Tuesday, August 12, 2008

August Blues: Depression

One of my patients painted the above picture
when he was struggling with depression.

I was fascinated with the use of colour and abstract design.

Why is blue associated with depression? The question was asked in the comments on the last post. I contemplated the possibilities and came to some inconclusive ideas. Blue is a cool colour and cold can make the skin take an unpleasant bluish hue. Illness and death also cause the body to become blue. No one at the hospital looks forward hearing "Code Blue" which is called over the intercom in the event of cardiac or respiratory arrest. Others associate blue with storms and rain. Blue is a peaceful and calming colour, but too much calm may cause melancholy.

I work with many depressed elderly people. Our Geriatric Assessment Unit admits patients with physical problems that are often compounded with moderate to severe depression. Treatment may be pharmaceutical or a combination of drugs and behaviour therapy. Many people respond to group activities, music or art therapy, spiritual care, exercise, pain management, or just having a routine to their day. Meals are taken in a dining room and patients forge friendships with each other that are often mutually beneficial.

Mental illness is poorly understood by many people yet its effects can ripple through generations of a family. A patient's daughter reported that her mother had been depressed for fifty years. She is now in her nineties and was recently started on a low dose antidepressant. Her daughter came to me and said,

"My mother just smiled at me and told me she liked the colour of my nail polish!"

She did not remember seeing her mother smile spontaneously and had not heard her give a compliment. How sad!

Our facility uses the short Geriatric Depression Scale (GDS) to assess a patient's mood and their response to treatment. A score above 5 indicates further assessment is warranted. A score greater than 10 is strongly indicative of depression. The bold responses are scored. Here are the questions. (The full test which includes thirty questions can be viewed here.)

Choose the best answer for how you have felt over the past week:

1. Are you basically satisfied with your life? YES / NO

2. Have you dropped many of your activities and interests? YES / NO

3. Do you feel that your life is empty? YES / NO

4. Do you often get bored? YES / NO

5. Are you in good spirits most of the time? YES / NO

6. Are you afraid that something bad is going to happen to you? YES / NO

7. Do you feel happy most of the time? YES / NO

8. Do you often feel helpless? YES / NO

9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO

10. Do you feel you have more problems with memory than most? YES / NO

11. Do you think it is wonderful to be alive now? YES / NO

12. Do you feel pretty worthless the way you are now? YES / NO

13. Do you feel full of energy? YES / NO

14. Do you feel that your situation is hopeless? YES / NO

15. Do you think that most people are better off than you are? YES / NO


  1. that is an interesting assessment--I do believe that Canada does a good job of working with mentally ill patients--I know some very good studies seem to come out of Canada. That painting was impressive--so many great talents struggle emotionally.

  2. That is a very expressive painting. Depression is a major issue that society tends to ignore. For so many, that low degree of a constant funk becomes their norm and they don't even know how depressed they are. So good that you facility screens clients well.

  3. Anonymous8:11 am GMT-4

    I'm not an abstract person, but this picture is very interesting. Great artist, I hope painting it gave her/him enjoyment.

    Great program the hospital has. Depression is more common then we really know, especially in our seniors. Little things like the outside garden, flowers and eating together can be huge for ones in a emotional state.

    The color blue - is this why the Toronto Maple Leafs don't do so great? Maybe they should consider changing their uniform colour - maybe to orange (lol)

  4. An interesting post on a sunject that is often swept under the carpet......my mother has suffered with depression all of her life.....she had medication for twenty years when the condition was often misunderstood. She is now frightened of taking any drugs....as you say the ripples affect the family......I never know how she will be from day to day.....and my poor father has had a dreadful time.............I thought about it long and hard, she has never had blue in her home.....

  5. That painting moves me. Depression has been a member of my family for at least three generations.

  6. I was thinking about my mom[96] the whole time that I was reading your post. She now lives with me after the regular rehab stay. She had a stroke April 07. I asked her doctor about the idea of a mild antidepressant, and I believe that it has helped tremendously. God bless you for the work that you do.

  7. The painting is wonderful at evoking a mood of how the painter felt.
    As for why blue--some of what you say really works backward. Code blue, for example, is derivative rather than causative.
    As for the body turning blue, yes--but that presumes the patient is Caucasian in ancestry. And blood, being red when oxygenated, is not good if it is blue--deprived of oxygen.
    But why that leads to itsblue's association with DEPRESSION. . .who knows?

  8. Anonymous3:15 pm GMT-4

    Your questionnaire left me feeling great! As your Grandmother would have said "for my age". I could truthfully say the opposite to all of your highlighted answers.
    Unexpected news can bring a swift downturn and fear can be devastating as we see in many present economical situations. I keep remembering my oncologist's question - "Are you afraid to die?" I didn't even have to think about it. "I'm not afraid to die but I don't want to."
    He then told me that he feels he loses more patients to fear than to cancer,
    Could be true?

  9. The painting is very interesting and at first I did not see any image in it but then as I looked I found the frightened looking face within the yellow center.

    This is a fascinating post and I'm sure is helpful to many with family members facing these aging diseases.

  10. Ruth,

    I have struggled with depression since I was a child. It is not severe, but moderate but it has always been part of my life.

    Brandon also suffers from depression. Like me, he only smiles if there is really something to smile about. Many things on your list pertain to Brandon. I think that it goes hand in hand with the OCD and the Asperger`s.

    Take care. I certainly have enjoyed your last two posts. Mental illness and depression is something that we all need to be aware of, for it will touch each of us either directly or indirectly.


  11. My daughter's doctoral dissertation (psychology) was on depression and coping skills and a whole lot of statistics. So I was very interested in this post...

  12. Beth- Our patients do get a good work up and good treatment in our health care system. It would be very expensive individually in the USA.

    Jayne- The screening tool is very simple and quick to give. Some people are always in a funk but can still function. Many of our patients have given up looking after themselves.

    Cheryl D- This patient paints a lot and brought his material in to the hospital. He hopes to have an exhibition sometime.
    The Toronto Maple Leafs...what can I say, but I remember when they won the Stanley Cup...a once in a lifetime event ;-)

    Cheryl- Many elderly are over medicated and fear how drugs make them feel. Hope your mum has a good doc. How hard for her and those who love her.

    Lynne- It is a member of most families but is often hidden well.

    KGmom- I know...the blue/depression link is obscure. I Googled it and came up with another obscure connection to Zeus, plus a connection to a play, George Colman's farce Blue Devils. (I know nothing of either story)

    Mom- I have seen many wonderfully brave people die of cancer, people with lots of fight and determination. And I see many fearful people live on and on. I have seen people who have endured many losses, like WW2 civilian survivors, who cope well and move ahead with their lives. Others struggle...

    Mare- Thanks for visiting and commenting. Your mother is fortunate to have you! It is surprising what a little medication does for some people.

    Ann- You are the first to comment on the face. Some people do not see it. I think the painting is superb.

    Mary- Brandon is fortunate to have understanding people around him. I hope he can overcome his challenges. His loving grandmother is a special gift.

    RW- Statistics are important, but of little interest to those who suffer depression. Our psychologist is such a help and is loved by the patients. Kudos to your daughter for her work and career choice.

  13. Thought provoking post here. I like the painting. Considering the person was depressed when they painted it, I find it interesting that they included such a sunny yellow color in the center of all that blue. It reminds me of sunlight reflected in a blue pool.

  14. Kathie- I asked about the mournful yellow face. Seems there is hope either vanishing or emerging. Art is so open to various interpretations. That is what makes it so interesting.

  15. I like the painting, especially the use of yellow which is interesting for someone suffering depression.
    Is it more prevalent in the 21st century? Do we have too many expectations of life? Have we lost the ability to cope?

  16. Some people with lifelong depressions haven't a clue what it's like to not be depressed. I love the follow-up visits after they start anti-depressants. Often I can tell as I greet them in the waiting room how well it's working by their outfit (a touch of bright color) or their hair color (newly highlighted perhaps). Here's part of a poem published in JAMA by a man after he started Paxil:

    I feel more like myself,
    a feeling that can hardly be true
    after 60 years of prowling
    outside the fence, with the gates
    locked, or scarier still, open,
    swinging and I would stand there
    paralyzed, afraid to step in
    my feet starved for affection
    and serotonin shooting itself
    in the foot each time a foot perked up
    and started to dance. But that can
    hardly be true, the way I feel today,
    so vividly myself, so grounded
    you might say the first draft is done.
    I'm in the process of revision.

  17. Mouse- I think depression is talked about more these days and the big drug companies have promoted the diagnosis too. I don't think we have more pressure than say, the generation who lived through the great depression and the world wars.

    Internist- I like your new ID. The poem is so true. Meds do have their place but I do believe other therapies need to be explored first or concurrently.


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