ill health and as a reaction to changes in environmental circumstances (Alexopoulos, 2005). The Mood Disorders Association of Ontario (n.d.) states that depression accounts for 30% of all disability in large companies in Canada. Employers are becoming more aware of not only the cost to health care system but of the loss of productivity. Employers are developing employee management plans to assist the employee in recovery and returning to work (Jilks, 2003; Nease et al, 2003; Ottawa-Carleton District School Board, 2006; Ottawa Carleton Elementary Teacher’s Federation, 2000; Trillium Lakelands District School Board, 2007). This trend continues as the loss of productivity in employees becomes increasingly significant.
Pharmaceutical responses by the medical profession do not address the underlying causes of this disorder. Freud’s dream therapy can be helpful in assisting the patient in understanding her subconscious mind. Doidge (2007) cites work on recurring dreams, which contain memory fragments buried in the brain. Educating the client, providing research information, literature, and expectations regarding the progression of the disorder helps empower them to assuage fears of what is normal and what can be expected.
Nemeroff & Owens (2002) reports that the results are achieved more quickly with ECT than with antidepressants. It is a treatment that is still being debated, with biases against it preventing some from making it a treatment choice, despite changed in the method of delivery in current practice. Tecoult & Nathan (2001) found complications in 68% of patients administered ECT . Psychosurgery in extreme cases is still one treatment method for those for whom other treatments have proven ineffective (Ridout, 2007).
Implications for Clients and Their Families
Families with a history of suicide and drug abuse need to be vigilant and seek medical help for teenagers who are at risk. Clients, their families and their advocates are wise to watch for signs of depression and explore the options for treatment. Many resources are available online, particularly. One company posts daily positive suggestions for improvement with practical daily reminders to take medications as prescribed and to seek counseling as required (iCan, 2007).
Many resources are available online, particularly. One drug manufacturer has created an on-line, interactive, self help community in which the patient takes weekly self-tests to determine their progress (Fig. 1). The company posts daily positive suggestions for improvement with practical daily reminders to take medications as prescribed and to seek counseling as required (iCan, 2007).

Implications for Counselling & Counsellors

Important choices in the repertoire of the counsellor include psychotherapy, group therapy, non-directive counseling, interpersonal therapy, psychodynamic therapy, exercise, diet, in an integrative cognitive-behaviour therapy approach (Likierman, 2003; Balkan, 2007). In order to formulate a plan for therapy and recovery the counsellor should involve family and provide support regarding potential suicidal ideations and take a complete biopsychosocial history. It is crucial that clients at risk be contacted on a regular basis. Referrals to health care professionals are important to deal with the biological impact of the disorder. Comino et al (2000) urges general practitioners to monitor unemployed patients.Implications for Community/Society
A silent disorder, often undiagnosed by the medical community (Nease et al, 20003) depression is preventable, if not treatable. All stakeholders need to become involved in the prevention and treatment of this disorder. The cost to society, in terms of health care. This disorder impacts the client, her social and work-related goals and her family.

Implications for Employers

Comino et al (2000) urges general practitioners to monitor unemployed patients. At the same time, workplace stress, including bullying by peers and bosses, is on the increase leading to environmental and emotional stress (Jilks, 2003). Often a patient's first medical contact is with the medical profession is as an employee who is referred through Employee Assistance Programs (EAP) or as a result of using sick leave. Clients who do not follow up with costly psychological support, limited by most insurance carriers, or do not follow doctor's medication recommendations result in the perception that medication or psychotherapy does not work.

Implications for Community /Society

There are many stakeholders in the healing profession, with vested interests in drug therapy, counselling, and the cost to public health. As our understanding of depression, with increasingly scientific and objective research being published, in conjunction with modern treatments, humankind can learn to recognize and prevent, rather than cure, this disorder. Workplace stress, the resulting emotional issues, and the use of the health care system, is on the increase resulting in lost productivity. This is of concern to many employers (Jilks, 2003). Prevention, rather than cure will help those avoid depression.
It would appear that vigilance on the part of family, friends, counsellors and the busy medical profession is warranted. With the pressing concerns of daily life, and our responses to stress is documented through fMRI and positron emission tomography. It is morally imperative that the mental health community supports and works with other professionals in an holistic approach to therapy.


Further research in the area of lost productivity due to clients taking medications unreliably or not following prescription recommendations, or discontinuing their medications, could contribute to the low success rates in depression patients. Studies tend to examine those already seeking medical therapy or psychotherapy and do not include those who take medications irregularly, or improperly, or those who do not have the funds or the emotional strength, the time or the willingness to seek psychotherapy.
Further research is warranted in the area of murder/suicide prevention. Women are diagnosed more often with depression disorder (Bosker et al, 2004).
Technology is an underutilized resource that requires further study. On-line resources are many, all highlighting the need for prevention, identification and cure. Ontario Mood Association (2006), CTV Documentary Fighting the Dragon , and biographies all aid the patient and her family in understanding this disorder.


I firmly believe that we learn from one another's stories...
Reference Description
Amanda Autism biographical video
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Brittany Maier
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Jason McElwain News coverage | Unlikely Hero
Mukhopadhyay, T.R. (2003). The Mind Tree. Arcade Publishing. Autism- an autobiography
Sarsfield, M. (2004). No Crystal Stair . Toronto: Canadian Scholar's Press/Women's Press. Growing up Black in Montreal
Simon, L. Detour: My bipolar road trip in 4D
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Todd, P. (2004). A Quiet Courage: Inspiring Stories from All of Us. Thomas Allen. Paula Todd interviewed incredible people with incredible survival stories.
Ye, Ting-Xing (2003). Throwaway Daughter. Toronto, Ontario, Seal Books: Random House of Canada. An abandonded Chinese Orphan - raised in the era of the one-child policy.
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Bibliography - learn more...

Signs of Depression      Learn about the Signs, Symptoms, and Treatments for Depression
Depression is treatable      If you are sad, angry, anxious it may be depression. Learn more.
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Jennifer A. Jilks   [ Articles ] Last update: July 8/2007