Ask the Doctor: Recalling Painful Memories; Depression Causes; Sundowning

Q: I’ve heard that people often repress painful memories, but that with therapy or hypnosis they can recover those lost memories. Is that true?

A: There is a common misconception that traumatic memories, such as childhood abuse, are likely to be repressed—locked away somewhere an individual’s subconscious. It’s viewed as a means of survival in that the painful memory won’t get in the way of a person’s mental health and emotional development. However, research shows that most child abuse victims and other survivors of trauma actually remember those events very clearly.

Most mental health experts, including a consensus of the American Psychological Association, say that people who were abused as children or who endure other painful and traumatic situations usually remember all or part of what happened to them. But because they may not be able to understand or explain what happened, or because discussing the events is emotionally wrenching, these individuals often choose not to share those memories.

Q: Does depression usually stem from a specific cause or can someone become depressed for no apparent reason?

A: In many cases, depression can be connected to an experience such as the loss of a loved one or the onset of a chronic disease. At the same time, depression often has no obvious trigger. But it’s important to understand that there is always a “cause” for depression. Looking for a “reason” why a person might be depressed isn’t always helpful. In fact, when people can’t think of reasons that justify their feelings, they may be less likely to seek treatment or talk about what they’re going through. It’s not uncommon for an individual who has friends, a loving family, a good job, good health, and other markers of a happy and successful life to try to mask feelings of sadness and hopelessness.

The truth is that depression often develops due to a combination of causes. You may be genetically predisposed to the condition. There may be environmental factors or other contributors beyond your control. Though we are still learning much about the brain chemistry involved with depression, there are some established facts. An imbalance of certain chemicals called neurotransmitters can contribute to depression. No one is immune.

Q: My wife is in the early stages of Alzheimer’s disease and sometimes shows signs of agitation in the evenings. Her doctor called it “sundowning.” Is this common and can it be prevented?

A: Sundowning is very common in people with Alzheimer’s disease. It’s marked, as you say, by behavioral changes including agitation, increased confusion, impatience, and anxiety that begin in the late afternoon or evening. These changes, which can be troubling to loved ones, may be the result of fatigue at the end of the day or changes in a person’s circadian rhythms. Lower light levels later in the day may contribute to feelings of confusion and anxiety. We still don’t know exactly what causes sundowning, but there are some ways to address it.

Check for signs of physical discomfort. Are her bed and wheelchair comfortable? Is she getting up and moving during the day? Is she getting enough fluids during the day to keep her hydrated? You may also want to review her medications with her doctor. Could the dose or timing of certain medications be adjusted to see if that makes a difference? Other approaches may be helpful. Reducing bright lights and other stimuli may help. That may require fewer visitors at one time or changing her schedule so that stimulating activities, such as bathing or doctor visits, don’t occur late in the day.

Caring for a spouse with Alzheimer’s is a challenge. As much as possible try to be reassuring and patient during the difficult times.

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