Could the sadness, loneliness or anger you feel today be a warning sign of depression? It’s possible. It is not unusual for caregivers to develop mild or more serious depression as a result of the constant demands they face in providing care.
Caregiving does not cause depression, nor will everyone who provides care experience the negative feelings that go with depression. But in an effort to provide the best possible care for a family member or friend, caregivers often sacrifice their own physical and emotional needs and the emotional and physical experiences involved with providing care can strain even the most capable person. The resulting feelings of anger, anxiety, sadness, isolation, exhaustion—and then guilt for having these feelings—can exact a heavy toll.
Everyone has negative feelings that come and go over time, but when these feelings become more intense and leave caregivers totally drained of energy, crying frequently or easily angered by their loved one or other people, it may well be a warning sign of depression. Concerns about depression arise when the sadness 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 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 a general low-level sadness for months, while others suffer a more sudden and intense negative change in their outlook. 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?
What do lack of sleep, dementia and whether you are male or female have in common? Each can contribute in its own way to a caregiver’s increased risk for depression.
Researchers have found that a person who provides care for someone with dementia is twice as likely to suffer from depression as a person providing care for someone without dementia. The more severe the case of dementia such as that caused by Alzheimer’s disease, the more likely the caregiver is to experience depression. It is critical for caregivers, especially in these situations, to receive consistent and dependable support.
The study also 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.
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 out 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. If you feel uncomfortable using the term depression, tell the professional that you are “feeling blue” or “feeling down.” The professional will get the message. The important thing is to seek help.
Those with chronic illnesses also may suffer from depression. If you suspect this is the case with your loved one, look for an opportunity to share your concern with him or her. 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 psychiatrist, psychologist, or social worker. 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 can be evaluated by your physician during an exam. 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 it’s not unusual for a physician to prescribe antidepressant medication, medication alone may not be the most effective treatment for depression. The guidance of a mental health professional throughout your treatment is strongly recommended. The therapist or counselor will listen to your concerns, screen you for symptoms of depression and assist you in setting up an appropriate course of treatment.
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 EAP program. 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 what the cost will be, how much your insurance will pay and how many scheduled sessions you should expect to have with the mental health therapist. Any treatment should be evaluated regularly to ensure that it continues to contribute towards your improved health and growth.
Upon review of the physical and mental evaluation, a course of treatment will be recommended. Primary treatment options are psychotherapy (also referred to as mental health therapy) and antidepressant medication. These treatments are used alone or in combination with one another. (Electroconvulsive therapy or shock therapy is used for severe cases of depression and is recommended only when other approaches have not been effective.) The most frequent treatment for depressive symptoms that have progressed beyond the mild stage is antidepressant medication, which provides relatively quick symptom relief, in conjunction with ongoing psychotherapy, which offers new strategies for a more satisfying life. Following are the most common treatments used today:
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.
St. John’s wort. One of the most studied alternative treatments for depressive symptoms is St. John’s wort (Hypericum perforatum). It is an herb used extensively in the treatment of mild to moderate depression in Europe and is now undergoing studies in the United States. St. John's wort extract is sold “over the counter” in the U.S. as a nutritional supplement.
It is promoted as a "natural” way to improve mood, and as a treatment for mild to moderate depression. Researchers are studying it for possibly having fewer and less severe side effects than antidepressant drugs.
Yet, questions remain regarding whether St. John's wort really does what its promoters claim. For nonprescription drugs in the U.S. 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. The 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 St. John’s wort or considering its use, talk with your health care provider to ensure it will not interfere with any other treatment you are receiving.
Seasonal Affective Disorder. 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.
Phototherapy, 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.
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. 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.
Private health insurance and Medicare will typically pay for some mental health care. 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 obtaina 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.
Caregivers without health insurance or who pay out of pocket for care will find that fees vary by professional, with psychiatrists charging at the higher end of the fee scale and psychologists and social workers offering their services at a more moderate rate. In some instances, a mental health center will apply a fee based on your ability to pay. 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. The National Institute of Mental Health offers the following recommendations for dealing with depression:
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.
University of Michigan Depression Toolkit
Mental Health Screening.org
myhealth.va.gov (search depression screening)
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 (Ph.D.): 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 (L.C.S.W.): Has specialized training in human behavior, family behavior, psychology, and problem solving. Has a Master's degree in Social Work (M.S.W.) with two years of supervised postgraduate work providing clinical treatment.
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.
American Geriatrics Association
National Institute for Complimentary and Alternative Medicine
National Institute of Mental Health
National Alliance for the Mentally Ill
National Mental Health Association
National Library of Medicine
Gallagher-Thompson, Coon, Rivera, Powers and Zeiss. (1998). Family Caregiving: Stress, Coping and Intervention. Handbook of Clinical Geropsychology, Chapter 21, Plenum Press, New York.
National Institute of Mental Health (2001). Depression. Publication No. 00-3561, Bethesda, MD. National Institute of Mental Health (2001). Women Hold Up Half the Sky. Publication No. 01-460,7 Bethesda, MD.
Ory M., Hoffman R., Yee J., Tennstedt S. and Schultz R. (1999) Prevalence and Impact of Caregiving: A Detailed Comparison Between Dementia and Nondementia Caregivers. The Gerontologist Vol. 39, No 2 177-185
Schultz R., O’Brien A.T., Bookwala J., et al. (1995) Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates and causes. Gerontologist. Vol. 35, 771-791.
The Caregiver Helpbook: Powerful Tools for Caregiving by Vicki Schmall, Marilyn Cleland and Marilyn Sturdevant. Published by Legacy Health System. Accompanies a class by the same name. Class information and the 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 Renewalby 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 by Claire Berman. Published by Henry Holt and Company, Inc. 115 West 18th Street, New York, NY 10011, (212) 886-9200.
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 family support services for caregivers of those with Alzheimer's disease, stroke, head injury, Parkinson's and other debilitating disorders that strike adults.
Prepared by Family Caregiver Alliance in cooperation with California's Caregiver Resource Centers. Reviewed by Steven H. Zarit, Ph.D. Professor of Human Development and Assistant Director, Gerontology Center, Pennsylvania State University. Funded by the California Department of Mental Health and the Archstone Foundation. © 2002, 2008 Family Caregiver Alliance. All rights reserved.