Give support this season

10 ways to support loved ones during the holidays

With the holiday season gearing up, I thought I’d share a reminder about how difficult this time of year can be for many people.

For those who have experienced loss, are alone, or living with mental illness, the holidays can be particularly stressful and overwhelming.

For a depressed person, it can be impossible to be cheerful or merry even when every aspect of our culture seems to demand it.

If you have a loved one with depression or another mental illness, simply offering your support at this time of year may be the best gift you could give. Here are a few simple ways to show your support during the holidays or any time of year.

1. Listen. You probably won’t be able to solve any problems but if a loved one chooses to talk to you, just listen. Even if you don’t understand and can’t fix things, listening can be a comfort and help in itself.

2. Give a hug. Simple gestures of physical love like a hug can make a big difference.

3. Be patient. It can be frustrating, confusing and demoralizing to watch a loved one who is depressed.

When you are not experiencing those feelings yourself, it is easy to wonder why the person doesn’t simply snap out of it.

A person dealing with mental illness can also say and do very hurtful things. Try not to take it personally and remember it is the illness talking.

4. Get them out of the house. Depressed people often lose motivation to do things they enjoy or even to get out into the world. Some fresh air and a non-stressful outing can be a helpful distraction.

5. Give them space. It’s important for your loved one to know you are there for them, but if they ask for space, respect their request.

6. Do the little things. Gestures like bringing a cup of tea, making a meal, helping with a household task or offering to run an errand help a person feel less overwhelmed and show your support in a tangible way.

7. Separate the person from the illness. Mental illness does not define your loved one. Remind them of that.

8. Encourage small steps. Remember that movie, What About Bob? The psychiatrist encouraged baby steps. Progress is progress and small steps can build to bigger ones. Your encouragement is a gift.

9. Understand you are not to blame. When someone you love is unhappy, it is easy to put the blame on yourself. You are not responsible for mental illness.

Nothing you could have done differently would have prevented it and you can’t simply will the person to feel better.

Mental illness is just that, an illness.

10. Encourage getting help. If your loved one is dealing with chronic depression or other mental health symptoms, professional help could be needed for them to get better.

You usually can’t force the issue, but encouragement or assistance in getting help might be needed.

Cannabis worsens bipolar

Cannabis use and treatment of bipolar disorder

In several previous columns, I have written about the effects of cannabis use on various psychiatric disorders. 

Cannabis is, of course, a widely used drug and many people use it regularly in spite of (or sometimes as a form of self-medication for) mental illness. 

Unfortunately, cannabis does not generally have a positive effect on any psychiatric conditions and is known to make many conditions worse.

Although people often talk of its positive effects, cannabis use actually makes ADHD, anxiety and depression worse and can also trigger psychotic symptoms in susceptible individuals. 

Research is also proving cannabis to have a negative effect on treatment outcomes for people with bipolar disorder. 

A Spanish study of almost 2,000 bipolar patients from centres in 14 European countries confirmed the drug hinders recovery.

This was the first study to examine the long-term consequences of cannabis use or cessation on bipolar disorder.

Results showed continued cannabis use led to lower rates of remission and recovery as well as higher recurrence of mood episodes.

Cannabis use was also associated with a higher rate of suicide attempts.

Interestingly, the study also showed that when cannabis use was stopped, so were its negative effects on bipolar treatment.

For patients who stopped using cannabis during a manic or mixed episode, their clinical outcomes two years later were similar to those who had never used the drug. 

This is positive news as it shows there is a real benefit to encouraging patients to stop drug use when dealing with bipolar disorder.

It seems the negative effects can be reversed and patients can expect good treatment results and functioning if they are able to stop using cannabis. 

Bipolar disorder is a chronic mental illness with no cure. It can be managed with a combination of medications, but requires ongoing interaction with a mental health professional as it often requires some treatment adjustments over time.

Whenever there is a proven way to improve outcome and quality of life, it is good news for both doctor and patient. 

Substance use in general is very common among individuals with bipolar disorder and cannabis is one of the most frequently used and easily accessible substances.

Many people feel because it is a ‘natural’ drug it will be therapeutic, especially with mood or anxiety conditions.

Unfortunately, this is simply not the case. This study is one more piece in a growing body of evidence strongly suggesting cannabis use has negative consequences when used by people with psychiatric conditions. 

If you are struggling with bipolar disorder or other mental health symptoms, your safest and most effective option is to speak with a medical professional about options proven to provide relief.

Social anxiety disorder

Everyone knows someone who is painfully shy. More than simple introversion, but a person who seems to actually fear social situations, public speaking or being put on the spot. 

For some, this fear can cause a lot of difficulty in daily functioning. 

Social anxiety disorder is one of the most common psychiatric conditions, affecting 18 per cent of the population.

It occurs when a person experiences intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some parts of daily life.

Socially anxious people have a fear of criticism and disapproval, do not like to be the centre of attention or to perform under scrutiny. 

People experiencing social anxiety disorder also often go on to develop other disorders such as depression and substance-use disorder. 

Although the exact causes of social anxiety are not fully understood, it is thought to be about 20-40 per cent genetically based with experience accounting for the rest.

Although social fear may not sound too terrible a plight, it can be a very debilitating disorder. 

School-age children may not want to go to school, have difficulty making friends and may have greater difficulty performing in school because of anxiety. 

They will feel compelled to avoid asking questions or making classroom presentations. They are also likely to resist participating in physical education or other athletic activities because of performance fears. 

As adolescents, they may have difficulty dating or engaging in important social pursuits. Young adults may lack the confidence to go on to post-secondary education and may avoid applying for jobs because of their social anxiety.

Social anxiety disorder often begins early in life – 50 per cent of those with this condition have developed it by age 11. 

Some of the earliest warning signs are apparent right from toddlerhood. Children who exhibit a temperamentally anxious predisposition and who show behavioural inhibition are most likely to develop social anxiety as they grow. 

The good news here is that although a child with a shy disposition will likely remain shy throughout life, it does not necessarily have to become a disabling disorder. 

Childhood interventions for highly anxious children have the potential to prevent the development of full-blown social anxiety and its related issues later in life.

Childhood behavioural inhibition typically emerges during the second year of life around the time of normal stranger anxiety – it involves excessive shyness and avoidance behaviour in social situations.

Adverse environmental experiences such as abuse, bullying, neglect or even simple lack of sensitivity to the fears of the child can have a negative impact on how this early anxiety evolves. 

Similarly, supportive encouragement to social engagement could help in overcoming fears and is quite similar to what happens during cognitive therapy for adults with social anxiety disorder.

Unfortunately, many parents do not have the natural ability to respond appropriately to an anxious child. 

Sometimes this is because they are socially anxious, depressed or overwhelmed by the other demands of life. 

Families living in poverty often have less opportunity for the social engagement of their children.

Social anxiety disorder can be treated with cognitive behaviour therapy and medication later in life, but often only moderately so.

The same fear that keep socially anxious people from school and work tend to keep them from therapy as well. 

A focus on early intervention aimed at prevention is likely to be a much more effective solution than treatment after the fact. 

The sooner child are helped, the less likely they are to suffer negative consequences of their anxiety including lost opportunities and the development of co-morbid conditions. 

If you have a toddler or young child who seems to be exhibiting more fear or anxiety than other kids, consider talking with your doctor about strategies to gently encourage social engagement and coping.

It will be much better to help a young child than to attempt intervention later in life

Dementia under diagnosed

We have known for some time that dementia is under-recognized in most places around the world. 

One study published in Neurology examined a group of 845 seniors 70 years or older and found that 55 per cent of individuals with clear symptoms of cognitive decline had not had a formal evaluation of their cognitive function.

The authors extrapolated from these data to conclude that in the U.S. nearly two million seniors with clinical dementia had not seen a physician about their memory problems.

In the U.K., the same problem was recognized and led the government to introduce a controversial program in which general practitioners were to be paid for each diagnosis of dementia made.

In that country, the National Health Service estimated that only about half as many people with dementia had been diagnosed as should be based on population studies of the prevalence of this condition. 

What is concerning about these findings is that dementia is a serious, life-changing condition requiring action from patients and their families.

Both sufferers and their loved ones need support and may also need to make legal and financial decisions to cope with the reality of what is typically a degenerative disorder. 

Of course, recognizing dementia is also a necessary step for treatment and research. Although there is currently no treatment that will stop the progression of dementia or reverse its effects, there are some treatments that can provide modest help. 

There are also a growing number of investigational treatments in various stages of research that are actively seeking volunteers.

Not only are volunteers essential in order for new treatments to be developed and approved, but there is also a chance of receiving help not otherwise available when taking part in a clinical study.

Obviously, when unaware of a diagnosis, it is difficult to take part in treatment or study options. 

Of course, not everyone with memory problems has dementia. As I wrote in last week’s column, there are many psychiatric conditions with cognitive deficits that can be difficult to treat and can even closely resemble dementia. Certainly, in my own specialist psychiatric practice, most people with memory issues do not have dementia.

One of the big concerns with the U.K. idea to pay physicians for a specific diagnosis is the likelihood of false positives. 

Unfortunately, aside from the basic cognitive testing available from most physicians, more sophisticated testing for dementia is either hard to come by or costly – often leaving people reluctant to pay for it. 

There are few specialists with the tools and training required to give more detailed testing for dementia and these services are not usually included under regular or extended medical coverage. 

Fear and stigma are also barriers for people concerned about the possibility of dementia. Many people are afraid to ask the question because they don’t want to hear the answer or fear the possibility of losing their driver’s license or independence in other ways.

Even doctors are sometimes reluctant to bring up the topic of dementia because they may feel ill equipped or as though there is little they can do to help patients and their families. 

Dementia is a progressive disease whose consequences are eventually unavoidable. It is easier to deal with those consequences — both individually and as a community — when we can do so in a gradual, progressive way rather than when suddenly faced with a crisis. 

If you have concerns about your memory, I encourage you to speak with your doctor.

We are also seeking volunteers for an ongoing study at Okanagan Clinical Trials examining an investigational treatment for Alzheimer’s disease.

Contact us to learn if you may be eligible to participate.

More States of Mind articles

About the Author

Paul Latimer has over 25 years experience in clinical practice, research, and administration.

After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar.

Since 1983 he has been practicing psychiatry in Kelowna, BC, where he has held many administrative positions and conducted numerous clinical trials.

He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders.

He is an avid photographer, skier and outdoorsman.

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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