Everyone has days when they’re a bit down but depression is a far more serious issue which will affect one in five women at some stage of their lives.
And it is a condition that often needs to be treated by healthcare professionals. Depression can be a major factor in suicides which are at a 10-year high in Australia, with middle age and older women showing increased vulnerability.
This was highlighted in a report published in Psychology Today which states: “What research is showing is that the largest growing number of completed suicides is occurring in later life, more specifically with women aged 50 and older. Clinical studies have shown a staggering 49% rise in emergency room visits for drug-related suicide attempts by females of this age population.”
Clearly seeking help for depression is essential but for older women an added dimension is that some symptoms of depression are very similar to those of normal hormonal changes for women in that age group. The average age for the onset of menopause is 51 some women it can happen before age 40 or into their 60s.
This can make diagnosis of depression more difficult and dissuade some sufferers from seeking appropriate treatment as they think what they are going through is a normal change of life process.
Dr Stephen Carbone, beyondblue Policy, Research and Evaluation Leader, said this crossover of symptoms needed to be recognised.
“Some of the physical changes in women in this age bracket may overlap with what you may expect from menopause,” Dr Carbone said. “As a result it may be a little difficult to discern if the underlying cause is menopause or depression. The woman’s sex life may change, their energy levels may decline and they may be more tearful and emotional and all of these are symptoms common to depression and also to menopausal change.
“The result is that some women may not realise that what they are going through is not a normal part of the change of life but in fact may be more mental health focused.”
An added factor was that the issue of the mental health needs of the “invisible” middle-age woman who feels she is socially marginalised or irrelevant.
“In our society we glamorise youth and are pretty cognisant of older people’s needs,” he said.
“But the middle category is often sandwiched and a bit neglected. We talk about youth mental health and old-age mental health, but not so much about mid-age mental health.
“They are in a situation where often their children are leaving the nest, they are often looking after aged relatives and they are also noticing physical changes in themselves. Chronic disease and other health conditions become more common so their health deteriorates and they may become less independent.”
Seeking expert help from a healthcare professional is the first step in helping to manage depression and one group of healthcare professionals not often associated with this work are community pharmacists.
Community pharmacists are the most visited and easily accessible of all health professionals and patients generally see their pharmacist much more often than they do their doctor.
Increasingly community pharmacies are offering mental health services, including some employing trained counsellors, to help their patients. These services are backed by specialist training courses and are additional to the pharmacists’ role of helping to ensure medicine compliance and adhering to care regimens.
George Tambassis, National President of the Pharmacy Guild of Australia, said community pharmacies play a pivotal role in helping people with depression to firstly acknowledge they may have a problem, then helping to manage it and when necessary referring them for further treatment and counselling.
“Pharmacists, as highly experienced healthcare professionals, are ideally placed to help people who may be experiencing depression,” Mr Tambassis said.
“Community pharmacists are the most accessible of all health professionals and so help is at hand for people who may need it.
“In addition, many community pharmacists have undergone specific training in dealing with mental health conditions like depression and so have expertise in this area.”
Dr Carbone agreed pharmacists had a pivotal role to play in the recognition and detection of depression.
“A good example is when people come into the pharmacy looking for over-the-counter solutions for things like insomnia or tiredness and in these cases the pharmacist needs to be aware that these symptoms can be a marker of an underlying depression,” Dr Carbone said.
“The pharmacist needs to ask the right questions and it can be as simple as ‘how’s your mood been recently’ that can be the key in identifying an issue.
“The pharmacist also needs to be alert for people who may be less talkative than usual, who may unusually be avoiding eye contact and being less engaged than usual with the pharmacist. If the pharmacist notices changes like these they need to ask questions.”
The universal Patient Health Questionnaire 2 suggests two questions to be asked: Over the past two weeks have you been bothered by any of the following problems: Loss of interest or pleasure in doing things. Feeling down, depressed or hopeless. Patients can give each answer a score from 0-3
Dr Carbone said women generally tended to experience higher rates of depression than males in each age and stage but the signs and symptoms of depression were generally similar across the age groups
He said the common features included prolonged feelings of sadness and low mood, and this was usually taken to mean two weeks of feeling this way.
“Having these feelings for a couple of weeks is a sign that something is wrong and that help is needed,” he said.
“The other very common symptom is a sense of loss of interest or loss of pleasure in life.
“Physical changes include tiredness and fatigue, loss of appetite, loss of weight, sleeping problems, loss of motivation and enthusiasm.
“Other signs are people becoming withdrawn and cut off. There may also be a loss of attention so work and productivity might decline, and they may be taking more time off work. People can become withdrawn and irritable and conflicts can arise.”
Dr Carbone said one thing which was common to general practice and pharmacy was that a lot of people would complain of myriad ill-defined physical complaints.
“They may be talking about headaches and stomach aches and these might actually be reflecting underlying psychological distress,” Dr Carbone said.
“Again if they are coming in more often with minor and vaguely defined physical complaints this can be a marker of depression so the pharmacists should gently ask one or two probing questions.
“The pharmacist doesn’t have to make a diagnosis but they must be able to identify people who need further help and support.”
Referring back to the concept of the “invisible” age group, Dr Carbone stressed that these women often felt as if their needs were overlooked.
“But they need support like everyone else and pharmacists have to be attuned that women in this age groups, like anyone else, can develop anxiety and depression,” he said.
“Although there is a higher prevalence of mental health conditions in younger people, it’s not just a younger person’s condition”.