5 Hidden Signs of Depression and How to Spot Them in Others

By Kat Gal 

Your friend seems fine.

She is social and appears to be cheerful all the time. Her life is in order. She rarely even complains.

There is no way she’s depressed.

The truth is, though… depression shows up differently for everyone.

Not everyone dealing with depression shows it in public. Not everyone struggling sits in the corner, cries all the time or acts withdrawn either.

There are people who have hidden depression and because they hide it so well, it can sometimes be very difficult to support them in getting better and finding happiness again.

But support is crucial and I want to show you how to spot a friend or loved one who may need you during this time… even if they aren’t openly asking for it.

5 Things To Look For With Hidden Depression

1. They may be irritated or angry a lot.

Anger and irritation are two common signs of depression. When you think of depression, you usually think of sadness, helplessness, apathy and melancholia. When someone is angry or irritated, you may mistake it for a bad mood or bad temper. However, anger and irritation are often a way to express depression, especially in men.

2. They may withdraw.

When someone is dealing with depression, it’s common for them to lose all interest in anything, especially in the activities they once loved doing. They may become more withdrawn, sleep in late and call into work more often, etc. Becoming withdrawn can be one of the biggest signs that someone is suffering.

3. They may become flakey and unreliable.

People dealing with depression may make plans with you when they feel up to it or feel pressure to do so, but then they may not follow through with it, cancel or not show up at all. You may consider this rude. If they do this several times in a row, you may even consider cutting ties with them. But be aware, someone who suddenly begins flaking out on you could be secretly depressed.

4. They may be exhausted, have trouble sleeping or sleep too much.

Dealing with depression is difficult and tiring. Everything becomes way too hard, even sleeping and/or staying awake. People with depression may have trouble falling asleep, staying asleep or may be tired even when they’ve slept all day long. They may be coping with depression by sleeping far too much. Sleep problems and unusual sleep patterns can often be a warning sign of deeper issues.

5. They may suddenly gain or lose a noticeable amount of weight.

There can be many reasons for weight loss and weight gain. People often lose weight because they’ve started eating better and exercising. They may gain weight because of indulging during the holidays, having less time to exercise or having a few too many brownies. A variety of illnesses and health conditions can also cause weight loss or weight gain.

Be careful trying to associate someone’s weight loss or weight gain with depression (or eating disorders) right away. Just keep in mind that not eating enough or eating too much can be a coping mechanism as well. Look for other signs of depression along with the weight fluctuation. If there is no other explanation – an improved diet, more or less exercise, or a medical condition, etc. – it may be a sign of depression.

What Can You Do If Someone You Know May Be Dealing With Hidden Depression?

  • Talk to them. Don’t interrogate them, but be there for them. Genuinely express interest in their lives and well-being.
  • Offer support. Do so by listening and trying to understand, without judgement. Also offer non-emotional support, like cooking a healthy meal or helping them around the house or with their pets of children.
  • Be patient. Depression is difficult. Healing is a difficult journey too. It takes time and may be full of ups and downs.
  • Believe in them. Don’t give up on them, even if they seem to have given up on themselves. Tell them you believe in them and that you believe they can heal.
  • Love them. Tell them that you love them unconditionally. Love them through words and actions.

What Can You Do If You Have Hidden Depression?

  • Become vulnerable. You don’t have to do this alone; you are not alone. Just sharing your story can be liberating. This is a great way to begin healing and allowing those that love and care for you to help.
  • Eat better. When you are dealing with depression, sometimes the last thing you want to do is to eat healthy (or eat at all). But an unhealthy diet can lead to further depression. Focus on organic, plant-based whole foods: vegetables, fruits, nuts, seeds, legumes and whole grains. Your gut influences your brain, so take care of your gut flora and consider adding in a quality probiotic.
  • Move your body. Stretch, walk, do yoga, run, dance or anything you’d like. You don’t have to do too much, but try to move at least a few minutes – preferably 20-30 minutes each day.
  • Be in nature. Connecting with nature is healing. Walk barefoot in the grass. Hug a tree. Watch the sunset. Go for a hike. Swim in a lake. Play with animals.
  • Journal. Journaling is an excellent way to express your emotions, recognize patterns, let go of limiting beliefs and just ‘let it all out.’
  • Do some art. Art is another way to express your emotions, deal with negative feelings and create happiness. You don’t have to be an artist and you don’t have to show your work to anyone. Draw, paint, take photos, make some sculptures, knit, crochet, do some craft work, make a picture album, or color in an adult coloring book.
  • Do something that makes you happy. For now, it doesn’t have to be profound. If watching your favorite show puts a smile on your face, do that. It is important to start somewhere and that looks different for everyone.
  • Start practicing self-love. Do some mirror-work by looking into your own eyes in the mirror and talking positively to yourself. Practice affirmations. Practice smiling.
  • Get professional help. There is no shame in seeking professional support. A psychologist, therapist, counselor or a life coach can help you find answers and find happiness in life.

Always remember that there is HOPE. Help, love and guidance is out there, even when it doesn’t feel like it is. Don’t give up on yourself and most importantly, don’t give up on those you love.

We’re all in this together – no matter what.


Merry Christmas and Happy New Year

Merry Christmas and Happy New Year from all of us at We Elderly Care

NY Times: No Place Like Home for Rehab

There has long been a debate over sending a patient to a post-acute facility versus utilizing at-home rehabilitation following joint replacement surgery. However, being at home, even if someone lives alone, can be more beneficial than going from the hospital to a post-acute facility, according to a recent article from The New York Times.

The number of people receiving joint replacements, specifically knee and hip replacements, is increasing due to the fact that people are living longer. Along with the increase in joint replacements comes the increased need for rehabilitation services, and in-home services may be less expensive with comparable, if not better, outcomes than inpatient rehab facilities, the article reported.

There needs to be a re-examination of who, if anyone, should go to a rehab facility after joint replacement, Dr. Javad Parvizi, chairman of research in orthopedics at Thomas Jefferson University, explained in the article.

In one of Dr. Parvizi’s studies he worked with 769 patients who underwent either a knee or hip replacement for advanced arthritis. Of the patients, 36 were discharged from the hospital to a rehab facility, and the rest went home and received outpatient rehab, even those who lived alone.

“Based on an assessment of the patients’ function, pain relief and personal satisfaction three months after their surgery, the team concluded, ‘Patients living alone can expect a safe recovery, equivalent to those not living alone, when discharged directly home after total joint arthroplasty,’” the article stated.

Another potential perk of in-home rehab services is that patients who go directly home from after joint replacement surgery may be less likely to experience adverse events like blood clots and infections. This is because there was “substandard treatment, inadequate patient monitoring, and failure to provide needed treatment” at inpatient facilities.

Cost is also a huge differentiator between inpatient and in-home rehab. Inpatient rehabilitation is typically much more expensive than receiving in-home services. Dr. Parvizi’s study found that the cost per patient is reduced by more than $10,000 without inpatient rehab.

Read the full article from The New York Times.

Written by Alana Stramowski

Dementia and Sleep: Eight Tips to Keep Nighttime from Becoming a Nightmare

Dementia and Sleep: Eight Tips to Keep Nighttime from Becoming a Nightmare


Recently, I was visiting a Brookdale community and met Renee, the daughter of a new dementia care resident. Renee told me she was her mother’s full-time care partner prior to the move. I asked how they were both adjusting to her mother’s new living arrangements and she lit up. She said her mother loved her new home and had transitioned quickly. Renee said the most beneficial part of the move for her as a care partner was that she was actually sleeping again. “Mom had her days and nights turned around, and sometimes I would stay up all night with her. It was really bad for both of us.” Unfortunately, this is a common issue.

Night can become an anxious time as dementia progresses. The disease may interfere with the sleep/wake cycle in the brain, leading to overnight restlessness and daytime drowsiness, which can make symptoms worse. It may also rob care partners of the rest they need, leading to chronic and even dangerous exhaustion.

For all adults, aging tends to change sleep patterns. Typically, people begin waking up throughout the night, sleeping fewer hours and achieving a lower percentage of deep sleep. All of these issues also affect those with dementia as they age, but they can be more pronounced. The synchronized circadian sleep rhythm becomes disrupted, breaking sleep up into several segments over a 24-hour period. This can cause excessive sleepiness during the day and insomnia at night.

In addition, a few forms of dementia are associated with certain sleep disorders. People living with Alzheimer’s are more likely to wander at night, while those with vascular dementia may experience altered breathing while sleeping. Parkinson’s can cause daytime drowsiness, or sudden onsets of sleep, and dementia with Lewy Bodies can produce hallucinations and the more frequent awakenings at night due to vivid dreams.

While sleep medication might seem like an answer to the problem, research has not proven that it helps. In fact, a number of studies show that it can lead to more sleep disturbances rather than less. Plus, these medications can negatively affect cognition, which increases confusion for people living with dementia. However, there are a number of helpful steps care partners can take that don’t involve drugs. They include:

1. Checking with a physician to make sure a physical condition such as undiagnosed pain or a urinary tract infection isn’t the culprit.

2. Ensuring exposure to natural light during the day.

3. Making sure the person with dementia exercises for least 30 minutes a day, although not within four hours of bedtime.

4. Providing purposeful things to do throughout the day. Being engaged in meaningful ways discourages daytime sleeping and contributes to feeling pleasurably tired in the evening.

5. Not serving alcohol, caffeine and large meals as bedtime approaches.

6. Scheduling a bathroom visit right before going to bed.

7. Using time-honored methods for relaxing, such as a short massage, a warm bath or snuggling with a pet.

8. Limiting screen time before bed or using an amber-colored nightlight. Studies show white light interferes with a person’s ability to return to REM level sleep. Shutting off electronic devices or switching them to the night shift setting can help. Amber light doesn’t affect a person’s ability to sleep like white light does.

Dementia’s impact on sleep is something to take very seriously. Just as Renee did with her mom, care partners should carefully consider how much it is compromising their own health and ability to cope. Chronic exhaustion can become dangerous, even causing accidents and injury.

If the issue can’t be addressed, it may be time to consider a dementia care community, where teams of specially-trained people can provide the care that’s needed both day and night. This ensures high quality of care for the person with dementia and enables family members to get the rest they need to continue their invaluable role of cherishing their loved one.



Managing Editor


Here are some tips to help your loved one maintain their friendships and stay social:

1. Advocate. Your friends may not understand dementia and may accidentally act patronizing. Remind them of your loved one’s abilities and needs.

2. Plan Ahead. Let your friends know what changes to expect as the disease progresses. Warn them, for example, of potential emotional outbursts, or the need to repeat themselves.

3. Quiet Environment. Meet in a calm and quiet space. This will help your loved one focus on your friends.

4. Choose activities. Pick a shared activity suited to your loved one’s abilities—looking at old photo albums, taking a walk, listening old records.

We’re Closer To An Alzheimer’s Blood Test For Early Diagnosis

As with many diseases, including cancer and heart disease, detecting Alzheimer’s early would help providers create a better treatment plan to stop further damage. Right now, we can’t identify the disease before major symptoms, like memory impairment, appear, but scientists have been working on creating a blood test that could diagnose it early, and now believe they’ve created a technique that would be accurate.

The method examines white blood cells, also known as leukocytes, and looks for pieces of DNA specific to Alzheimer’s. In tests, the method successfully distinguished among Alzheimer’s, Parkinson’s, and healthy control subjects. But don’t expect the test to be available soon, as the research is still preliminary, according to a news release on Science Daily.

The hallmark signs of Alzheimer’s disease include confusion, memory troubles, and other cognitive delays. Patients may be afflicted with the disease for up to 18 years before they begin to experience these symptoms, Time reported. That’s years’ worth of brain damage caused by the disease before it’s ever diagnosed, which makes treatment especially difficult.

“What we’ve done in our paper is to replicate our own work multiple times with different populations and even using different technologies,” Paul Coleman, an Alzheimer’s researcher at the ASU-Banner Neurodegenerative Disease Research Center (NDRC), who was also involved in the study, explained in the release. “We also presented data showing the ability to detect people at risk of a future diagnosis for Alzheimer’s disease.”

The study is now published online in Neurobiology of Aging.

According to the Alzheimer’s Association, about 5 million Americans are currently living with the disease, and this number is expected to significantly increase as populations further age. The association also notes the disease is progressive; although cognitive problems may not seem too serious in the beginning, they can progress over time and make it difficult to complete everyday tasks.

For a disease as widespread as Alzheimer’s, we have few options to diagnose the disease and just a few options to slow it down. Researchers hope that when the test is availabe, it will identify the disease in patients before it has caused much damage. The test likely wouldn’t be given to every patient, as those with family history and a genetic predisposition have the highest risk.

Source: Delvaux E, Mastroeni D, Volz J, et al.  Multivariate analyses of peripheral blood leukocyte transcripts distinguish Alzheimer’s, Parkinson’s, control, and those at risk for developing Alzheimer’s. Neurobiology of Aging . 2017

We Have Moved

We Elderly Care has relocated our offices from 214 E Stuart Ave (Lake Wales) to 229 E Stuart Ave, Suite 15 (across the street in the Arcade Building).

CNA/HHA Help Wanted Highlands County

Looking for CNA/HHA’s in the Highlands County area. Go to our website to begin the process!




Study Links Moderate Drinking to Reduced Risk of Dementia

Study Links Moderate Drinking to Reduced Risk of Dementia

But finding comes with cautions against excessive alcohol use over extended periods

En Español

SUNDAY, Aug. 6, 2017 (HealthDay News) — Moderate drinking may be associated with a reduced risk of dementia in seniors, a new study suggests.

But the study authors stressed that the findings shouldn’t be interpreted as a signal to drink freely. The study only found an association between some alcohol consumption and mental sharpness, not a cause-and-effect link.

Researchers followed more than 1,300 adults from 1984 to 2013. They lived in a white-collar, middle- to upper-middle-class suburb in San Diego County, California. Most were white with at least some college education.

Their thinking and memory (cognitive) skills were assessed every four years.

Among men and women 85 and older, those who drank moderate amounts of alcohol five to seven days a week were twice as likely to show no signs of dementia than non-drinkers, according to the study in the August issue of the Journal of Alzheimer’s Disease.

Moderate drinking was defined as up to one alcoholic beverage a day for adult women of any age and men 65 and older, and up to two drinks a day for men under 65.

Heavy drinking was defined as no more than three alcoholic beverages per day for adult women of any age and men 65 and older, or four drinks a day for men under 65.

Previous studies have found a link between moderate alcohol intake and longevity.

“This study is unique because we considered men and women’s cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age,” said senior author Linda McEvoy. She is an associate professor at the University of California, San Diego School of Medicine.

“It is important to point out that there were very few individuals in our study who drank to excess, so our study does not show how excessive or binge-type drinking may affect longevity and cognitive health in aging,” McEvoy said in a university news release.

Excessive drinking over a long period is known to cause alcohol-related dementia.

The researchers emphasized that this study does not suggest drinking is responsible for a decreased risk of dementia. They noted that alcohol consumption, particularly wine, is associated with higher incomes and education levels, which in turn are linked to lower rates of smoking and mental illness as well as better access to health care.

“This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging,” study author Erin Richard said in the news release.

“However, it is not a recommendation for everyone to drink,” she added. “Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences.”

Richard is a student in a joint doctoral program in public health at San Diego State University and UC San Diego.

More information

The Alzheimer’s Association has more on brain health.

SOURCE: University of California, San Diego, news release, Aug. 1, 2017

— Robert Preidt

What I Wish I’d Known About My Knees


Serious questions are now being raised about the benefits of the arthroscopic procedures that millions of people endure in hopes of delaying, if not avoiding, total knee replacements.

The latest challenge, published in May in BMJ by an expert panel that systematically reviewed 12 well-designed trials and 13 observational studies, concluded that arthroscopic surgery for degenerative knee arthritis and meniscal tears resulted in no lasting pain relief or improved function.

Three months after the procedure, fewer than 15 percent of patients experienced at best “a small or very small improvement in pain and function,” effects that disappeared completely within a year.

As with all invasive procedures, the surgery is not without risks, infection being the most common, though not the only, complication.

Furthermore, the panel added, “Most patients will experience an important improvement in pain and function without arthroscopy.”

That, in fact, was the experience of a friend who, at about age 70 and an avid tennis player, consulted the same surgeon who had operated on my knee years earlier. My friend was told he had a torn meniscus that could be repaired arthroscopically, but he chose not to have the procedure. Instead, after several weeks of physical therapy, the pain had subsided, he returned to the court and has been playing without a recurrence for at least eight years.

“Arthroscopic surgery has a role, but not for arthritis and meniscal tears,” Dr. Reed A.C. Siemieniuk, a methodologist at McMaster University in Hamilton, Ontario, and chairman of the panel, said in an interview. “It became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn’t work.”

Arthroscopic surgery can sometimes be useful, he said, citing as examples people with traumatic injuries and young athletes with sports injuries. My son Erik is a case in point. When he was 23, Erik was playing basketball when he sustained a rupture of the anterior cruciate ligament in one knee that was successfully repaired arthroscopically. He’s been playing tennis and basketball on that knee without pain for the last 24 years.

The panel noted that about one-quarter of people older than 50 experience knee pain from degenerative knee disease, a percentage that rises with age. Arthroscopic procedures for this condition “cost more than $3 billion per year in the United States alone,” the report stated, suggesting that it was a near-complete waste of money.

Other common interventions include steroid injections into the knee. These can reduce painful inflammation, but if used repeatedly, steroids can speed the development of arthritis in the joint. A study published in May in JAMA by researchers at Tufts Medical Center found that the injection of a corticosteroid every three months over two years resulted in greater loss of knee cartilage and no significant difference in knee pain compared to patients who received a placebo injection.

The value of the other procedure I had, injections of hyaluronic acid (Synvisc and Monovisc are common brands), has somewhat better research support for patients with knee pain. One large study, published last year in PLOS One, included more than 50,000 patients treated with one or more courses of these injections and compared them to more than 131,000 patients who had no injections.

For those who underwent five or more courses, the injections delayed the average time to a total knee replacement by 3.6 years, whereas those who had only one course averaged 1.4 years until knee replacement, and those who had no injections had their knees replaced after an average of 114 days.

Dr. Siemieniuk conceded that treatment for degenerative knee arthritis can be “frustrating for both doctors and patients” because there is no clear answer as to what will help which patients.

Until there is better evidence, he suggested the following approaches that are known to help keep many patients out of the operating room.

• If you are overweight, lose weight. The more you weigh, the more pressure on your knees with every step and the more they are likely to hurt when walking or climbing stairs.

• Pay attention to the activities that aggravate knee pain and try to avoid those that are not essential, like squatting or sitting too long in one place.

• If the pain is bad enough, take an over-the-counter pain reliever like acetaminophen (Tylenol and others) or an NSAID (nonsteroidal anti-inflammatory drug) like ibuprofen or naproxen.

• Probably most helpful of all, undergo one or more cycles of physical therapy administered by a licensed therapist, perhaps one who specializes in knee pain. Be sure to do the recommended exercises at home and continue to do them indefinitely lest their benefits dissipate.

• Consider consulting an occupational therapist who can teach you how to modify your activities to minimize knee discomfort.