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Depression is an illness that affects the body, mood, and thoughts. About twice as many women suffer from depression as men. People who are depressed may feel hopeless, worthless, very sad, and have no energy or interest in doing anything. Some people describe depression as an "empty, or sad feeling that won't go away." This kind of depression that does not go away is called "clinical depression." It is different from feeling "blue" or down for a few hours or a couple of days.
Many things cause depression. Depression can run in families. Changes in your brain chemistry and living through painful and difficult events in your life can cause depression. Sometimes depression is caused by certain medications people take for cancer, arthritis, heart problems, and high blood pressure. Some illnesses such as Parkinson's disease, stroke, and hormonal problems can cause depression.
Here is a list of the most common signs of depression. If you have some of these signs that last for more than two weeks, see your health care provider.
Most people with depression get better when they get treatment. The two most common treatments for depression are medication and psychotherapy (talking with a trained counselor). Support groups can help. Sometimes just one treatment is used and sometimes a person takes medicine and sees a psychotherapist. Health care providers may need to try different medicines to find the one(s) that help you the most. It also may take a few weeks or months on the medicine before you begin to feel a change in your mood and outlook.
Here are ways to get help for your depression.
Depression is not something you can just snap out of and feel better. Depression is a serious illness that needs to be treated. It's not your fault that you are depressed, and you can get better.
Having a baby can be one of the biggest and happiest events in a woman's life. While life with a new baby can be thrilling and rewarding, it can also be hard and stressful at times. Many physical and emotional changes can happen to a woman when she is pregnant and after she gives birth. These changes can leave new mothers feeling sad, anxious, afraid, or confused. For many women, these feelings (called the baby blues) go away quickly. But when these feelings do not go away or get worse, a woman may have postpartum depression. This is a serious condition that requires quick treatment from a health care provider.
Postpartum depression (PPD) is a condition that describes a range of physical and emotional changes that many mothers can have after having a baby. PPD can be treated with medication and counseling. Talk with your health care provider right away if you think you have PPD.
There are three types of PPD women can have after giving birth:
The signs of postpartum depression include:
A woman may feel anxious after childbirth but not have PPD. She may have what is called postpartum anxiety or panic disorder. Signs of this condition include strong anxiety and fear, rapid breathing, fast heart rate, hot or cold flashes, chest pain, and feeling shaky or dizzy. Talk with your health care provider right away if you have any of these signs. Medication and counseling can be used to treat postpartum anxiety.
Postpartum depression (PPD) affects women of all ages, economic status, and racial/ethnic backgrounds. Any woman who is pregnant, had a baby within the past few months, miscarried, or recently weaned a child from breastfeeding can develop PPD. The number of children a woman has does not change her chances of getting PPD. New mothers and women with more than one child have equal chances of getting PPD. Research has shown that women who have had problems with depression are more at risk for PPD than women who have not had a history of depression.
No one knows for sure what causes postpartum depression (PPD). Hormonal changes in a woman's body may trigger its symptoms. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman's body increase greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops and keeps dropping to the amount they were before the woman became pregnant. Researchers think these changes in hormones may lead to depression, just as smaller changes in hormones can affect a woman's moods before she gets her menstrual period. Thyroid levels may also drop sharply after giving birth. (The thyroid is a small gland in the neck that helps to regulate how your body uses and stores energy from foods eaten.) Low thyroid levels can cause symptoms that can feel like depression, such as mood swings, fatigue, agitation, insomnia, and anxiety. A simple thyroid test can tell if this condition is causing a woman's PPD. If so, thyroid medication can be prescribed by a health care provider.
Other things can contribute to PPD, such as:
It is important to know that postpartum depression (PPD) is treatable and that it will go away. The type of treatment will depend on how severe the PPD is. PPD can be treated with medication (antidepressants) and psychotherapy. Women with PPD are often advised to attend a support group to talk with other women who are going through the same thing. If a woman is breastfeeding, she needs to talk with her health care provider about taking antidepressants. Some of these drugs affect breast milk and should not be used.
Everybody knows what it's like to feel anxious the butterflies in your stomach before a first date, the tension you feel when your boss is angry, the way your heart pounds if you're in danger. Anxiety isn't always a bad thing. It can help you cope with life's everyday stress. It makes you study harder for that exam, keeps you on your toes when you're making a speech, and helps you stay focused when looking for a job or asking for a raise.
But if you have an anxiety disorder, this normally helpful emotion can do just the opposite. It can keep you from coping and can disrupt your daily life. Anxiety disorders aren't just a case of "nerves." They are serious illnesses that can grow worse when not treated. They are thought to be related to the biological makeup and life experiences of a person, and often run in families. Every year, more than 19 million American adults suffer from anxiety disorders. There are treatments for these disorders that can help people lead full and healthy lives. And, research is being done to find new ways to help people with anxiety disorders.
There are five types of anxiety disorders, each with different symptoms. They include:
Generalized anxiety disorder (GAD) is a real illness, called an anxiety disorder. It's not just simply worrying, and it can be treated to help a person have a healthy and full life. From time to time, we all have worries about our health, family, money, and work. But when a person has GAD, they worry all the time, even when nothing is wrong. A person with GAD always expects the worst will happen, can't relax, and feels tense most of the time. Aches and pains, plus feeling tired a lot, can also happen with GAD. Sometimes, though, the source of the worry is hard to pinpoint. Just the thought of getting through the day causes anxiety.
It's important to know that when a person has this illness, it's not her or his fault. And, it's not something a person can just "snap out of." No one knows for sure what causes GAD. Most often GAD begins in childhood, but can start in an adult as well. More women than men have this illness. And, GAD may run in families.
The biggest symptom of GAD is constant worry. Physical symptoms can also happen. Research suggests that GAD symptoms can become worse when a person is under stress. Symptoms include:
Many people with GAD startle more easily than other people. They sometimes suffer from depression, too. Most people with GAD have mild symptoms that don't limit them in regards to social settings or in the work place. Unlike other anxiety disorders, people don't usually avoid certain situations as a result of their disorder. But, GAD can be severe for some people, making it hard to do even the simplest daily tasks. The symptoms of GAD tend to lessen with age.
OCD is a real illness that can be treated with medicine and therapy. When you have OCD, you have recurring, upsetting thoughts (called obsessions). You repeat doing the same thing, over and over again (called compulsions) to make the thoughts go away. And, you feel like you can't control or stop these thoughts or actions. The obsessions, or upsetting thoughts, can include things like a fear of germs, a fear of being hurt, a fear of hurting others, and disturbing religious or sexual thoughts. The compulsions, or actions you repeat to make the thoughts go away, can be things like counting, cleaning, hand washing, and checking on things. While these actions provide only short-lived relief, not doing them only increases anxiety.
Many people who have OCD know that their actions often don't make sense. They may try to hide their problem from family and friends, and may have trouble keeping a job because of their actions. Without treatment, obsessions and the need to perform rituals can take over a person's life. OCD is an anxiety disorder that can be life-long. A person with OCD can also recover and then get the illness again, or relapse. This illness affects women and men in equal numbers. Most often, OCD begins during the teenage years or early childhood, although it can start in an adult. The exact cause of OCD is not known. Researchers are looking at differences in brain activity among people who have OCD and persons who do not, for clues about it's cause. OCD is not caused by family problems. Nor is it caused by something in a person's childhood, such as an unusual focus on cleanliness, or a belief that certain thoughts are dangerous or wrong. It's important to know that when a person has OCD, it's not her or his fault. And, it's not something a person can just "snap out of."
OCD shouldn't be confused with sometimes acting "compulsive." Individuals who act this way expect a lot from themselves, are very organized in their work and play, and are sometimes called "perfectionists." This type of "compulsiveness" often has value in a person's life. It can help a person feel good about themselves and help them be a success on the job. It differs greatly from OCD, which is an illness that can have a devastating effect on a person's life. Symptoms of OCD include:
People with OCD sometimes also abuse alcohol and drugs and can have other illnesses, such as depression, eating disorders, attention deficit hyperactivity disorder (ADHD), or other anxiety disorders. When a person also has other illnesses, OCD is often harder to diagnose and treat.
Panic disorder is a real illness that can be treated to help a person have a healthy and full life. It is a type of panic disorder. With this disorder, a person can feel frequent and sudden intense fear for no reason. These frequent "bursts" of intense fear are called panic attacks. During these attacks, you can have scary physical feelings like a fast heartbeat, trouble breathing, or dizziness. Panic attacks can happen at any time and without any warning. They can happen anywherein grocery stores, malls, crowds, or when traveling. A person can live in constant fear of another attack, staying away from places where past attacks have happened. This fear can take over a person's life, making her or him unable to leave their home (a condition called agorophobia). While panic attacks don't last long, they are scary, making them feel like they could last forever. This disorder can last for a few months or go on for many years, even with treatment. It's important to know that when a person has this illness, it's not her or his fault. And, it's not something a person can just "snap out of." No one knows for sure what causes panic disorder. It most often starts when people are young, around 18 to 24 years old. It also can begin when a person is already under a lot of stress, such as after the death of a loved one or having a baby. While anyone can have this disorder, it affects women more than it does men. And, it can run in families.
With panic disorder, a person has sudden bursts of fear for no reason. Physical symptoms can also happen: Research suggests that symptoms can become worse when a person is under stress. Symptoms include:
When a person has a panic attack they can:
This may cause a person to avoid places or situations they may have triggered the attack (like an elevator or crowded amusement park).
Panic disorder is not the same as everyday anxiety. This disorder usually doesn't go away by itself. But, with proper treatment, a person with this illness can be helped. If it is not treated, the illness can take over a person's life and affect relationships and work. A person can also become very depressed without treatment, turning to alcohol and drugs for relief.
A phobia is something a person fears to the point that they feel they have to change how they behave. One type of phobia, called specific phobia, can involve fear of an object (like an elevator) or a situation (like public speaking) that poses little or no danger. Phobias can also involve fear of being embarrassed, looked at, or made fun of in social or work situations. These are called social phobias. With both of these phobias, the fear is extreme and hard to control. Without treatment, phobias can last many years and affect a person's career, relationships, and daily life activities. Both specific and social phobias are types of anxiety disorders. It's important to know that when a person has a specific or social phobia, it's not her or his fault. And, it's not something a person can just "snap out of." No one knows for sure what causes phobias.
Specific phobias are commonthey strike 1 out of every 10 Americans. Women are twice as likely as men to suffer from this illness. Starting in the teenage and adult years, they may run in families. They begin suddenly and tend to last longer than childhood phobias (like being afraid of the dark). When a person has a specific phobia, they have an intense fear of something that poses little or no real danger. Because there is no or little danger, a person's fear is not based on reality (called irrational fear). Some of the more common specific phobias involve fear of closed-in places, heights, escalators, elevators, tunnels, highway driving, bridges, water, flying, dogs, and injuries involving blood. And, a specific phobia often makes no sense. For instance, you may be able to jump out of airplanes with ease but not be able to go above the 4th floor of an office building. Most people with these phobias know that they don't make sense. But, facing their fear, or even thinking about it, can bring on a panic attack or severe anxiety.
Specific phobias can be treated, helping a person have a full and healthy life. But, when the object of the fear is easy to avoid, a person may decide to do so rather than get treatment. Not getting treatment, though, can cause a person to make decisions that will affect their personal life and limit their career. Go to the question on how are phobias treated for more information.
Social phobia involves feeling very self-conscious in everyday social situations. It is more than just being shy or nervous, and can cause extreme anxiety. A person can feel afraid and uncomfortable when around other people. It may be hard to be at work or school, when you have to interact with others. While many people with these phobias know that their fear may be extreme, they are unable to control it. They often worry for days or weeks in advance of a situation they are dreading. This illness most often starts in childhood or the teenage years, and may run in families. Women are just as likely as men to develop social phobia. Other anxiety disorders or depression often go hand-in-hand with this phobia. Some people also turn to alcohol or drugs for relief.
Symptoms include:
People who have social phobias most often know that their fears don't make sense. But, even if they manage to face what they fear, they can still feel anxious and uncomfortable. Social phobias can be treated, helping a person have a full and healthy life. Not getting treatment can cause a person to make decisions that will affect their personal life. Go to the question on how are phobias treated for more information.
Post-traumatic stress disorder (PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people to whom they were once close.
War veterans first brought PTSD, once referred to as shell shock or battle fatigue, to the public's attention, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, torture, or being held captive. The event that triggers it may be something that threatened the person's life or the life of someone close to her or him. Or it could be something witnessed, such as mass destruction after a plane crash or a terrorist incident. Whatever the source of the problem, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult.
PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe - people may become easily irritated or have violent outbursts. In severe cases, they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person - such as a rape, as opposed to a flood. Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours, or very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again. Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure, but the symptoms generally decrease over time and eventually disappear. However, about 8 percent of men and 20 percent of women go on to develop PTSD, and roughly 30 percent of these individuals develop a chronic form that persists throughout their lifetimes. PTSD is diagnosed only if the symptoms last more than a month. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event.
Antidepressants and anxiety-reducing medications can ease the symptoms of depression and sleep problems; and psychotherapy, including cognitive-behavioral therapy, is an integral part of treatment. Being exposed to a reminder of the trauma as part of therapy - such as returning to the scene of a rape - sometimes helps. And support from family and friends can help speed recovery.
Anxiety disorders are among the most common of all the mental disorders. Many people misunderstand these disorders and think people should be able to overcome the symptoms by sheer willpower. But, the symptoms can't be willed or wished away. There are treatments, developed through research, that work well for these disorders. Anxiety disorders are treated in two ways with medication and with certain types of psychotherapy (sometimes called "talk therapy"). Sometimes only one treatment is used or both treatments are combined. If you have an anxiety disorder, talk with your doctor about what will work best for you. If you do choose psychotherapy, make sure the therapist is able to provide you with medication, if needed.
A number of drugs used for treating depression, called antidepressants, have been found to help with anxiety disorders as well. Monoamine oxidase inhibitors (MAOIs) are used, along with the newer selective serotonin reuptake inhibitors (SSRIs). Other medicines include anti-anxiety drugs called benzodiazepines and beta-blockers. Treatment with psychotherapy includes cognitive-behavioral therapy (CBT) and behavioral therapy. In CBT, the goal is to change how a person thinks about, and then reacts to, a situation that makes them anxious or fearful. In behavioral therapy, the focus is on changing how a person reacts to a situation. CBT or behavioral therapy most often lasts for 12 weeks. It can be group or individual therapy. Some studies have shown that the benefits of CBT or behavioral therapy last longer than do those of medications for people with panic disorder, OCD, PTSD, and social phobia.
Keep in mind that it can be a challenge to find the right treatment for an anxiety disorder. But, if one treatment doesn't work, the odds are good that another one will. Your doctor and therapist will work together to help you find the best approach. New treatments are being developed through ongoing research. So, don't give up hope. If you have recovered from an anxiety disorder and it comes back at a later date, don't think that you've failed. You can be treated again. And, the skills you learned dealing with the disorder the first time can help you in coping with it again.
If you think you may have symptoms of anxiety, a visit to your doctor is the best place to start. Your doctor will perform a careful exam to figure out whether your symptoms are really due to an anxiety disorder, which disorder you have, and if there are any other problems present. Be aware that all anxiety disorders are not treated the same. The next step your doctor may suggest is a visit with a mental health professional. This includes psychiatrists, psychologists, social workers, and counselors. It is best to look for a professional who has special training in cognitive-behavioral and/or behavioral therapy. Try to find someone who is open to the use of medications, should they be needed. And if they are not a medical doctor, be sure they work with one so medication can be prescribed. Keep in mind that when you start taking medicine, it may not start working right away. You need to give your body a few weeks to get used to the medicine. Then, you and your doctor can decide if it's working. You can get free information about anxiety disorders from the National Institute of Mental Health. Call toll free 1-88-88-ANXIETY. It's very important that you feel comfortable with your treatment. If this is not the case, seek help elsewhere. If you've been taking medication, don't stop it all of a sudden. These drugs need to be tapered off slowly, under the care of your doctor. Talk with your doctor about how to stop the medication you're taking.
Many people find it helps to join a support group because they can share their problems and successes with others who are going through the same thing. While it doesn't take the place of mental health care, talking with trusted friends or a member of your faith community can also be very helpful. Family members can play an important role in a person's treatment by offering support. Learning how to manage stress will help you to stay calm and focused. Research suggests that aerobic exercise (like jogging, bicycling and swimming) may be of value as well. Other studies have found that caffeine, illegal drugs, and some over-the-counter cold medicines can worsen the symptoms of these disorders. Check with your doctor or pharmacist before taking any over-the-counter medicines.
The National Institute of Mental Health supports research into the causes, prevention, and treatment of anxiety disorders and other mental illnesses. Studies are ongoing for how family background (genetics) and life experience puts a person at risk for these disorders. New drugs are being tested in clinical trials, as well as therapy approaches. For information on clinical trials, go to the NIMH web site http://www.nimh.nih.gov/studies/index.cfm and the National Library of Medicine's clinical trials database at http://www.clinicaltrials.gov.
Dementia refers to a group of symptoms that are caused by changes in brain function. Signs of dementia include changes in memory, personality, and behavior. Dementia makes it hard for a person to carry out normal daily activities.
A person with dementia may ask the same questions repeatedly and get lost in familiar places. He or she may be unable to follow directions; be disoriented about time, people, and places; and neglect personal safety, hygiene, and nutrition.
Older people with dementia were once called senile, and it was thought that becoming senile was just part of getting old. But dementia is not a normal part of aging. It is important to find out the cause of a person's dementia. Some causes of dementia can be treated and reversed. Others are due to irreversible changes in the brain and cannot be cured.
Dementia is caused by many conditions that affect the brain. Some causes of dementia can be reversed, and others cannot. Treatable conditions that can cause dementia include a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury. Medical conditions like these can be serious and should be treated by a doctor as soon as possible. Conditions or diseases that cause irreversible dementia, especially in older people, include Alzheimer's disease (AD), dementia with Lewy bodies, and multi-infarct dementia (MID), also called vascular dementia.
Other less common causes of dementia include Huntington's disease, Parkinson's disease, Pick's disease, Binswanger's disease, and AIDS. Sometimes depression in older people is mistaken for dementia.
Doctors can diagnose dementia and its causes or probable causes through a complete medical history and through physical exams and tests. A person's medical history includes use of prescription and over-the-counter medicines, diet, past medical problems, and general health. The doctor also may ask a family member for information about the person.
Tests of blood and urine may be done to look for problems. There are also tests of mental abilities (tests of memory, problem solving, counting, and language). Other kinds of tests used may include brain scans using computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).
The elderly, those with family histories of dementia, and those with stroke risk factors are at higher risk for dementia. More women than men have dementia because women in general live longer than men.
Even if the doctor diagnoses an irreversible form of dementia, much can be done to treat the individual and help the family cope. A person with dementia should be under a doctor's care. The doctor can treat the person's physical and behavioral problems and answer questions that the person or family may have.
For some people in the early and middle stages of AD, there are several drugs that may delay the worsening of some of the disease's symptoms. For people with MID, doctors believe it is very important to try to prevent further strokes by reducing risk factors. This means controlling high blood pressure, monitoring and treating high blood cholesterol and diabetes, and not smoking. Other kinds of medicines are used to help control behavioral symptoms of dementia such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes individuals more comfortable and makes their care easier for caregivers. Drugs used include antidepressants, antipsychotics, and anxiolytics.
Nondrug treatments include assuring that the person with dementia has a healthy diet, exercise, social activities, regular medical care, and a safe environment. Caregivers can learn useful methods to help cope with problem behaviors.
Yes. Caring for a person with dementia can be difficult. It can affect your family life, your job, your finances, and your physical and mental health. Most often, spouses or other family members provide day-to-day care for people with AD and other types of dementia. People with dementia usually need more and more care as the disease worsens.
There are many resources for caregivers to get help and support. The Alzheimer's Association has chapters across the country that offer educational programs and support groups for caregivers and family members of people with AD. Other resources you may find helpful include the Caregiver Guide available from ADEAR and the Eldercare Locator service provided by the Administration on Aging (see below).
Alzheimer's disease (AD) is the most common cause of dementia in older people. Dementia is a brain disorder that makes it hard for a person to carry out normal daily activities. Symptoms of dementia include changes in memory, personality, and behavior. There are other conditions besides AD that can cause dementia. For example, small strokes or changes in the brain's blood supply can cause multi-infarct or vascular dementia. Some causes of dementia are reversible, such as drug reactions, dehydration, and thyroid problems.
AD affects the parts of the brain that control thought, memory, and language. It is a slow disease that starts with mild memory problems and leads to severe brain damage. People with AD lose their abilities at different rates. AD can last from 3 to 20 years or more after the onset of symptoms. It is not yet clear what causes AD and there is no known cure. An estimated 4 million people in the U.S. suffer from AD. The disease usually begins after age 60, and the risk of AD goes up with age. However, some cases of AD occur in younger people. About one in ten persons over 65 have AD, and nearly half of those age 85 and older may have the disease. But AD is not a normal part of aging. AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called neuritic plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered hallmarks of AD. Scientists have found other changes in the brains of people with AD. There is a loss of nerve cells in areas of the brain that are vital to memory and other mental abilities. There also are lower levels of chemicals in the brain that carry complex messages back and forth among nerve cells. AD may disrupt normal thinking and memory by blocking these messages in the brain.
Scientists do not yet fully understand what causes AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years beyond age 65.
Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases. For example, familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, can be inherited. However, in the more common form of AD that occurs later in life, no obvious family pattern is seen. Scientists still need to learn a lot more about what causes AD. In addition to genetics, they are studying education, diet, environment, and infections to learn what role they might play in the development of this disease.
AD begins slowly. At first, the only symptom may be memory problems. People with AD may have trouble remembering recent events, activities, or the names of familiar people or things. They may ask the same question over and over again. Simple math problems may become hard to solve. Such difficulties begin to interfere with jobs or other activities.
As the disease gets worse, people with AD may:
Eventually, persons with AD need total care. The behavioral problems in AD are not something the person can control. They result from the brain damage that worsens over time.
An early, accurate diagnosis of AD helps persons with AD and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease. Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, doctors must wait until they do an autopsy, which is an exam of the body done after a person dies. Therefore, doctors must make a diagnosis of "possible" or "probable" AD. Finding new and better ways to diagnose early AD is one area of current research. At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time. Doctors use several tools to diagnose probable AD:
Information from the medical history and from test results helps the doctor rule out other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully. Recently, scientists have focused on a type of memory change called mild cognitive impairment (MCI). MCI is different from both AD and normal age-related memory change. People with MCI have ongoing memory problems but do not have other losses like confusion, attention problems, and difficulty with language. Researchers are studying MCI to learn whether early diagnosis and treatment might prevent or slow further memory loss, including the development of AD.
No treatment can stop AD. However, the Food and Drug Administration (FDA) has approved several drugs that may help some people in the early and middle stages of the disease. These drugs include tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl). Because of side effects, tacrine is rarely used today.
These drugs are cholinesterase inhibitors that slow the breakdown of acetylcholine in the brain. Acetylcholine is a chemical in the brain that carries messages between nerve cells. These drugs may help some people with AD with memory and thinking. Other kinds of medicines are used to help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes persons with AD more comfortable and makes their care easier for caregivers. Drugs used include antidepressants, antipsychotics, and anxiolytics.
Nondrug treatments include assuring that the person with AD has a healthy diet, exercise, social activities, regular medical care, and a safe environment. The use of memory aids, such as calendars, lists, and written directions, can be helpful for people in the earlier stages of AD. Caregivers can learn behavioral management methods to help cope with problem behaviors.
Scientists have come a long way in their understanding of AD. These advances are the foundation for the National Institutes of Health (NIH) Alzheimer's Disease Prevention Initiative, which is designed to:
Developing new treatments for AD is an active area of research. Scientists are testing a number of drugs to see if they prevent AD, slow the disease, or help reduce behavioral symptoms.
Other drugs currently being tested in humans include statins (cholesterol-lowering drugs) and certain B vitamins (folic acid, B6 and B12) that reduce homocysteine in the blood. A recent animal study found that the hormone testosterone may have a role in preventing AD. People with AD who want to help scientists test experimental drugs may be able to take part in clinical trials. Clinical trials are studies to find out whether a new treatment is both safe and effective. To find out more about these studies, contact the Alzheimer's Disease Education and Referral Center (ADEAR) listed below.
Researchers are studying ways to prevent Alzheimer's disease. Vitamins including vitamin E and several of the B vitamins may prove to be helpful in preventing AD. A healthy, varied diet with lots of fruits, vegetables, and whole grains is a good place to start to get vitamins and other nutrients. However, many older people do not get enough vitamins and other nutrients in their diets, or their bodies are less able to use them.
Ask your health care provider about taking multivitamins or other vitamin supplements or herbal remedies such as ginkgo. Remember that even seemingly harmless vitamins and other over-the-counter remedies can have side effects or interact with other medicines.
Most often, spouses or other family members provide day-to-day care for people with AD. People with AD usually need more and more care as the disease worsens. Taking care of a person with Alzheimer's disease can be very hard. It can affect your family life, your job, your finances, and your physical and mental health.
There are many resources for caregivers to get help and support. The Alzheimer's Association has chapters across the country that offer educational programs and support groups for caregivers and family members of people with AD. Other resources you may find helpful include the Caregiver Guide available from ADEAR and the Eldercare Locator service provided by the Administration on Aging (see below).
Stress can arise for a variety of reasons. Stress can be brought about by a traumatic accident, death, or emergency situation. Stress can also be a side effect of a serious illness or disease. There is also stress associated with daily life, the workplace, and family responsibilities. It's hard to stay calm and relaxed in our hectic lives. As women, we have many roles: spouse, mother, caregiver, friend, and/or worker. With all we have going on in our lives, it seems almost impossible to find ways to de-stress. But it's important to find those ways. Your health depends on it.
Stress can take on many different forms, and can contribute to symptoms of illness. Common symptoms include headache, sleep disorders, difficulty concentrating, short-temper, upset stomach, job dissatisfaction, low morale, depression, and anxiety.
We all deal with stressful things like traffic, arguments with spouses, and job problems. Some researchers think that women handle stress in a unique way: we tend and befriend.
During stress, women tend to care for their children and find support from their female friends. Women's bodies make chemicals that are believed to promote these responses. One of these chemicals is oxytocin (ahk-see-toe-sin), which has a calming effect during stress. This is the same chemical released during childbirth and found at higher levels in breastfeeding mothers, who are believed to be calmer and more social than women who don't breastfeed. Women also have the hormone estrogen, which boosts the effects of oxytocin. Men, however, have high levels of testosterone during stress, which blocks the calming effects of oxytocin and causes hostility, withdrawal, and anger.
Everyone has stress. We have short-term stress, like getting lost while driving or missing the bus. Even everyday events, such as planning a meal or making time for errands, can be stressful. This kind of stress can make us feel worried or anxious. Other times, we face long-term stress, such as racial discrimination, a life-threatening illness, or divorce. These stressful events also affect your health on many levels. Long-term stress is real and can increase your risk for some health problems, like depression. Both short and long-term stress can have effects on your body. Research is starting to show the serious effects of stress on our bodies. Stress triggers changes in our bodies and makes us more likely to get sick. It can also make problems we already have worse. It can play a part in these problems:
Any change in our lives can be stressful even some of the happiest ones like having a baby or taking a new job. Here are some of life's most stressful events:
Post-traumatic stress disorder (PTSD) can be a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat. Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects that remind them of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also can have emotional numbness, sleep disturbances, depression, anxiety, irritability, or outbursts of anger. Feelings of intense guilt (called survivor guilt) are also common, particularly if others did not survive the traumatic event.
Most people who are exposed to a traumatic, stressful event have some symptoms of PTSD in the days and weeks following the event, but the symptoms generally disappear. But about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these people develop a chronic, or long-lasting, form that persists throughout their lives.
Don't let stress make you sick. As women, we tend to carry a higher burden of stress than we should. Often we aren't even aware of our stress levels. Listen to your body, so that you know when stress is affecting your health. Here are ways to help you handle your stress:
Deep breathing is a good way to relax. Try it a couple of times every day. Here's how to do it.
Doctors used to think that ulcers were caused by stress and spicy foods. Now, we know that stress doesn't cause ulcers; it just irritates them. Ulcers are actually caused by a bacterium (germ) called H. pylori. Researchers don't yet know for sure how people get it. They think people might get it through food or water. It's treated with a combination of antibiotics and other drugs.
Care giving means caring for others, whether friends or relatives, who have health problems or disabilities and need help. Caregivers provide many kinds of help to care receivers, from grocery shopping to helping with daily tasks such as bathing, dressing, and eating. Most people who need help from caregivers are elderly.
Caregiver stress is a daily fact of life for many caregivers. Care giving often takes a great deal of time, effort, and work. Many caregivers struggle to balance care giving with other responsibilities including full-time jobs and caring for children. Constant stress can lead to "burnout" and health problems for the caregiver. Caregivers may feel guilty, frustrated, and angry from time to time. Caregivers often need help caring for an elderly or disabled care receiver. Sometimes other family members or friends and neighbors are able to help, but many caregivers do most or all of the care giving for a loved one alone. Research has shown that caregivers often are at increased risk for depression and illness. This is especially true if they do not receive enough support from family, friends, and the community.
Caring for a person with Alzheimer's disease (AD) or other kinds of dementia at home can be overwhelming. The caregiver must cope with declining abilities and difficult behaviors. Basic activities of daily living often become hard to manage for both the care receiver and the caregiver. As the disease worsens, the care receiver usually needs 24-hour care.
Caregivers can call upon others for support and assistance. Other family members, friends, and neighbors may be able to help in different ways. It may not be easy to ask for help, and you may need to make very specific requests. But getting help from others will benefit you and the person you are caring for.
Respite care can be a good way to get a break (respite) from constant care giving. If other caregivers aren't available to fill in for the main caregiver, respite care services may be available in the community.
As a caregiver, you can take steps to take care of your own health:
The National Family Caregiver Support Program (NFCSP) is a federally-funded program through the Older Americans Act. It helps states provide services to help family caregivers. These services include:
There are resources with staff who can help you figure out whether and what kinds of assistance you and your care receiver may need. The local Area Agency on Aging (AAA) is one of the first resources you should contact when help is needed caring for an older person. Almost every state has one or more AAAs, which serve local communities, older residents, and their families. In a few states, the State Unit or Office on Aging serves as the AAA. Local AAAs are generally listed in the city or county government sections of the telephone directory under "Aging" or "Social Services." You can also call the National Eldercare Locator, a toll-free service funded by the Administration on Aging (AoA), at 800-677-1116. The Eldercare Locator can help you find your local or state AAA. Eldercare Locator operators are available Monday through Friday, 9:00 a.m. to 8:00 p.m., Eastern Time. When contacting the Locator, callers should have the address, zip code, and county of residence for the person needing assistance. The Eldercare Locator is also available online at www.eldercare.gov. If your family member has a limited income, he or she may be eligible for AAA services including homemaker home health aide services, transportation, home-delivered meals, chore and home repair as well as legal assistance. These government-funded services are often targeted to those most in need. While there are no income criteria for many services, sometimes you may have more service options if you can pay for private help. AAAs can direct you to other sources of help for older persons with limited incomes such as subsidized housing, food stamps, Supplemental Security Income, and Medicaid. Supportive services for the person needing care can include both in-home and community-based services, such as:
If you are an employee covered under the federal Family and Medical Leave Act, if you meet the eligibility requirements, you are entitled to take up to 12 weeks of unpaid leave during any one-year to care for certain relatives.
People with low incomes may be eligible for AAA services including homemaker home health aide services and other services. Check with your local or state AAA or the Eldercare Locator service (see resources below). Government-funded services are often targeted to those most in need. While there are no income criteria for many services, sometimes you may have more service options if you can pay for private help. If you decide to hire a home care worker, you will need to decide how much help your older relative needs. Will several hours a day be enough, does he or she need help all day until the family returns home, or does your relative live alone and need round the clock care? You also need to decide what type of home care worker your relative needs. Home care personnel include:
Nonprofit and for profit home care agencies recruit, train, and pay the worker. You pay the agency. Home health care agencies focus on the medical aspects of care and provide trained health care personnel, such as nurses and physical therapists. Medicare may pay for their services.
To get Medicare home health care, a person must meet all of these four conditions:
For more information about Medicare, call 800-MEDICARE or visit the Medicare Web site (www.medicare.gov).
Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets. Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare.
American College of Obstetricians and Gynecologists (ACOG)
Phone Number(s): (800) 762-2264
Internet Address: http://www.acog.com
American Institute of Stress
Phone Number(s): (914) 963-1200
Internet Address: http://www.stress.org
American Psychological Association
Phone Number(s): (800) 374-2721
Internet Address: http://www.apa.org
Anxiety Disorder Education Program
Phone Number(s): (800) 647-2642 or (888) 826-9438
Internet Address: http://www.nimh.nih.gov/anxiety/index.htm
Anxiety Disorders Association of America
Phone Number(s): (301) 231-9350
Internet Address: http://www.adaa.org
"Depression After Delivery, Inc. "
Phone Number(s): (800) 944-4773
Internet Address: http://www.depressionafterdelivery.com/
National Alliance for the Mentally Ill
Phone Number(s): (800) 950-6264
Internet Address: http://www.nami.org
National Depressive and Manic Depressive Association
Phone Number(s): (800) 826-3632
Internet Address: http://www.ndmda.org
"National Foundation for Depressive Illness, Inc. "
Phone Number(s): (800) 239-1265
Internet Address: http://www.depression.org
National Institute of Mental Health
Phone Number(s): (301) 443-4513
Internet Address: http://www.nimh.nih.gov
National Mental Health Association
Phone Number(s): (800) 969-6642
Internet Address: http://www.nmha.org
National Mental Health Consumers' Self-Help Clearinghouse
Phone Number(s): (800) 553-4539
Internet Address: http://www.mhselfhelp.org
"National Mental Health Information Center, SAMHSA, HHS "
Phone Number(s): (800) 789-2647
Internet Address: http://www.mentalhealth.org
Obsessive-Compulsive Foundation Inc
Phone Number(s): (203) 315-2190
Internet Address: http://www.ocfoundation.org
Postpartum Education for Parents
Phone Number(s): (805) 564-3888
Internet Address: http://www.sbpep.org
The National Center for Post Traumatic Stress Disorder
Phone Number(s): (802) 296-5132
Internet Address: http://www.ncptsd.org/index.html