The changes that occur in life as we age such as an increases in medical problems, the loss of loved ones and an increase in isolation can often lead to depression. Depression is no laughing matter as 15 percent of the senior population suffers from this debilitating disease. Sure it’s normal to feel a little blue now and then, but if you are feeling down in the dumps for more than a couple weeks straight it may be time to get help.

The signs of depression in the elderly are often overlooked because as a person ages these behaviors are more likely to be dismissed as crankiness or grumpiness. In addition, confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood disorders and changes can be caused by medicines the elderly may take for high blood pressure or heart disease.

It is important to remember that depression can happen at the same time as other chronic diseases so it can be difficult for a doctor to make an accurate diagnosis. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to a depressed state of mind. These include; Parkinson’s disease, stroke, heart disease, cancer, diabetes, thyroid disorders, Vitamin B12 deficiency, dementia, lupus and multiple sclerosis.

Depression does not have to be a normal part of aging and if you seek treatment early you are more likely to make a quick recovery. There are many steps you can take to overcome the symptoms of depression, no matter your age or the challenges you face. Medication, therapy, support groups and even light therapy as well as a healthy diet and adequate exercise can help alleviate the symptoms of depression and get you on the road to recovery.

Your brain continues to change throughout life, so it’s never too late to make positive changes and experience the joy of your golden years. Learn to recognize the signs of depression and get the help you need.

Emotional symptoms may include constant sadness, irritability, hopelessness, feeling worthless or guilty for no reason, crying for no apparent reason, loss of interest in your favorite activities including sex and thoughts of suicide.

Physical symptoms may include trouble sleeping, low energy or fatigue, significant weight change (gain or loss), difficulty concentrating and memory loss. In Cupertino, seniors can find help at Live Oak Senior Day Services or for immediate help call the Bay Area Crisis Suicide and Crisis Intervention Alliance.

It is important for family and friends to watch for signs of depression in the elderly. Don't ignore the warning signs as serious depression can lead to suicide. Listen intently if a loved one complains about being depressed or has feelings of hopelessness. He or she may be reaching out for help.

Read the rest of this entry »

For Nancy King, the start of depression was the death of her husband when she was in her mid-60s. An on-the-job back injury for nursing aide Dee Miller caused her chronic pain in her late 60s, sinking her mood and erasing her desire to get out of the house. The deep blues arrived for Richard Janecek later in life, as medical conditions weakened the workaholic and left him unable to perform his usual physical activity.

Grief. Pain. Disability. They're among the primary causes of depression at late age for adults. Retirement, social isolation and chronic insomnia are other factors that trigger lower feelings among some elderly than they experienced when younger.

Fortunately for King, Miller and Janecek, they have received help as participants in studies at the University of Pittsburgh's Center for Late Life Depression Prevention and Treatment Research. It is one of the few academic centers focused on late-life depression nationally, with the National Institute of Mental Health recently awarding it a five-year grant totaling nearly $9 million to bolster its efforts.

Charles Reynolds, a psychiatry professor and director of the center, said its focus has evolved from treatment in the early years to equal emphasis on prevention now. Different studies search for methods to identify symptoms early and figure the right therapy, medication and other means to keep them from overwhelming individuals who have become vulnerable to what can seem like an inexplicable but paralyzing inertia.

"There are peaks and valleys, but no one told me the valleys would be so deep," said King, 82, who credits the center with giving her the coping skills to get over her bereavement-related depression.

Victims experience low energy and mood, lack of pleasure in activities, sleep disturbances, loss of appetite and other problems.

For Miller, a 68-year-old former nursing aide, a back injury led to problems at work, constant pain and reduced motivation she didn't recognize as depression because she'd never experienced it before. She came to the center for help last year and was revived by a program of counseling, temporary drug therapy and exercise.

"My body still aches, but I deal with it," she says now, noting that lots of social interaction with other residents of her senior housing complex also helps.

Jordan Karp, an associate professor of psychiatry and anesthesiology who is heading one of Pitt's new prevention studies -- one specifically focused on people troubled by pain -- said about one-fourth of older adults with chronic pain have major depression. Chronic lower back pain is worst of all for them, he said.

When older adults are in pain, they don't sleep well. When they don't sleep well, they might not take their medication properly. With all of those out of sync, they're more likely to be depressed.

"We're trying to break this cycle," which ties the pain and depression together, Karp said. "You have to treat them as linked conditions."

Reynolds said depression is rarely an isolated condition among the elderly, but "amplifies the disabilities that exist otherwise in old age."

Thus, the rate of depression among people over age 60 is estimated to be between 20 and 30 percent in long-term care settings, where patients or residents would presumably have physical afflictions limiting them. In the general community, Reynolds said, no more than 3 percent of people in the same age range are presumed to have depression.

Janecek said finding the right drug was crucial in his case to recover from his low moods resulting from physical ailments. Cancer treatment, knee replacement and other maladies left the former sheet metal worker, now 78, unable to care for animals and do other physical labor in the way he had been accustomed.

"Richard was depressed because he couldn't accomplish as much at 78 as he had at 68 or 58," said his wife, Karen.

George Niederehe from NIMH called such tales "the story of late life. ... It's rare to find people age 75 and older (with depression) who don't have some other combination of illnesses that complicate the picture."By GARY ROTSTEIN, Pittsburgh Post-Gazette

Read the rest of this entry »

Psychiatrist Dr. Suhail Khan said in a press conference on the side of the seminar that depression was spreading more — but not exclusively — among people who had passed their 40s. Depression, he said, could also be found among people who were against the status quo and were not adhering to social norms. In addition, it can be found among innovative thinkers who have been distinguished in the music and art sectors.

Khan said that consulting a psychiatrist was a major problem in many societies: “It has been a major concern for doctors in the Kingdom, who are also expressing concern about the legal issues related to treating patients.”

Asked about the addiction of anti-depression drugs, he said that not all anti-depressants were addictive. Instead, only medications that help people to sleep are likely to cause dependency. Commenting on the competition between drug companies, Khan said it was a good competition that aimed at minimizing side effects of medications. “Scientific research is generally in the advantage of human beings, and in the end the restrictions of the Saudi Food and Drug Authority are even stricter than those implemented in the US and Europe,” explained Khan.

New studies, he said, had revealed that people suffering from depression sometimes delayed their consultation by 10 years, which tends to mark a real threat to the social well-being of patients. Among the main indications that can mark depression are losing the ability to feel pleasure, sleeping difficulty, negative thinking, anxiety, not willing to eat, hoping for death, or attempts to commit suicide.

Dr. Osama Al-Ibrahim, general supervisor at Al-Amal hospital for psychological and mental heath, said that depression tended to affect both the victims and their families. According to a Saudi study conducted in Alkhobar in the Eastern province, some 33 percent of patients visiting psychiatrists suffer from mental illnesses that include depression and anxiety. However, only eight percent of them have been given the right diagnosis.

In Riyadh, on the other hand, 30 to 40 percent of outdoor patients suffer mental disorders, but the majority of them have not been given the right diagnosis. According to the same study, in the central region 18 percent of adults suffer from mental disorders that can be of medium to minor degrees.

In an op-ed published in Al-Watan newspaper, Saudi businessman Abdullah Dahlan stated that there were half a million patients in the Kingdom suffering from some form of physiological disorders who have seen a doctor. In addition, there is an unidentified number of patients who have not been given the diagnosis or even seen a doctor. People with psychological disorders tend to consult some 21 hospitals and 100 clinics.

Read the rest of this entry »

People who suffer from migraine headaches also run a higher risk of developing clinical depression, new Canadian research says. According to Reuters, scientists at the University of Calgary found that 22 percent of the 15,000 study participants who suffered from migraines also experienced depression over the course of the 12-year study.

That means participants with migraines were about 80 percent more likely than people without migraines to develop depression. This statistic held true even after adjusting for other characteristics like age and sex.

Led by Geeta Modgill, the team monitored the participants between 1994 and 2007, checking in with them every two years. Because of their findings, Modgill told Reuters that people who suffer from migraines ought to be aware of the signs and symptoms of depression as well.

And the link between the conditions may even be a two-way street, she said. People with clinical depression were found to have a higher risk of developing migraines during the study, though researchers were quick to note the finding “could have been due to chance.”

Overall, people with depression seemed to be 40 percent more likely than those without depression to develop the painful headaches. The evidence was not as strong, however, and the relationship all but disappeared when researchers adjusted for influences like stress and childhood trauma. While the study was unable to determine a cause-and-effect link between the two conditions, Modgill said there seemed to be something at play. “Something is going on here,” she said.

Read the rest of this entry »

Stigma and ignorance are the biggest challenges for people suffering from depression, says an Oakville teenager. Despite having depression and even attempting suicide, Rita (not her real name) says she is a normal person. “People see you differently. They don’t see you as the people they know, but as a pity party,” she said.

“We’re normal people. We have hobbies, we like different things, we own a dog or a cat. People need to stop thinking depression is everything about us. Depression is a little part of me.”The 17-year-old spoke to The Oakville Beaver on condition of anonymity. She wants to reduce the stigma and raise awareness of mental health issues and promote a charitable event being led by Oakville’s Frank Zamuner.

Zamuner will be doing his third annual Swim for Mental Health at Appleby College Nov. 24-26. This year’s event, so far, has reached $22,000 in donations, which will help pay for upgrades to a seclusion room at Oakville-Trafalgar Memorial Hospital’s (OTMH) emergency department, where children often go when they arrive for a mental health emergency.

Rita graduated high school last year but is now improving her grades for university. Now at the third high school she has attended, the road to depression was a long one, she admits.

Recalling Grade 5, Rita said, “I loved school, but I found it difficult to find friends,” she said. “I didn’t seem to mesh. I felt (I was) the odd one out.”She got along better with adults and though she had a few good friends, she said she was bullied in school.

Depression struck in Grade 7, when things got tougher. She was in a small grade group at her school with a lot of gossip going around. As the rumours increased, her grades decreased.

At the suggestion of her teachers, Rita received tutoring for her schoolwork, but that did not solve the conflict with her tormentors at school. She would come home in tears, but when asked about it by her mother, she said nothing.

By Grade 8, she said she was sent to a psychologist. That was after her parents learned of her unhappiness at school and the  bullying she faced despite efforts by adults to resolve the problem.

She stayed at the school until Grade 9, but when the psychologist first mentioned the word depression, her parents took her out of the school, she recalled. At first, the transition to a new school was easy. Rita made friends easily, but soon learned there was a social order at this school just as in the previous. “So much is focused on material things for the level you were at, I didn’t understand it,” she said.

Soon after a break up with a boyfriend, rumours began to swirl and again she began losing friends. “I couldn’t understand it. I felt like, why can’t I mesh with the people who are in my area and the same age? Why can’t I fit? Am I that different? No one accepts me,” she said.

By the second semester in the new school, she began struggling with her grades again. By Grade 10 she said she developed an eating disorder and the already petite girl weighed only 90 pounds.

She thought things would improve in time and, as a coping mechanism for her depression, put  bad thoughts away in an imaginary box on a shelf. The box soon filled and in Grade 11, Rita was hospitalized after contemplating suicide.

In the middle of a cold winter night, she snuck out of her house and walked to Lakeshore Road, thinking she would jump in front of a moving car. She contemplated it for three hours. At 6 a.m. she went home.

“I didn’t want to give people  what they wanted,” she said of deciding to return home, “that I was the weird girl, that I never meshed and I never would so I took the easy way out. I don’t like to give people the satisfaction that I failed.”

She was taken to a nearby hospital and stayed there through the weekend and released on the following Monday as a low-risk case. By this time, she was cutting herself and, later that same school year, overdosed on pills at home.

She was taken to hospital, this time as a serious case. She believes she was treated poorly in hospital and was then institutionalized for a month and a half with others in similar situations. When she returned home, she learned she could not complete her schoolwork to pass the semester, so it had to be repeated.

That summer she tried to make up a lost credit with a school program abroad. During the trip, she told her friend about her experience with depression. Soon after other students found out and then the school administration did too.

Though she had the go-ahead and the recommendation of doing this school program from her psychiatrist, she was forced out of the course and returned home. “So many people are so scared when they hear the world depression they think this person is going to kill themselves right now, right next to me,” she said.

Throughout her journey with mental illness, she said she has been called many things. “You’re being called crazy, being told you’re a problem, that you are just putting on a show, you’re just acting like this because you want to,” she said through tears.

“No one wants to be depressed. No one wants to try to kill themselves. Being told that, I don’t understand it. It shouldn’t happen.”She said mental illness cannot be ignored. She said she has witnessed depression at every single school she’s attended and, yet, it is swept under the rug.

“It doesn’t happen to just a small group of people,” she said. “It happens every day, but no one talks about it because they don’t want to be labelled crazy. That’s why people don’t talk about it, but people need to talk about it.”She said having a mental illness is not the person’s fault — not of their choosing.

“Stigma is still there. I want to change that. As soon as people hear mental health issues — red flag,” she said. “People have the stigma or fear, but they also choose to be ignorant because they’re so scared. They don’t want to learn about it.”She said the road to change is not just through children, but through parents and the entire family. Children learn from their parents, she explained.

Rita is much better now, but admits she is still a work in progress. “I want people to know, if they meet me — ask anyone I know — I’m a happy person. I am myself. Depression isn’t me,” she said. “I’m still planning my life. I’m not saying because I have depression I can’t do any of the things I wanted to do. I know I’m going into university next year. I know.”

Read the rest of this entry »

The concept of "midlife crisis" has been a staple of popular culture for years, and yet the best recent research seems to suggest that it might not exist. This doesn't mean that people -- your husband most likely included -- don't go through rough times in the middle years of their lives; it only means that there does not appear to be a classic condition unique to middle age, nor does arriving in middle age strongly predict the development of a "crisis."

On the other hand, depression is a well-recognized and dangerous disease condition that affects up to a quarter of the U.S. population at one time or another in their lives. Men appear to become more vulnerable to depression as they age. You can tell if your husband has depression if he has the symptoms of depression, which include:

• Feeling down, sad, or blue most of the day

• Losing interest in things he used to enjoy

• Sleeping too much or too little

• Eating too much or too little

• Suffering emotions ranging from low self-esteem to illogical guilt

• Feelings of hopelessness and helplessness

• Difficulties thinking or concentrating

• Fatigue or lack of energy

• Thoughts or plans of suicide

If your husband is demonstrating these symptoms, and if they are interfering with his ability to function, then he has major depression. But this doesn't address the question of why he has these symptoms, and this goes back to your question about a midlife crisis.

There is no way I can tell from your very brief question the degree to which circumstances in your husband's life are driving his emotions, and this is an important point. At one extreme, your husband may have one of the rare depressions that seem to come out of nowhere, meaning that his depression is out of all proportion to the circumstances in his life. This scenario becomes more common the more often a person has been depressed in the past. Said differently, each episode of major depression seems to sensitize the body and brain so that a person becomes depressed over smaller and smaller things with the passage of time.

On the other hand, your husband's depression might be a reaction to stressors and circumstances that would make almost anyone upset. Has he lost a job recently, or suffered a real blow to his self-esteem or health? Has he lost people close to him? All these factors can powerfully drive depression.

Your comment about him thinking the marriage is over and feeling worthless strikes me as especially suggestive. If the marriage is sound, and a source of comfort to both of you, his feelings are classic symptoms of depression. But sometimes people feel this way (i.e. marriage over and worthless) when they have done something they are ashamed of, but can't confess. Not knowing your situation, I have no idea which scenario more closely approaches the truth.

Although I can't give specific advice in this column, people struggling with depression are almost always best helped by seeing a trained clinician. In addition, from your question it does not seem to me that you have a clear sense of why your husband is feeling the way he is -- assuming that there is a "why" for his emotions. Often it can be very healing -- although also painful and not without risks -- to find a way to help him actually talk about what is going on. Coming clean, if there is something he needs to tell you that he hasn't, can be a remarkable healer.

Read the rest of this entry »

Cases of clinical depression have jumped at least 10 per cent per month since September due to anxieties over unpaid leave and other job-related issues, according to physician Yang Tsung-tsai. The bleak economic times are taking a toll on Taiwan's nine-to-fivers, said Yang, a mental health specialist at the Cardinal Tien Hospital.

Since this September, the hospital's number of clinical depression patients has increased by more than 10 per cent every month. Most new patients are male, reporting habitual insomnia, anxiety, depressed affect, and autonomic nervous system disorders. Moreover, male patients appear to experience greater symptoms than women do, said Yang, who cited the tendency of male patients to display listlessness. Blood tests of male patients show low white blood cell counts and low levels of male and thyroid hormones.

Yang also said that many of the new patients are from tech industries or the financial sector. In surveys, patients linked their depression to the same key causes: the furlough situation, the fear of being fired, the situation of having been fired, the lack of a paycheck, or the closing of a business.

Some patients are graduates of big-name schools like National Taiwan University and National Tsing Hua University. These are persons accustomed to success and who are disappointed with their progress in today's job market, said Yang.

He noted that patients seek treatment only after a bout of self-medicating through alcohol use and reckless spending. Often, it's the family that pressures a patient into a clinic. Yang suggested alternative coping mechanisms such as the development of second and third skill sets and positive thinking.

Read the rest of this entry »

A recently published multi-center pilot study supports use of deep brain stimulation (DBS) for major depressive disorder for people who have not responded to more traditional modes of treatment.

The study, conducted at three research facilities in Canada, is published online in the Journal of Neurosurgery.

Researchers determined that DBS therapy, targeted to an area of the brain known as Brodmann Area 25, provided noticeable improvement in depression symptoms and increased overall quality of life in patients who typically don’t respond to treatment.

“The reduction in depression scores is clinically significant as these patients had previously tried multiple medications, psychotherapy and/or electroconvulsive therapy (ECT) without success,” said Andres Lozano, M.D., neurosurgeon at Toronto Western Hospital, author of the paper and a primary investigator in the study.

In deep brain stimulation, electrical impulses course through electrodes implanted within the brain, where they are thought to affect brain cells and neurochemical transmitters. It has been used effectively for some other conditions such as Parkinson’s disease and essential tremor, but has not yet been approved by the Food and Drug Administration (FDA) for treating depression.

The study enrolled 21 patients who on average had suffered from depression for 20 years, had tried in excess of 16 depression medications and were considered disabled or unable to work at the time of enrollment.

Investigators discovered that at one year, 62 percent of all patients in the study had a 40 percent reduction in symptoms and 29 percent had symptoms cut in half as measured against their baseline.

“To see 62 percent of the patients in this study respond at one year gives us hope that this research may lead to a therapy for this hard-to-treat patient population,” Lozano said.

Patients in the study were also evaluated using a Clinical Global Impression of Severity (CGI-S) rating scale that measures the severity of their illness. Before DBS, 70 percent of the patients were categorized as severely or extremely ill. After 12 months of DBS, over 80 percent of the patients experienced improvement and none of the patients were rated as severely or extremely ill.

Additionally, eight of the study patients returned to daily life activities such as work, school and sustaining relationships with family and friends, and two patients were considered to be in remission.

“These findings are significant as they confirm the basis on which we established the BROADEN pivotal study,” said Rohan Hoare, Ph.D., president of St. Jude Medical Neuromodulation Division. “These results add to the growing evidence suggesting that DBS therapy may help patients who currently don’t have an adequate treatment option in managing severe depression.”

Read the rest of this entry »

A FOOTBALLER was plagued with depression and embarrassment after rumours about his fiancée’s alleged affair with his team-mate hit the national headlines, an inquest heard. Horden-born Rushden and Diamonds goalkeeper Dale Roberts was also nervous about returning to the pitch after months of feeling lethargic as he was recovering from a leg injury and consigned to the bench.

Manchester City star Adam Johnson, who played youth football with Dale as they grew up in Easington, gave evidence at the inquest into the 24-year-old’s death at Northampton Coroner’s Court yesterday.

Dale, who started as a trainee with Sunderland before moving to Nottingham Forest and then Rushden and Diamonds, was found hanged at his home in Rushden, Northamptonshire, on December 14 last year.

The England star, who was one of Dale’s closest friends, said the goalkeeper was upset following unsubstantiated rumours about his fiancée, Lindsey Cowan, sleeping with Paul Terry, the elder brother of England captain John Terry.

The inquest heard that Dale had introduced his fiancée to Paul Terry and he would occasionally sleep over on the couch at the flat they shared. They had been good friends before rumours about the infidelity emerged in the press and Terry was subsequently transferred from Rushden to Darlington, the inquest was told. The former Middlesbrough winger said: “I’m not sure he could deal with the embarrassment the story caused him.

“There’s no way Dale would have gone to the press, no matter how upset he was.”Isabelle Roberts, Dale’s mother, said her son told her he was worried about the reaction from the public.  “I believe this was because he was worried what people thought about him and what was said in the press,” she said.

The inquest heard that Roberts was found dead on the day he was due to return to goalkeeping duties after suffering an injury while playing for the England C team in September last year. He had been prescribed anti-depressants after feeling down and missing training sessions. On the night before his death, Dale received a text message from manager Justin Edinburgh telling him he would be playing the next day, which caused him some anxiety. “He said he was nervous and just wanted to be on the bench,” Miss Cowan said.

She and Roberts went through their normal routine the next day and she left for work at around 7.45am. It was the last time she saw him alive. During the day she received a text message from him that said: “I’m so scared about playing tonight.”

Returning a verdict of suicide, Coroner Anne Pember said: “From the evidence I’ve heard and the mode of his death, I believe that, at a time when he was feeling low and depressed, he no longer wished to live.

“I return a verdict that he killed himself.”Speaking after the inquest, Mrs Roberts stood with her arm around Miss Cowan and her husband George beside her as a statement was read on their behalf. The statement said: “We wish to thank everyone for their help, support and kindness over the past year.

“It’s been a difficult time for everyone concerned but the love and support we’ve been shown has helped us during this difficult time.”

Read the rest of this entry »

Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a few days. Depression is common and should be taken seriously, but many suffering from depression need treatment to get better.

According to the National Institute of Mental Health, a component of the U.S. Department of Health and Human Services, men and women both can be affected by depression and many with a depressive illness never seek treatment. People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms will vary depending on the individual and their particular illness.

Anxiety disorders , such as post– traumatic stress disorder, obsessive– compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression. People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism, or military combat.

People with PTSD often re–live the traumatic event in flashbacks, memories, or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a recent NIMH funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.

Alcohol and other substance abuse or dependence may also co–occur with depression. In fact, research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.

Depression may cause feelings of exhaustion, helplessness and hopelessness. It may be extremely difficult to take any action to help yourself. But it is important to realize that these feelings are part of the depression and do not accurately reflect actual circumstances. As depression is recognized and treatment begins, negative thinking will fade.

NIMH advises there is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors. Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior appear to function abnormally. In addition, important neurotransmitters– chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.

Even the most severe cases of depression are treatable. As with many illnesses, the earlier that treatment can begin the more effective it is and the greater the likelihood that recurrence can be prevented. The first step to getting appropriate treatment is to visit a doctor.

Certain medications and some medical conditions, such as viruses or a thyroid disorder, can cause similar symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview, and lab tests. If the doctor can eliminate a medical condition as a cause for depression symptoms, they will refer the patient to a mental health professional.

If you are feeling depressed, please seek help. There are numerous avenues you can take to feel better. Contact your doctor – depression is treatable and seeking help is a sign of strength.

Eisenhower’s Department of Behavioral Health, located on the 13th floor, is open from 7:30 a.m. to 4:00 p.m., Monday – Friday (excluding holidays). They may be contacted by phone at (706) 787-3143/8134/3780. For appointments, self-referral patients may call for an intake appointment. During duty hours emergencies may come in on a walk-in basis. Patients are triaged by level of emergency and then seen on a first come, first served basis. Providers can refer patients for evaluation and treatment through consult. After duty hours emergencies should go to Eisenhower’s Emergency Room for care. All military medical beneficiaries may receive services through this department. Based on provider availability, nonactive duty clients may be referred to civilian providers.

Read the rest of this entry »