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Discussion, Thursday

On seniors and mental health

Continued from Page 1

It is important that they be monitored regularly especially early during a course of treatment. Drug interactions can occur for example the level of blood thinners can increase so it is very important to monitor for this.

I also want to stress that psychosocial interventions can be very effective for some individuals eg psychotherapies (talk therapies). For example There is lots of evidence that CBT (cognitive behaviour therapy) works very well. However - it may be hard to find qualified therapists in many areas.

Gregory Alan Elliott from Canada: When all is said and done, if they have a life partner who loves them, all of these challenges seem unimportant. I'd rather lose my mind and be truly loved by someone who I love, than be perfectly sane and alone.

Dr. David Conn: Thanks for your comment. Certainly having support makes experiencing mental health issues a lot easier than facing these challenges alone. I do think it is important to recognize that the challenges of mental health and dementia can have an impact on family caregivers, and in fact can increase their risk for depression. If you are supporting someone with mental health issues it is important to make sure you get support too!

Jenny charbonneau from Canada: In my opinion, seniors need professional, experienced, non-judgemental, non religious, caring, supportive, firm care from intelligent, caring, concerned, talented educated mentally well non violent experienced workers. They are hard to find.

Dr. David Conn: Hi Jenny. (I would like to mention that Kim Wilson the Executive Director of the Canadian Coalition for Senior's Mental Health is assisting me with some of these responses.) It can be a challenge to find health care providers who are trained to work with seniors with mental health issues. There are some groups working to improve the training of professionals, including the CCSMH, the National Initiative for the Care of the Elderly, and the Geriatric Education and Recruitment Initiative.

You may also want to explore the Canadian Academy of Geriatric Psychiatry, the Canadian Gerontological Nursing Association, and the Canadian Geriatrics Society. There is also a 'Care of the Elders' program that is offered by the College of Family Physicians. Certainly those who work in the field recognize that there is a shortage of trained professionals and are advocating to ensure there are more trained to work with older adults with mental health issues.

Nicole Campbell from Canada: Can you please comment on the role of physical activity and mental health. Does strength training and aerobic training improve mental health?

Dr. David Conn: There have been many positive studies of the effects of exercise on mental health and especially depression, including a variety of studies of older adults. Many of these studies suggest very good benefits.

A recent scientific review of these studies was published as a Cochrane Review (a process that tries to integrate all of the best scientific studies). I'm inserting a summary below.

Overall it suggests modest benefit for depression. I believe that for severe depression exercise can help but additional interventions are generally necessary.

1: Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004366.

Exercise for depression.

Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA.

School of Clinical Sciences and Community Health, University of Edinburgh, Room F1424, Royal Infirmary, Little France Crescent, Edinburgh, UK, EH16 4SA. gillian.e.mead@ed.ac.uk

BACKGROUND: Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression.

OBJECTIVES: To determine the effectiveness of exercise in the treatment of depression.

SEARCH STRATEGY: We searched Medline, Embase, Sports Discus, PsycLIT, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com.

SELECTION CRITERIA: Randomized controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression.

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