Confronting Depression in Older Men with Bleeding Disorders
Pain and isolation can lead to depression—but help is available.
Few who didn’t know him well would have pegged Barry Haarde as depressed. The 52-year-old Houston area resident, who had hemophilia and was HIV-positive, was a tireless “blood brother,” raising money and awareness through a series of cross-country bicycle rides. He was formerly on the board of the Lone Star Chapter of the National Hemophilia Foundation.
But in February 2018, Haarde died by suicide. “It was a shock to our community,” says Debbie de la Riva, a licensed counselor and former executive director of the Lone Star chapter. “We couldn’t believe someone so heroic was in this much pain.”
Haarde wasn’t unique as a middle-aged or older man with a bleeding disorder who is also, painfully and quietly, dealing with depression or suicidal thoughts. Research shows that depression is a significant issue for people with bleeding disorders, particularly among those who have dealt with the condition for many years.
Why Older Men?
There’s a good reason more older men with bleeding disorders have depression than their younger counterparts, says Dana Francis, MSW, a social worker in the adult hemophilia program at the University of California San Francisco Medical Center. “Because the treatment for hemophilia has gotten so much better over the last 30 years, older men—who may have missed out on the benefits of those treatments—are often in worse physical shape,” he says. The longer-term effects of hemophilia, chiefly chronic joint pain and other types of pain, can be a blueprint for depression, Francis says.
Plus, many older men contracted HIV or hepatitis C in their younger years. Though these conditions can now be effectively managed (in the case of HIV) and even cured (hep C), the stigma of these diseases follows men who may have developed them. For some, their condition, or multiple conditions, caused them to shy away from relationships, both romantic and otherwise. The result: emotional and physical isolation.
Haarde’s sister, Emily Cobb, says her brother’s physical pain had taken a toll on him. “He had severe neuropathy in his feet, and it was so bad he was barely able to walk. He had stopped riding his bike months before,” Cobb says. Today, she’s hopeful that Barry’s story will help bring attention to the problem of depression in the bleeding disorders community.
De la Riva has advice for loved ones of men who might be depressed: Educate yourself. “I took a ‘Mental Health First Aid’ course, which teaches people how to recognize depression and signs of possible suicide,” she says. De la Riva urges people in the bleeding disorders community to take this course or something similar. “Research shows a strong support system is crucial for recovery from depression,” she says.
As for men themselves, Francis promotes connection: “Try to engage with people more. Join a club or go to a support group meeting.” Or, he says, reinvigorate the friendships and connections you already have. Consider volunteering. “Getting out of your own head and helping others can be a big boost,” Francis says.
Also, discuss with your doctor if an antidepressant medication might be useful—and safe. Despite some warnings about antiplatelet activity with selective serotonin reuptake inhibitors (SSRIs), most antidepressants, including SSRIs, can be taken safely, says Craig M. Kessler, MD, a hematologist and director of the coagulation lab at Georgetown University. That said, some types of antidepressant medications can have interactions with anti-retroviral drugs for HIV. For those patients, Kessler suggests asking a psychiatrist or primary care doctor about SSRI alternatives.
If your primary physician or a psychiatrist prescribes medication, be sure he or she monitors your response to the medication and its effect on your symptoms, says Laurel Pennick, MSSW, LCSW, a social worker at the Arizona Hemophilia and Thrombosis Center in Tucson. “Many patients are prescribed antidepressants by their primary care physician but once the patient receives the medication, no one monitors him or her to see if it works or not,” Pennick says. “A mental health professional can notice behavior changes and refer the patient back to their doctor for reassessment, if necessary.” A combination of medication and counseling or talk therapy has been shown to be most effective, Pennick says.
“Suicide is preventable,” says de la Riva, and watching for warning signs—such as a lack of interest in activities a person normally enjoys—is important for everyone to be aware of.
• For details about “Mental Health First Aid” courses and to find one near you: mentalhealthfirstaid.org
• If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at: 800.273.8255
Know the Warning Signs
Depression symptoms can vary, but the following common clues should not be ignored. If you or a loved one experience these flags, speak with a doctor.
• Overeating or not eating enough
• Sleeping all the time or not enough
• Lacking concern for one’s appearance or environment
• Experiencing a general lack of interest in life
• Isolating oneself emotionally or physically
• Feeling tired all the time
Source: National Hemophilia Foundation, HemaWare