ASK AN EX­PERT

Health-care pros tell us their pa­tients’ mostasked ques­tions. This is­sue, our ex­perts talk about de­pres­sion, os­teo­poro­sis and in­som­nia.

Canadian Living - - Contents - DR. VA­LERIE TAY­LOR, PSY­CHI­A­TRIST-IN-CHIEF, WOMEN’S COL­LEGE HOS­PI­TAL, TORONTO; DR. SAN­DRA KIM, MED­I­CAL DI­REC­TOR OF THE CEN­TRE FOR OS­TEO­PORO­SIS & BONE HEALTH, WOMEN’S COL­LEGE HOS­PI­TAL, TORONTO; DR. RUTH HEISEY, CHIEF OF THE DEPART­MENT OF FAM­ILY AND COMMUNIT

Doc­tors dis­cuss de­pres­sion, in­som­nia and os­teo­poro­sis

Q

How do I know whether I’m de­pressed or just hav­ing an off week? Dr. Tay­lor says

“The ill­ness of de­pres­sion is dif­fer­ent from feelings of de­pres­sion in that there’s a sig­nif­i­cant im­pair­ment in terms of your abil­ity to func­tion. That is, your symp­toms cause dis­tress and in­ter­fere with your abil­ity to func­tion in day-to­day life—work­ing, par­ent­ing or so­cial­iz­ing—for at least two weeks. Symp­toms will rep­re­sent a clear de­vi­a­tion from your nor­mal pat­terns and may in­clude a sig­nif­i­cantly low mood; a change in sleep pat­terns, such as in­som­nia or over­sleep­ing; dif­fi­culty con­cen­trat­ing; a change in ap­petite; feelings of in­ap­pro­pri­ate guilt; or thoughts of self-harm. If you’re ex­pe­ri­enc­ing one or more of these things, ask some­one close to you for a sec­ond opin­ion—some­times fam­ily or friends are a bet­ter barom­e­ter than your­self—or take the PHQ-9, a free on­line as­sess­ment tool, at phqscreen­ers.com. If you’re con­cerned, sched­ule a visit with a men­tal-health pro­fes­sional.” Q

I frac­tured my wrist do­ing the most ubiq­ui­tous task. Do I need to worry about os­teo­poro­sis? Dr. Kim says

“A bone-min­eral den­sity test is rec­om­mended only for peo­ple aged 65 and older, un­less there’s a risk fac­tor, such as a his­tory of low­trauma frac­tures or pro­longed steroid use. Other in­di­ca­tions could in­clude a fam­ily his­tory of os­teo­poro­sis—in par­tic­u­lar, a par­ent who has suf­fered a hip frac­ture; hav­ing a med­i­cal con­di­tion as­so­ci­ated with bone loss, such as an au­toim­mune dis­ease; pre­ma­ture menopause [be­fore age 45]; and use of high-risk med­i­ca­tions, such as pred­nisone for in­flam­ma­tory con­di­tions. Whether or not you have one or more of these risk fac­tors, be sure to prac­tise good bone­health mea­sures: Eat a bal­anced diet with ad­e­quate cal­cium and vi­ta­min D, and en­gage in reg­u­lar phys­i­cal ac­tiv­ity and ex­er­cise. Check out fit­ness guide­lines at os­teo­poro­sis.ca. In ad­di­tion, the el­derly and those prone to falls should prac­tise fall-pre­ven­tion strate­gies and con­sider wear­ing a hip pro­tec­tor that may help cush­ion the im­pact from any falls.” Q

Is in­som­nia com­mon for menopausal women? What can I do to get back to sleep? Dr. Heisey says

“When menopause hits, hot flashes and night sweats caused by low es­tro­gen lev­els can wake women, who then may have dif­fi­culty fall­ing back asleep. In ad­di­tion, gen­eral anx­i­ety and life stresses dur­ing this time can hin­der sleep. The good news is that there are steps you can take to pro­mote sleep. Ex­er­cise, man­age stress and avoid al­co­hol and caf­feine—es­pe­cially in the late af­ter­noon and evening. Be­fore bed­time, ta­per off stim­u­lat­ing ac­tiv­i­ties such as read­ing emails and be­gin a wind-down rou­tine. Wear light lay­ers or a comfy mois­ture-wick­ing T-shirt to bed; keep your bed­room cool; min­i­mize screen­time and keep your smart­phone away from your night­stand; and in­stall black­out cur­tains in your bed­room. If prob­lems per­sist, your health-care provider may pre­scribe hor­mone ther­apy, an­tide­pres­sants or other med­i­ca­tions to help.”

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