Many people with symptoms of depression don’t describe themselves as feeling depressed. Some people don’t recognize the symptoms in themselves, while others may have a hard time admitting they feel depressed. It can be embarrassing to talk about. An individual may feel like a failure or that people will judge them. But here’s what you need to know: for caregivers, depression is more common than you might think, and it’s a normal response to a difficult situation. It is not unusual for caregivers to develop mild or more serious depression as a result of the constant demands they face while providing care.
Depression is an extremely complex condition with many research studies underway to pinpoint the cause(es). Known contributing factors include genetic characteristics, hormone levels, environmental triggers, certain medications, the effects of living with a major illness, grief and loss due to the the death of a loved one, having experienced physical or emotional abuse, living with someone with serious depression, and other factors. Not everyone will experience the negative feelings that go with depression. But we know that in an effort to provide the best possible care for a family member or friend, caregivers often sacrifice their own physical and emotional needs. The complex and varied aspects involved with providing care can strain even the most capable person. Feelings of overwhelm, agitation, anxiety, distress, pessimism, isolation, exhaustion—and sometimes guilt for having these feelings—can exact a heavy toll.
Everyone has negative thoughts or feelings that come and go over time, but when these feelings become more intense and leave you drained of energy, tearful or irritable towards a loved one, it may well be a warning sign of depression. Concerns about depression arise when the emptiness and crying don’t go away, or when those negative feelings are unrelenting.
Unfortunately, feelings of depression are often seen as a sign of weakness rather than a sign that something is out of balance. Comments from others such as “snap out of it” or “it’s all in your head” are not helpful, and reflect a belief that mental health concerns are not real. Ignoring or denying your feelings will not make them go away.
Early attention to symptoms of depression through exercise, a healthy diet, positive support of family and friends, or consultation with a trained health or mental health professional may help to prevent the development of a more serious depression over time.
People experience depression in different ways. Some may feel classic symptoms, like sadness and hopelessness. Others may have signs that you might not equate with depression, such as extreme fatigue or irritability. The type and degree of symptoms vary by individual and can change over time. Consider these common symptoms of depression. Have you experienced any of the following for longer than two weeks?
As stressful as the deterioration of a loved one’s mental and physical abilities may be for the caregiver, dealing with dementia-related behavior is an even bigger contributor to developing depression. Dementia-related symptoms such as wandering, agitation, hoarding, embarrassing conduct. and resistance or non-cooperation from the loved one makes every day challenging and makes it harder for a caregiver to get rest or assistance in providing care. The more severe the case of dementia, the more likely the caregiver is to experience depression. It is critical for caregivers, especially in these situations, to receive consistent and dependable support and respite.
A Mental Health America study found that many women do not seek treatment for depression because they are embarrassed or in denial about being depressed. In fact, 41% of women surveyed cited embarrassment or shame as barriers to treatment. Keep in mind that doctors have heard it all. It is important to both your mental and physical health to get a complete physical exam. Take time during the exam to bring up the subject of depression if you suspect you are experiencing symptoms of depression.
People assume that once caregiving is over, the stress from providing hands-on care will go away. Yet, researchers found that even three years after the death of a spouse with dementia, some former caregivers continued to experience depression and loneliness. In an effort to return their life to normal, former caregivers may need to seek help for depression as well.
Depression deserves to be treated with the same attention afforded any other illness, such as diabetes or high blood pressure. Likewise, the best way to figure out what is causing symptoms is to talk to a qualified professional, like your doctor. If you feel uncomfortable using the term depression, tell your doctor that you are “feeling blue” or “feeling down,” and describe your personal experience and symptoms. The more specific you can be, the better your doctor can help you. The important thing is to make it a priority during your appointment and be as honest as possible so your doctor can help you.
It’s not uncommon for a person receiving care to suffer from undiagnosed depression. Everything can feel worse than it is from their perspective adding to any daily caregiving challenges you may be experiencing. If you suspect this is the case in your caregiving situation, look for an opportunity to share your concern with them. If they are reluctant to talk about it with you, encourage a trusted friend to talk with them or consider leaving a message for their doctor regarding your concern prior to their next appointment.
The first step to getting the best treatment for depression is to meet with a mental health professional such as a psychologist, social worker, or other licensed therapist. At the same time, schedule a physical exam with your doctor. Certain medications, as well as some medical conditions such as viral infection, can cause the same symptoms as depression, and should be evaluated by a physician. The exam should include lab tests and an interview that tests for mental status to determine if speech, memory, or thought patterns have been affected.
Although a physician may prescribe antidepressant medication, medication alone is not the most effective treatment for depression. Concurrent guidance of a mental health professional is strongly recommended. The therapist or counselor will listen to your concerns, screen you for symptoms of depression, and assist you in developing ways to address your stress and build new coping patterns.
One way to find a professional is to ask a friend for the name of someone they know and trust. You may also find someone by asking your minister or rabbi, your doctor, or if you are employed, you may check your employer’s health insurance provider list or Employee Assistance Program (EAP). In addition, national organizations can provide contact information for mental health professionals in your community. (See “Finding a Professional in Your Area” in this fact sheet.)
It is important to trust and feel comfortable with the professional you see. It is not uncommon to request a free introductory phone or in-person meeting to help determine if the professional is the right match for your particular needs and style. It is appropriate to clarify
Any treatment should be evaluated regularly to ensure that it continues to contribute towards your improved health and growth.
Upon review of a physical and mental health evaluation, a course of treatment may be recommended. Primary treatment options are psychotherapy (also referred to as mental health therapy and talk therapy) and antidepressant medication. These treatments may be used alone or in combination with one another. The most frequent treatment for depressive symptoms that have progressed beyond the mild stage is antidepressant medication, which provides relatively quick symptom relief. Critical to treatment for depression is the concurrent use of psychotherapy along with medication. Discussing your situation with a therapist can open up new self-awareness for addressing a particular emotional concern and provide guidance to address challenges in getting and staying healthy.
When choosing a therapist, be sure to ask about their experience working with family caregivers and their understanding of caregiving related stressors.
If drug therapy is recommended, a certain amount of trial and error is necessary to find the right type and dosage of medication for each individual and it may take several weeks before effects are felt. Good communication between patient and doctor is important. Older adults should be especially careful to watch for medication side effects caused from too high a dosage or interactions with other medications.
Many complementary medicines and alternative therapies are promoted for coping with depression. Some have been tested in scientific clinical trials, but many have not. Here is an overview of some of the most common therapies:
Physical Exercise: Exercise has been found to reduce the effects of depression. Walking three times a week for 30 to 45 minutes has been linked to reducing or alleviating symptoms of depression. If that seems like a lot of time you don’t have, then start with 15 minutes one-time a week. The important message is to get started with a regular exercise activity.
It is unknown whether physical activity prevents the onset of depression or just helps modify the effects. Arranging time for exercise is sometimes difficult for caregivers. It is often seen as a “value added” activity—something to do when everything else is done. You might consider adding it to your “to do” list, asking a friend to give you a “walk date” each week as a gift, or requesting that your doctor write a prescription for walking or joining an exercise class. All the research shows that for a healthier life, it makes good sense to make time for exercise.
Mind-Body Techniques: There is a growing body of research showing that our thoughts, beliefs and feelings can have a direct impact on our health, and our physical health can impact our mental state. Your mind and body are interrelated. Implementing mind-body techniques into your routine may help alleviate depression.
Even 5 to 10 minutes of any of these techniques may be beneficial. These are some to try:
Supplements: Herbal “over-the-counter” treatments such as St. John’s Wart (Hypericum perforatum) and other supplements such as SAMe and omega-3 fatty acids are under study and/or in popular use in the US and Europe for treating depressive symptoms. At present, for nonprescription drugs in the US, there are no established criteria for determining the amount of active ingredient a company puts in their product or what dose is right for a given person. Effectiveness of a product is difficult to determine and the effects of a product can have negative side effects. For example, the US Food and Drug Administration issued a warning stating that St. John’s wort may affect the metabolic pathway used by many prescription drugs prescribed to treat a number of conditions, including heart disease, depression, and HIV infections.
If you are taking any herbal supplements or considering taking them, talk with your health care provider to ensure they will not interfere with any other treatment you are receiving.
Light Therapy: Caregivers who feel “the blues” when confined indoors or in response to winter’s gray days may suffer from Seasonal Affective Disorder (SAD), also referred to as “winter depression.” As seasons change, there is a shift in our biological internal clocks or circadian rhythms, partly in response to the changes in sunlight patterns. This can cause our biological clocks to be out of sync with our daily schedules. People with SAD have a difficult time adjusting to the shortage of sunlight in the winter months. SAD symptoms are most pronounced in January and February, when the days are shortest. SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.
Light therapy, using specially designed bright fluorescent lights, has been shown to reverse SAD’s depressive symptoms. Experts believe that the light therapy works by altering the levels of certain brain chemicals, specifically melatonin. Antidepressant medication along with other treatments, including exercise, may be helpful as well. If you experience mild depressive symptoms seasonally, experiment with increasing the light in your surroundings, using lamps or other sources. If the symptoms are strong enough to impair your day-to-day functioning, seek out a mental health professional with expertise in treating SAD.
Private health insurance and Medicare may pay for some mental health care, and the Affordable Care Act (ACA) has increased insurance coverage for mental health benefits. Policies vary widely, so it’s best to call the mental health professional directly to find out if they accept your insurance for payment. Health insurance providers will usually list mental health professionals in the same insurance material that lists health plan medical doctors. Medicare recipients will find the booklet titled, “Medicare and Your Mental Health Benefits” a helpful source of information. See the “Resources” section of this fact sheet to find out how to obtain a copy.
The “covered services” of the insurance plan will specify mental health coverage for inpatient (hospital, treatment center) and outpatient (professional’s office) care, how many visits are paid for, and at what rate of reimbursement. Employed caregivers may also have access to an Employee Assistance Program, where licensed professionals (usually psychologists and social workers) are available for confidential sessions to discuss personal or professional problems.
Professionals who don’t accept insurance are called “out-of-network providers,” and may be able to provide you with a receipt that you can submit to your insurance for partial reimbursement. Check with the professional to see if this is an option. If so, you’ll have to contact your insurance company to make sure they’ll cover some of the cost. They may require you to meet a deductible before they will start paying.
Caregivers without health insurance or who pay out-of-pocket for care will find that fees vary by professional and region, with psychiatrists and psychologists charging at the higher end of the fee scale, and therapists and social workers offering services at a more moderate rate. Some professionals offer a sliding scale fee, meaning they may slide their fee down to meet your need. There may also be low- fee clinics that have a set low fee or will apply a fee based on your ability to pay. In these settings, you are often meeting with a mental health intern who is being supervised by a licensed mental health provider. In any case, find out what the fee is up front to avoid any misunderstandings later on.
Depressive disorders can make one feel exhausted, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and may not accurately reflect the situation. Below are guidelines adapted from The National Institute of Mental Health offering recommendations for dealing with depression. Set realistic goals in light of the depression. You may not be able to accomplish as much as you are accustomed to when you are feeling well.
Direct assistance in providing care for your loved one, such as respite care relief, as well as positive feedback from others, positive self-talk, and recreational activities are linked to lower levels of depression. Look for classes and support groups available through caregiver support organizations to help you learn or practice effective problem-solving and coping strategies needed for caregiving. For your health and the health of those around you, take some time to care for yourself.
Psychiatrist (MD): A psychiatrist is a medical doctor who specializes in the diagnosis, treatment, and prevention of mental illnesses, including substance abuse and addiction.
Psychologist (PhD): Licensed to practice psychotherapy and has special training in psychological testing. Although referred to as “doctor,” a psychologist cannot prescribe medications.
Licensed Clinical Social Worker (LCSW.): Licensed to practice psychotherapy, with special training in addressing the person-in-environment. Has specialized training in human behavior, family behavior, psychology, and problem solving. Has a Master's degree in Social Work (MSW) with two years of supervised post-graduate work providing clinical treatment.
Licensed Marriage and Family Therapists (LMFT): Licensed to practice psychotherapy and is trained to diagnose and treat mental health issues. Works with individuals, couples, families and groups. Has a Master’s degree in Counseling Psychology with supervised postgraduate work.
Note: Additional professionals may be licensed to practice psychotherapy in your state or county. Check with the local mental health department or hospital in your community for more information.
Call 1-800-MEDICARE (1-800-633-4227) to request a copy of “Medicare and Your Mental Health Benefits.”
National Institute of Mental Health
Provides free information on depression and other mental illnesses in English and Spanish.
National Institute for Complimentary and Alternative Medicine
Family Caregiver Alliance
National Center on Caregiving
(415) 434-3388 (SF Bay Area) | (800) 445-8106 (Toll-free)
E-mail: [email protected]
Family Care Navigator: www.caregiver.org/family-care-navigator
Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy.
Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers.
For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s, and other debilitating health conditions that strike adults.
The Caregiver Helpbook: Powerful Tools for Caregiving, Vicki Schmall, Marilyn Cleland, and Marilyn Sturdevant. Published by Legacy Health System. Accompanies a class by the same name. Class information and book are available by contacting Legacy Caregiver Services, 1015 NW 22nd Ave., Ste. N300, Portland, OR 97210, (503) 413-7706
Caregiving: The Spiritual Journey of Love, Loss, and Renewal, Beth Witrogen McLeod. Published by John Wiley & Sons, Inc., New York, NY
Caring for Yourself While Caring for Your Aging Parents, Third Edition: How to Help, How to Survive, Claire Berman. Published by Henry Holt and Company, Inc. 115 West 18th Street, New York, NY 10011, (212) 886-9200
Updated by Family Caregiver Alliance. Reviewed by Beth MacLeod, Licensed Clinical Social Worker (LCSW) in private practice specializing in care consultation and psychotherapy. Clinical supervisor for professionals in aging and those working with family caregivers. Funded by the California Department of Health Care Services. © 2002, 2008, 2016 Family Caregiver Alliance. All rights reserved.