Rest in Peace Robin Williams

Q. I was absolutely devastated to hear about Comedian Robin Williams' suicide. My family is still in shock.  I have an uncle who has suffered bouts of depression over the years, and I worry about him frequently, especially since my aunt died last year and now my uncle lives alone.

Do you have any suggestions for families like mine who have a loved one who suffers from depression?

A. My family and I are also still in shock over the tragic suicide of Robin Williams, one of our favorite actors and comedians. My wife and I grew up watching his antics on Mork and Mindy, and some of our favorite movies of all time are Mrs. Doubtfire, Jumanji, Patch Adams, and What Dreams May Come.

Like you, I have a very close family member whom I worry about - he suffered a severe bout of depression as a young man and now, as an older adult, suffers from bipolar disorder -- a close cousin to depression. Tragically, I also have two close family members who have taken their own lives as a result of depression, so I am very familiar with this disease.

In all the publicity surrounding the death of Robin Williams, one thing I found especially meaningful is the following dialogue from a 1979 episode of Mork and Mindy, where Mork (of course played by Robin Williams) and Orson (his alien "commander" voiced by Ralph James) described loneliness and depression very poignantly:

Orson: The report, Mork.
Mork: This week I discovered a terrible disease called loneliness.
Orson: Do many people on Earth suffer from this disease?
Mork: Oh yes sir, and how they suffer. One man I know suffers so much he has to take a medication called bourbon, even that doesn't help very much because then he can hear paint dry.
Orson: Does bed rest help?
Mork: No because I've heard that sleeping alone is part of the problem. You see, Orson, loneliness is a disease of the spirit. People who have it think that no one cares about them.
Orson: Do you have any idea why?
Mork: Yes sir you can count on me. You see, when children are young, they're told not to talk to strangers. When they go to school, they're told not to talk to the person next to them. Finally when they're very old, they're told not to talk to themselves, who's left?
Orson: Are you saying Earthlings make each other lonely?
Mork: No sir I'm saying just the opposite. They make themselves lonely, they're so busy looking out for number one that there's not enough room for two.
Orson: It's too bad everybody down there can't get together and find a cure.
Mork: Here's the paradox sir because if they did get together, they wouldn't need one

Unfortunately, loneliness and depression similar to the emotions described in the above dialogue is experienced by nearly 25% of people age 65 or older. According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens. More than half of doctor's visits by the elderly involve complaints of emotional distress, and 20% of suicides in this country are committed by seniors, with the highest success rate belonging to older, white men.

Depression frequently goes unrecognized and untreated, resulting in much unnecessary suffering and lost opportunities to age well. This is because depression in seniors often occurs in connection with other illnesses. For example, Parkinson's disease (which Robin Williams also suffered from) directly affects brain chemistry and can exacerbate depressive symptoms. Estimates also show that 25% of cancer patients are depressed and as many as 50% of stroke patients suffer from depression.

Experts say that seniors with co-existing depression and chronic illnesses tend to focus more on the physical ailment, which delays or impedes full recovery from a mood disorder. However, it is important to treat both and ensure that there is clear communication between your primary doctor and your mental health provider.

Below are some tips for seniors suffering from depression:

• Don't self-medicate: It's not uncommon for seniors to self-medicate with alcohol and drugs as a way of coping with their loneliness or dealing with chronic pain. But it's bad news. For one, alcohol itself is a depressant. Alcohol and certain drugs can also interfere with the effects of medications taken for diabetes, heart disease, and other common conditions among seniors. And finally, substance abuse increases the risk of suicide, especially in older men.
• Treat insomnia: Eight percent of people who are depressed experience sleeplessness, and the more depressed someone is, the more likely it is that he or she will have sleep problems. Experts say that to help overcome insomnia, it is important to go to bed at the same time every night, wake at the same time in the morning, and eliminate caffeine close to bedtime.
• Distinguish grief from depression: According to WebMD , each year, between 5% and 9% of the American population loses a close family member, and with type of loss it's natural to feel pain and grief. The grief process is normal, and most people go through it. But when grief takes over your life and you begin to feel hopeless, helpless, or worthless, then it's time to talk to your doctor about whether you are experiencing normal grief or depression. Sadly, for10 to 15% of married couples, the loss of their spouse leads to chronic depression. Johns Hopkins University School of Medicine distinguishes "grief" and "depression" in this way: "The sadness of grief usually comes in waves, with varying degrees of intensity and bouts of crying, and feelings of intense sadness, guilt, anger, irritability, or loneliness. A person experiencing grief, however, can enjoy some of life's activities. Grief is generally time limited and resolves on its own. Depression is a more persistent and unremitting sadness."
• Carry photos of loved ones: A new study by UCLA psychologists found that simply looking at a photograph of loved ones, such as a significant other, reduces loneliness and pain associated with depression.
• Make new friends: Countless studies have demonstrated that people with strong social networks are more resilient to depression, loneliness, and anxiety, especially in their senior years. And, since losing friends and family is part of growing older, it is especially important for seniors to make an effort to meet new people. Ways to make new friends can include things such as joining a bowling league, getting involved in your church or synagogue, or making a local restaurant or coffee shop your place to hang out. Maintaining friendships online is also important, especially when face-to-face interaction becomes more difficult.
• Exercise: Senior citizens who exercise -- even if they take it up at age 85 -- regularly experience fewer declines in their quality of life, are less lonely, and are more likely to stay independent.
• Find a sense of purpose in life: Met Life recently asked 1000 people between the ages 45 and 74 why they get up in the morning. The most popular answer, even before money or health, was a "sense of purpose." It is important to find purpose in your life, no matter how big or small: volunteer at a local food bank, provide free babysitting for your daughter so she can have a date night with her husband, spoil your grandchildren, or visit a lonely neighbor once a week. It doesn't have to require lots of time, energy, money, or brain power. All you need is a little motivation and a touch of kindness.

What if you have a friend or loved one who is suffering from depression? What should you do?

• Sincerely express your concern: Acknowledge your loved one's depression, loneliness, or anxiety and show genuine empathy and concern.
• Offer your support: Let your friend know that you are available if anything is needed, or if your friend would just like to talk.
• Talk to them the same way you did before: Let them know your feelings about them or respect for them hasn't changed; your relationship is stable.
• Realize that treatment is key: Remember that depression is a medical condition - typically a chemical imbalance that can be treated with medication. You can listen to a person and give your support, but most likely, the person will also need medical treatment from trained professionals. You can show your support for a friend or loved one's treatment by offering to drive him or her to appointments, maintaining regular contact, and praising small achievements (such as getting out of bed or getting out of the house.)

Depression and bipolar disorder are obviously very dangerous illnesses that that can lead to physical disability, mental incapacity, and of course suicide. These illnesses can be a huge barrier to quality of life of those who are aging. If you need help for yourself or someone you care about, below are resources that can help:

• If there is an emergency, always call 911 immediately.
• To reach local mental health helplines, call 1-800-273-TALK.
• To find a geriatric psychiatrist, go to GMHF: Geriatric Mental Health Foundation.
• To find a clinical psychologist, go to locator.apa.org.
• To find a clinical social worker, go to helpstartshere.org/find-a-social-worker.

A Special Needs Trust is one type of vehicle that provides funds with which a physically disabled or mentally incapacitated person can maintain his or her quality of life, while still remaining eligible for needs-based programs such as SSI and Medicaid that will cover basic health and living expenses. However, many people with mental illnesses such as Bipolar Disorder or chronic depression are never officially declared to be "disabled," and there are other types of trusts that are sometimes more appropriate for this type of special needs planning. If you or a loved one suffers from bipolar disorder, depression, or any type of mental illness, we can help. Please call The Fairfax Elder Law Firm of Evan H. Farr P.C. at 703-691-1888 in Fairfax or 540-479-1435 in Fredericksburg to make an appointment for an introductory consultation.

Dear Saki and Alley,

Q. I understand that physical wellness involves exercise and a healthy diet. How about mental wellness? What are some ways to maintain good mental health?

Thanks for your help,

Anne Opp-Thomas

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Dear Anne,

Health is often associated with physical fitness, and the desire to lose weight or get fit. We often forget that mental well-being is just as vital as physical well-being.  Mental wellness is how you meet your emotional needs, and it involves maintaining good mental health, a positive attitude, high self-esteem, and a strong self-image.

Good mental wellness is the ability to respond resiliently to emotional states and the flow of everyday life, as well as dealing with situations realistically and learning more about yourself and how things you do affect your feelings. The day-to-day stresses that affect many of us, such as not spending enough time with our families or friends, can all take a toll on our mental well-being.

While there are many daily stressors that are beyond our control, you may be surprised at how many you can control, and with very little effort.  With that in mind, I'd like to share some strategies that may help you reduce your stress:

• Develop a positive attitude: People with positive attitudes are likely to be happier, more successful, and better able to handle crisis and stress.
• Be thankful and don't dwell: In concert with the positive attitude, be thankful for what you have instead of dwelling on what you don't.
• Approach each "stressful" situation as a "problem solver": Many people pride themselves on being able to solve problems.  Every time you you're stressing out, ask yourself "what is the problem that's causing my stress"?  Then try to solve it.  Simply re-framing the stress as a problem to be solved can turn a negative situation into a positive one.
• Laugh: Humor is a great stress reducer. Studies indicate laughter can make you healthier.
• Exercise: Regular exercise increases energy and releases brain biochemicals to ward off depression and anxiety. Just a 15 minute walk a day will help keep your body and mind healthy.

Remember that part of mental wellness is having a plan in place for your future and for your loved ones. The greatest peace of mind comes with making sure your wishes are met and your loved ones are taken care of, especially if you should become incapacitated or need long-term care. If you have not done Long-Term Care Planning, Estate Planning or Incapacity Planning (or had your Planning documents reviewed in the past several years), please call The Fairfax and Fredericksburg Long-Term Care Planning Law Firm of Evan H. Farr, P.C. at 703-691-1888 in Fairfax or 540-479-1435 in Fredericksburg to make an appointment for an introductory consultation.

Purrs,