Question: Since the death of my father-in-law early last year, my wife and I have made it a point to call and drop by to see her 77 year-old mother at least four times each week. Lately, we have noticed that my mother-in-law seems to be very distant and lethargic. We began checking her food supply and found that her refrigerator is almost empty -- and what is in there is mostly rotten. Her house is filthy, she has lost weight, and she has little interest in any activities.

Because of our concern, my wife called her brother who lives several hundred miles away, but he was "too busy" to get involved. My mother-in-law denies that she has any problems and refuses to see her doctor. To make matters worse, her doctor won't talk to my wife about her condition. Because of her forgetfulness, we believe that she is beginning to show signs of dementia, but we are frustrated. How can we find out what's wrong and begin to take care of her?

Answer: As caregivers, you and your wife are in the best position to see the symptoms of depression -- the most widespread mental problem facing older Americans, yet not recognize the underlying problem.

According to the United States Department of Health and Human Services, there are 12 basic symptoms of depression: (1) continuing sadness or anxiety, (2) loss of interest in ordinary activities, (3) fatigue and lack of energy, (4) changes in sleeping patterns, (5) changes in eating patterns, (6) difficulty making decisions or remembering things, (7) feelings of desperation, (8) feelings of worthlessness, (9) suicidal or death thoughts, (10) grouchiness, (11) frequent crying, and (12) chronic aches and pains that have no physical basis.

While it may be easy to ignore or find reasons for one or two symptoms, if you see three or more of these symptoms during a two-to-three week period, it is probable that your mother-in-law is clinically depressed.

Depression can be caused by the side effects of medication, alcohol use, physical illness, genetic personality traits, and major changes in lifestyle. Once diagnosed, depression is often treatable with an estimated 90 percent success rate, but the key is early intervention and treatment.

That said, based upon information we have received from geriatric experts in this field, you should make sure your mother-in-law's physician is made aware of the problem. If he or she won't talk to you because of privacy concerns, then write him or her a letter outlining your concerns. At the same time, you should try to have frank discussions with your mother-in-law about your concerns and try to assure her that treatment will benefit her. You may want to try to have your mother-in-law sign an authorization or a durable health care power of attorney so the physician will be able to freely discuss these issues with your wife.

Should these efforts not be fruitful, because of safety concerns, we suggest that you contact a lawyer skilled in guardianship and conservatorship matters to discuss whether your mother-in-law is sufficiently incapacitated to justify court intervention. In our view, this should be your last option, but may be necessary to protect her.

Since these types of problems are very difficult for family members to face and successfully deal with, it is wise to read up on depression issues either in books or over the Internet to learn as much as you can about this most prevalent problem.

Jan Collins is an award-winning writer and editor. Jan Warner is a matrimonial, elder law, and tax attorney. Both are based in Columbia, South Carolina.

Please send your questions to P.O.Box 11704, Columbia, S.C. 29211 or send your questions by email to janwarner@nextsteps.net.