It’s not unusual for depression and anxiety to occur in seemingly healthy young people, what more for a 60-plus-something-year-old patient who underwent major, life-changing health crises such as stroke or heart bypass surgery.
“About one-third of stroke survivors suffer from post-stroke depression (PSD) and it is strongly associated with adverse impact on cognitive function and functional recovery as well. Therefore, we should be aware of it, evaluate it, and treat it to prevent PSD,” said Prof. Nathan Bornstein, director of the Brain Division, Shaare-Zedek Medical Center and president of European Society of Neurosonology and Cerebral Hemodynamics (ESNCH).
Gone are the days when people would use the term ‘depressed’ as a simple and ordinary term to describe how bad his day was.
As the prevalence of depression rises throughout the country and in many parts of the world, more and more people are seeing it as a topic that needs more serious attention.
According to Dr. Rafael Castillo, member of Executive Council of the International Society of Hypertension (ISH) based in United Kingdom, cardiovascular causes remain the leading cause of deaths in the country and many parts of the world.
One out of three deaths are due to a cardiovascular cause, which includes coronary artery disease, heart failure, fatal arrhythmias, as well as strokes and other vascular causes.
Worldwide, stroke is the second leading cause of death. Moreover, the leading cause of global burden of disability, including long-term physical, cognitive, and emotional disabilities.
After stroke or surgery, it is normal to feel sad or worried, but if the patient feels sad, miserable, or down for weeks, he is already experiencing depression.
People with depression often find it hard to take care of their health. They also tend to eat poorly, get less exercise, and smoke, which can lead to a more serious health problem.
How to motivate elderly patients
“Essentially and partly, it is the responsibility of the medical care system. When we discharge patients from hospitals, we give them two sets of instructions: one for lifestyle and second for medications. I always start with the lifestyle, because if that started first, patients will see it as important. For bypass surgery patients, the surgeons are the most powerful people,” said Prof. Nanette K. Wenger, professor of medicine in the division of cardiology at the Emory University School of Medicine.
Wenger, who is also a consultant to the Emory Heart and Vascular Center and is listed in Best Doctors in America, has trained surgeons on what to do and say to their patients.
According to Bornstein, there is a proper way of telling patients to participate in lifestyle and activity programs so they won’t complain they don’t have the energy to do it.
“Tell them like you’re prescribing a drug. You have to take this medication [program/activity]. This is part of your recovery. You have to go to this program as if it was prescribed by your doctor. It’s not an option to take your medications, you have to do it,” said Bornstein.
Bornstein added that stroke and cardiac surgery are major events. There are lifestyle programs for post-traumatic stress disorder or post-event depression or medications such as anti-depressants that can be taken within three months or six months, depending on the doctors’ prescription.
“It is cultural and mentality. You have to persuade your patient that this is the way. If you have an authority to tell your parents to do that, that’s the way to go. It should be a structured program for them. Or if not, they can take medications that can also improve motor functions,” said Bornstein.
Role of psychiatric help
According to the World Health Organization (WHO), more than 100 million people suffer from mental disorders in the Western Pacific region, including in the Philippines; 5.3 percent of mental disorders in the region are depressive disorders.
In the Philippines, over 4.5 million cases of depression were reported in 2004 by the Department of Health. Globally, more than 300 million people are living with depression.
“The prevalence of psychiatric illness in human beings in the society is extraordinarily high. There is an article in the United States from the Center of Disease Control and Prevention on the prevalence of depression. It is something in the order of 20-percent of the US population suffers from clinically diagnosable depression. That’s huge – one in five people,” said Prof. Zachary T. Bloomgarden, clinical professor in medicine, endocrinology, diabetes, and bone disease.
Bloomgarden considers psychiatry as a medicine that all physicians need to talk to their patients where communication skills should be used to help people deal with these kinds of problems that affect all human beings.
“Some of the basic questions are, ‘Are you anxious? Are you depressed? Are you angry?’ But you cannot just say, ‘Are you depressed?’ because he will just say, ‘Oh no, I’m not depressed. I’m perfectly happy’ and he’ll go sit and watch television for 14 hours,” said Bloomgarden.
“Maybe it’s true that we need psychiatrists. But we also need clergymen. We need authors. One of the greatest ways to understand human emotions is to read the very thoughtful articles of the great novelists, which talk about these issues we all struggle with,” he added.
Importance of human relationships
Bloomgarden emphasized the need to respect the wishes of older people who wanted to be left alone or be independent.
“One problem in the United States is that our families are not often close. Older people lose contact with their children. People live in New York, while their children live in Los Angeles, Seattle, or wherever. We are forced to rely on trying to develop smart phone apps. Telephone is great but it’s not the same as [interaction with] human beings,” said Bloomgarden.
He further added, “If in the Philippines, you have extended families, cultural and religious ties, you might be far ahead, where we lost that. Keep doing what you have as a wonderful and warm people. It is important medically, in terms of maintaining the spiritual and emotional health of older and younger people, too.”
For those patients who are having a hard time engaging in physical activities, Wenger suggested water aerobics as the most fantastic physical activity.
“Just get into the water. You don’t even have to know how to swim,” said Wenger, adding that the preparation for a healthy lifestyle for a family should really begin when one is younger to avoid, prevent, delay serious health conditions.
Global medical experts Bloomgarden, Bornstein, and Wenger, who are more recognized as the “rock starts of the medical world”, were in the country as speakers of the fourth edition of the Experts’ Convergence for Health Outcomes (ECHO) Summit recently at the Marriot Convention Center.
Bloomgarden talked about, “Diabetes Care for the Older Patient: What are the Appropriate Goals?”, Bornstein delved on, “Optimizing Cognitive Recovery and Managing Behavioral Complications in Post-Stroke Treatment”, while Wenger discussed, “Geriatric Cardiology: Octogearian Pearls.
The event with this year’s theme: “Longevity and Quality of Life Matters” was attended by over a thousand Filipino doctors who gained fresh insights from these medical experts.