March 12, 2019

Mental Health Part 1: Anxiety and Depression

The Signs, Symptoms, and Stigma

Mental illness is defined by the Public Health Agency of Canada as “alterations in thinking, mood, or behaviour.” Anxiety and depression
are the most common mental illnesses that affect Canadians, in every age group. Elders are not immune to mental health illnesses or injuries and may, in fact, be more at risk, especially for depression. However, anxiety and depression tend to be under-recognized, underdiagnosed, and undertreated in older adults. The symptoms of these mental illnesses are often brushed off as over-reactions or normal signs of ageing. Recognizing the signs and symptoms of mental illness and advocating for ourselves and others
is the first step in increasing awareness and reducing the stigma of mental illness.

In this four-part series, we present information on common mental illnesses, symptoms, treatments, getting and giving support, engaging others, and attaining and maintaining mental wellness. There are many mental illnesses, but anxiety and depression will be discussed here in part one as they are the most common.

  • Anxiety is characterized by worry, nervousness, or fear. These feelings can be normal in response to stressful situations, but when it becomes excessive or out of proportion to the perceived threat, it is said to be an anxiety disorder. There are many types, including generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.
  • Generalized Anxiety Disorder is a chronic, exaggerated worry about routine life events and activities, including almost always anticipating the worst even when there is little reason to expect it. Physical symptoms can include fatigue, shakiness, muscle tension, headache, and nausea. Episodes of panic attacks can occur.
  • Panic Disorder manifests as panic attacks, with symptoms of tingling in the hands, feet, and mouth; fast breathing; feelings of ‘floating’ or observing events from far away; sudden ringing in ears or muffled hearing; feelings of being unable to breathe; and intense fear. The person experiencing a panic attack may feel like they are dying or having a heart attack. These symptoms usually resolve on their own in a few minutes and have no discernible medical cause.
  • Phobias are intense fears that can lead to panic attacks in response to the feared experience or object, such as blood, snakes, or flying. People with phobias may experience panic disorder, where they seek to avoid the object or experience that causes panic to avoid the panic attack or the embarrassment. This situation can progress to social isolation, as people are reluctant to leave their homes for fear of experiencing an episode that may cause embarrassment or where help is not available. This fear is known as agoraphobia, which has been shown to increase later in life if illness or injury has occurred.
  • Obsessive-Compulsive Disorder has symptoms of panic if ‘rituals’ are not performed — rituals that the affected person may perform to avoid a fear-causing thought or event. Intrusive and unwanted thoughts can also occur and compel the person to perform behaviours, such as over-washing hands because of fear of contamination. The intrusive thought may tell the person that they didn’t clean well enough and will become ill; this could prompt the individual to wash their hands until it causes injury.
  • Post-Traumatic Stress Disorder (PTSD)
    can occur in anyone that has experienced a very stressful event, such as being a victim of a crime, being in a car accident, or becoming very ill or hospitalized. PTSD causes nightmares, flashbacks of the event, numb emotions, being easily startled, and feelings of anger, irritability, or distraction. Anxiety symptoms may also occur.

People with chronic illnesses, lung diseases, heart diseases, thyroid disease, alcohol abuse or misuse, stressful life events, negative childhood diseases, and sleep disturbances are all at a higher risk for anxiety disorders. Though anxiety disorders are distressing, anxiety is common and treatable and does not mean a person is hysterical or fragile — it means that their “fight or flight” nervous system is over-active in response to a stimulus. This affliction is controlled usually by therapy, medication, or a combination of both.

Depression is the most common mental health disorder in aging adults. Depression is defined as an intense, prolonged period of low mood and changed behaviour. It can cause feelings of hopelessness, sadness, guilt, irritability, or anger. Depression can cause people to lose interest in socializing with friends and loved ones, beloved hobbies, and daily tasks. People experiencing depression may sleep and eat too much or too little, have difficulty with basic hygiene, and may have trouble remembering things or taking in new information. Depression can also have symptoms of agitation or anxiety. People with depression may also become preoccupied with death and talk about dying or suicide.

People experiencing major life changes, such as loss of a loved one, caregiving, divorce, or illness are at a greater risk for developing depression. Older adults are at a much greater risk for depression due to the many potential life changes like retirement, illness, loss of independence, and physical changes; all of these events can cause depression.

There is an unfortunate perception that as we age, sadness is normal. This understanding is simply not true, and because of this misconception, depression is rarely recognized in older adults. As it goes unrecognized, people do not get the help and support they need, which contributes to suicide risk. Senior men (over the age of sixty-five) have a higher risk of suicide than any other age group. Yet when depression is recognized and treated, there is an eighty per cent chance of the individual making a full recovery. Treatment is often a combination of a medication regimen and counselling or therapy, and increasing supports such as home care, education, and community-based programs.

Mental illness is much like physical illness in that it has identifiable causes and effects, and treatments are available. As we gain more knowledge of how to lead long and healthy lives, the awareness of common mental illnesses has never been higher. However, seniors still go undiagnosed and untreated due to prevailing stigma and ageism. It is important to recognize the signs and symptoms of mental illness and respond to them to keep ourselves and others safer, happier, and mentally well. For anxiety and depression self-screening tools, see heretohelp.bc.ca/screening/online/. If you are concerned that you or a loved one may have anxiety or depression, see your family doctor as soon as possible for assistance.

In part two, we will give information on how to support those with mental illness and how to get support if you are struggling. We will also tackle the myths of mental illness and go in-depth on suicide and suicidal thoughts.

If you or someone you know is having thoughts of hurting themselves or of suicide, call 911, or go to a hospital emergency department right away for safety. The person thinking about suicide is at great risk, and they need immediate help.

For more information, visit these links:


By Hailie Rondeau, RN

ARTACares is provided by HumanaCare, an Alberta-based health and wellness provider with more than thirty-five years of Canadian health care experience.