Thursday 23 November 2017

Dear Dr Nina: My brother is making my elderly parents' life a misery

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Photo posed

Nina Byrnes

Our resident GP answers your medical queries.

Q. I am worried about my elderly parents. My older brother, in his forties, has recently moved back home after what he describes as a nervous breakdown and he is making their lives a misery. He hangs about the house all day expecting my parents, who are in their 80s, to cook, clean and act as his chauffeur. He never lifts a finger to help them and he often loses his temper at them and blames them for his life being such a mess as he is unemployed and never really worked consistently. We don't know anything about this breakdown, but from what I know of him it was self-diagnosed and he has not been for any professional help, and refuses to do so. I want to talk to my parents' GP to let him know what is going on so he can advise them as they listen to him. What do you think?

Dr Nina replies: It sounds like your brother may indeed be suffering from a mood disorder and it is important that he gets the help he needs. It is also most important to ensure that your parents' safety and wellbeing are addressed also. There is no way of forcing someone who is depressed to see a doctor or to get help. One of the best ways to achieve this goal is to understand what is going on, to be there to listen and to encourage them to seek help themselves.

We all suffer low mood from time to time in the same way we all have days where we feel extra happy. Low mood becomes depression when the symptoms are pervasive - being present daily for at least two weeks. There are eight main symptoms: feeling sad, low energy, poor concentration, disturbed sleep (excess fatigue or broken sleep), lack of interest or social withdrawal, feelings of guilt or low self-worth, physical aches or upset, feeling life isn't worth living. If five or more of these symptoms are present a diagnosis of depression is likely. Depression can occur after a major life event such as bereavement or can happen with no obvious cause. Whatever the reason for depression it's important to realise that it is a treatable condition and does not need to be endured in silence.

It may be that your brother is afraid of the diagnosis. Despite huge media campaigns about mental health, there remains a stigma attached to depression. People who are depressed often end up socially isolated and this makes improved mood less likely. Many people are also afraid of what the treatment might involve and so don't approach a health professional about their feelings. The fact is that treatment for depression has improved greatly over recent years and it can be tailored to each individual's personality and needs.

Encourage him to get out of isolation. In mild depression lifestyle change and psychological therapies have been shown to be as effective as medication. Exercise releases endorphins, which are natural feel-good hormones, and simply taking a daily walk, can help improve mood. Eating a healthy varied diet also helps. Caffeine and alcohol should be kept to a minimum as both have an adverse effect on mood.

Counselling and psychotherapy are invaluable in low mood. In more severe depression medication is usually required but should not be feared.

The most important factor in recovery from depression is social contact. Those who talk to family, friends and health professionals fare much better than those who suffer in silence. Your parents' GP can be a source of help. It is essential that they are safe in their own home so if your brother is emotional or violent this needs to be addressed.

It may be best to let your parents know that you want to talk to their doctor. If you talk to the GP without their consent he/she cannot discuss their file with you. It also makes it more difficult to raise the issue of your brother with them as they may wonder how the information was received. It is always best that in families issues are communicated openly and I wonder is starting with your brother the best way in this instance.

What are the safe upper limits of caffeine for a healthy adult and are there any conditions that caffeine makes worse?

Caffeine has a number of effects on the body. It increases heart rate and alertness. This can lead to a feeling of anxiety or jitters, racing heart, difficulty sleeping, headaches, dehydration or dizziness. As caffeine is a drug you do develop tolerance to it. This means that over time you may need more caffeine for the same effect. If you are used to ingesting caffeine and you stop it suddenly you may experience withdrawal symptoms such as drowsiness, headaches, irritability, nausea and vomiting. Ingestion of large amounts of caffeine may reduce calcium absorption increasing the risk of osteoporosis. It has also been linked to the development of fibrocystic breast disease.

A caffeine intake of over 500mg daily is considered high and may have detrimental health effects. A single shot of espresso has 40 to 75mg of caffeine. Remember that a large shop-bought coffee may have three or more of these. Tea has 14 to 60mg per cup. Energy drinks contain 12mg per standard can. A bar of chocolate has about 45mg. A can of energy drink has about 80mg of caffeine. Safe caffeine limits in children have not been established but the American Academy of Paediatrics advises that young children shouldn't drink caffeine regularly at all and adolescents shouldn't ingest more than 100mg daily.

The World Health Organisation has expressed concern about the effects of high caffeine intake on health. High caffeine drinks are not recommended for children or pregnant or breastfeeding women and in the UK drinks are labelled with this warning.

Caffeine provides no health benefits and is not necessary in a normal diet. However as in all things if you do ingest it, moderation is key.

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