The final blow came from his heart doctor. After a checkup, he threatened to hospitalize Kai because of weight loss and the severe emotional withdrawal described by his wife. The cardiologist said that depression could be complicating Kai’s recovery. He gave Kai the name of a psychiatrist who specialized in treating older people and said the psychiatrist would call Kai at home if that was all right. Kai agreed. He didn’t want to be hospitalized.

Kai liked what the psychiatrist said when she called. She explained that the body and mind were inseparable, one affecting the other. Heart attacks are often followed by depression and depression affects health, she explained.“If a heart attack caused a foot problem which kept you from walking wouldn’t you get your feet treated?’’ she asked. “Well, the depression is keeping you from walking away from disabling feelings. It’s time to treat the depression and get on your feet again,” she told Kai.

After the psychiatrist visited Kai at home several times, Kai agreed to continue meeting with her at her office. She also worked with Kai’s cardiologist to adjust his medications and to develop an exercise regimen. Kai’ s memory lapses and confusion abated. Eventually, he and his wife joined a support group for heart patients and their spouses. They found out their experience wasn’t really unique.

It took a while for Kai to learn how to accept himself and his “broken” heart and to enjoy life once more. He also learned that lifetime habits do not change overnight. Work is a major force in the lives of many people. More than a source of income and social contact, it serves the ego and fills the days. Without work, people such as Kai, who have not developed other interests, become extremely vulnerable to depression.

Of course, Kai received a double whammy when he had a heart attack. The disability associated with serious illnesses, especially those prevalent among older people, and the medications used to treat them, can also contribute to depression.

Then, too, older people are often dealing with the death of a beloved person or the loss of a familiar home or way of life. Sometimes, there are too many losses, and unrelieved mourning evolves into a depression that is unshakable without treatment.

In many cases, psychiatric treatment will alleviate symptoms of derangement and confusion and thereby contribute to the older person’s ability to live at home rather than in a long-term care facility.

While it makes absolute sense for people of all ages to check the credentials of all health practitioners before embarking on treatment, it is particularly important that homebound patients, who have limited access to health-care providers, take extra care. Although it is rare, there have been cases of improper and inadequate treatment foisted on the homebound by disreputable practitioners.

Ask for referrals from your doctor, or check with the psychiatric department of a local university hospital or community mental health center, or contact one of the professional or consumer groups listed under Helping Resources. For information about other services devoted to the elderly, call your local and State governments.

Helping the Depressed Employee

Enlightened employers are recognizing that it pays to help _ depressed employees. They have learned that many depressed people turn to alcohol or drugs in misguided attempts to alleviate their pain. Untreated depression, alcoholism, and drug abuse become very expensive in terms of lost productivity and accidents, so many employers are encouraging workers to get needed help.

In fact, the trend is growing among business, government, and educational organizations to provide onsite employee assistance programs (EAPs) that offer mental health, alcohol, and drug abuse counseling or, when appropriate, referral to outside resources. EAP services are free and convenient, yet many employees do not take advantage of them. Some only need encouragement from a supervisor to seek help; others need pressure. In some cases, EAP counselors help supervisors get help for their depressed employee, as happened in Jane’s situation.