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Today's Rural Caregiving: Managing Mood
Without Medication

Medication and Mood

Non-compliance with a medication regimen should also be suspected if an elder’s symptoms change over time. Since older adults metabolize drugs more slowly than younger adults, their medication programs are often more difficult to monitor and manage. It’s important for family caregivers to understand the elder’s medications and their side effects. Drugs currently used to treat memory loss can have troublesome gastrointestinal side effects including nausea, vomiting and diarrhea; antidepressants can cause side effects ranging from dry mouth and constipation to lowered blood pressure and mental confusion. Some elders conclude these types of side effects and/or the costs of some drugs are worse than the symptoms, and often discontinue those medications without consulting their family or health care provider.

Dementia and Mood

When changes in an elder’s functional status and abilities become apparent, families are frequently challenged to sort out a wide variety of symptoms that may be reflective of normal aging or a more serious health problem. While mild depression may herald the early onset of dementia or be mistaken for dementia, there are differences. The initial signs of dementia are memory loss for recent events that gradually develop over a period of years with the afflicted person unaware and often unconcerned about the memory deficits. In contrast, depression has a more abrupt onset, often occurring after a ‘single life event’ such as serious illness or death of a loved one, a move out of a long-standing living situation or the onset of a chronic disease. The depressed person complains of memory loss, both for recent and distant events and frequently admits to sleep and appetite disturbances and may even verbalize negative thoughts (“I am such a burden to you; I wish I had never …”) or sometimes, suicidal thoughts (“It would be better for everyone if I wasn’t around anymore”).

Blue Mood Thinking

Mrs. Reilly’s situation has a number of contributory factors for the development of depressive symptoms, including her experience of the loss of her spouse and close friend, a chronic illness that causes functional limitations and a medication program that may have serious side effects. However, the ways Mrs. Reilly thinks about her situation may also play a significant role in the development and control of her depressive symptoms. David Burns, the author of “Feeling Good: A Guide to the New Mood Therapy”, and a well-known depression researcher from the University of Pennsylvania, notes that it is not what happens to us, but rather, how we think about what happens to us, that governs our emotional responses. According to Burns, persons are likely to become depressed if they think in certain ways. The depressed person uses one or more of these thinking styles. (See Table Above)

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