Fact sheet : caregiving and depression

Fact Sheet
Caregiving and Depression
Could the sadness, loneliness or anger you feel
Symptoms of Depression
today be a warning sign of depression? It’s possible. It is not unusual for caregivers to develop mild or People experience depression in different ways. more serious depression as a result of the constant 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 Caregiving does not cause depression, nor will and degree of symptoms vary by individual and can everyone who provides care experience the negative change over time. Consider these common symptoms feelings that go with depression. But in an effort to of depression. Have you experienced any of the 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 • A change in eating habits resulting in experiences involved with providing care can strain even the most capable person. The resulting feelings • A change in sleep patterns—too much sleep 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 • A loss of interest in people and/or activities 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 Feeling that nothing you do is good enough when the sadness and crying don’t go away or when • Thoughts of death or suicide, or attempting those negative feelings are unrelenting. Unfortunately, feelings of depression are often seen • Ongoing physical symptoms that do not as a sign of weakness rather than a sign that respond to treatment, such as headaches, 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 Special Caregiver Concerns
not real. Ignoring or denying your feelings will not make them go away. What do lack of sleep, dementia and whether you are male or female have in common? Each can contribute Early attention to symptoms of depression through in its own way to a caregiver’s increased risk for 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.
Dementia and Care
• Men who are caregivers deal with
depression differently. Men are less likely to
Researchers have found that a person who provides admit to depression and doctors are less likely care for someone with dementia is twice as likely to to diagnose depression in men. Men will more suffer from depression as a person providing care for often “self treat” their depressive symptoms someone without dementia. The more severe the case of anger, irritability or powerlessness with 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 female caregivers to hire outside help for these situations, to receive consistent and dependable assistance with home care duties, they tend to have fewer friends to confide in or positive activities outside the home. The assumption • Caring for a person with dementia can be
all consuming. It is different from other types
weakness can make it especially difficult for of caregiving. Not only do caregivers spend significantly more hours per week providing care, they report more employment problems, • Lack of sleep contributes to depression.
personal stress, mental and physical health While sleep needs vary, most people need problems, less time to do the things they eight hours a day. Loss of sleep as a result of enjoy, less time to spend with other family caring for a loved one can lead to serious depression. The important thing to remember nondementia caregivers. As stressful as the is that even though you may not be able to get deterioration of a loved one’s mental and your loved one to rest throughout the night, physical abilities may be for the caregiver, you can arrange to get much needed sleep. dealing with dementia-related behavior is an Hiring a respite worker to be with your loved one while you take a nap or finding a care symptoms of depression. Dementia-related center or scheduling a stay over with another family member for a few nights are ways to every day challenging and makes it harder for a caregiver to get rest or assistance in providing care. • Depression can persist after placement in a
care facility. Making the decision to move a
• Women experience depression at a higher
loved one to a care center is very stressful. rate than men. Women, primarily wives and
While many caregivers are finally able to daughters, provide the majority of caregiving. catch up on much needed rest, loneliness, In the United States, approximately 12 million guilt and monitoring the care a loved one women experience clinical depression each receives in this new location can add new year, at approximately twice the rate of men. stress. Many caregivers feel depressed at the A National Mental Health Association survey time of placement and some continue to feel on the public’s attitude and beliefs about clinical depression found that more than one-half of women surveyed still believe it is People assume that once caregiving is over, the stress "normal" for a woman to be depressed during 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 The study also found that many women do not seek continued to experience depression and loneliness. In treatment for depression because they are an effort to return their life to normal, former embarrassed or in denial about being depressed. In caregivers may need to seek out help for depression fact, 41% of women surveyed cited embarrassment or
What to Do If You Think You Have
It is important to trust and feel comfortable with the Depression
professional you see. It is not uncommon to request a free introductory phone or in-person meeting to help Depression deserves to be treated with the same determine if the professional is the right match for attention afforded any other illness, such as diabetes your particular needs and style. It is appropriate to or high blood pressure. If you feel uncomfortable clarify what the cost will be, how much your using the term depression, tell the professional that insurance will pay and how many scheduled sessions you are “feeling blue” or “feeling down.” The you should expect to have with the mental health professional will get the message. The important therapist. Any treatment should be evaluated regularly to ensure that it continues to contribute towards your improved health and growth. Those with chronic illnesses also may suffer from depression. If you suspect this is the case with your Questions to Expect in a Mental Health
loved one, look for an opportunity to share your Exam for Depression
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. When did you first notice these symptoms? How long have you How is Depression Treated?
The first step to getting the best treatment for depression is to meet with a mental health things you don’t or can’t do anymore? 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 2. How often do you use alcohol or drugs (both tests for mental status to determine if speech, prescription and nonprescription) to help memory or thought patterns have been affected. Although it’s not unusual for a physician to prescribe 3. Have you had any thoughts about death or antidepressant medication, medication alone may not be the most effective treatment for depression. The guidance of a mental health professional throughout 4. Do you have any family members who have your treatment is strongly recommended. The therapist or counselor will listen to your concerns, 5. If so, did they receive treatment? What type? screen you for symptoms of depression and assist you in setting up an appropriate course of treatment. 6. Have you experienced any serious loss, difficult relationships, financial problems or 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, 7. Is there anything else you’d like to add to help 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 Treatment Options
provide contact information for mental health professionals in your community. (See “Finding a Upon review of the physical and mental evaluation, a Professional in your Area” in this fact sheet.) course of treatment will be recommended. Primary treatment options are psychotherapy (also referred to antidepressant drugs, tricyclics increase levels as mental health therapy) and antidepressant of neurotransmitters in the brain. May cause medication. These treatments are used alone or in combination with one another. (Electroconvulsive therapy or shock therapy is used for severe cases of • Monoamine Oxidase Inhibitors (MAOI)
depression and is recommended only when other (Examples: Nardil, Parnate) – These therapies approaches have not been effective.) The most are not often used today. MAOIs are drugs frequent treatment for depressive symptoms that have that increase the level of neurotransmitters in progressed beyond the mild stage is antidepressant the brain. They are most often used when medication, which provides relatively quick symptom other medication isn’t effective or tolerated. relief, in conjunction with ongoing psychotherapy, • Electroconvulsive Therapy (ECT) – A brief
which offers new strategies for a more satisfying life. pulse of electricity is delivered through Following are the most common treatments used electrodes on the scalp over a period of several days to produce changes in the brain Psychotherapy
function. ECT is used only for serious (possibly life-threatening) depression and • Cognitive & Behavioral Therapy – The
If drug therapy is recommended, a certain amount of changing persistent, self-defeating thinking trial and error is necessary to find the right type and and behaviors. The ultimate goal is to help dosage of medication for each individual and it may take several weeks before effects are felt. Good events in their lives and learn practical skills communication between patient and doctor is to deal with the problems they are facing. important. Older adults should be especially careful • Interpersonal Therapy – The therapist helps
to watch for medication side effects caused from too the caregiver self-evaluate problems in their high a dosage or interactions with other medications. communication, or lack of communication, with other people. The caregiver will come to Complementary and Alternative Therapies
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 • Psychodynamic Therapy – Although
extensively in the treatment of mild to moderate sometimes used to treat depression, this depression in Europe and is now undergoing studies therapy is thought to be less effective than the in the United States. St. John's wort extract is sold other two therapies already mentioned. Its “over the counter” in the U.S. as a nutritional goal is to surface deeply held conflicted feelings to better experience and understand It is promoted as a "natural” way to improve mood, and as a treatment for mild to moderate depression. Medication and ECT Therapy
Researchers are studying it for possibly having fewer and less severe side effects than antidepressant drugs. • Selective Serotonin Reuptake Inhibitors
Yet, questions remain regarding whether St. John's (SSRIs) (Examples: Prozac, Zoloft, Paxil) –
wort really does what its promoters claim. For Medications that work by stabilizing levels of nonprescription drugs in the U.S. there are no serotonin, a neurotransmitter. Low levels of established criteria for determining the amount of serotonin have been linked to depression. active ingredient a company puts in their product or Fewer side effects than tricyclic medications. what dose is right for a given person. The Food and • Tricyclics (Examples: Norpramin, Pamelor,
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, Paying for Treatment
depression, and HIV infections. If you are taking St. John’s wort or considering its use, talk with your Private health insurance and Medicare will typically health care provider to ensure it will not interfere pay for some mental health care. It’s best to call the with any other treatment you are receiving. mental health professional directly to find out if they accept your insurance for payment. Health insurance Seasonal Affective Disorder. Caregivers who feel
providers will usually list mental health professionals “the blues” when confined indoors or in response to in the same insurance material that lists health plan winter’s gray days may suffer from Seasonal medical doctors. Medicare recipients will find the Affective Disorder (SAD), also referred to as “winter booklet titled, “Medicare and Your Mental Health depression.” As seasons change, there is a shift in our Benefits” a helpful source of information. See the biological internal clocks or circadian rhythms, partly “Resources” section of this Fact Sheet to find out 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 The “covered services” of the insurance plan will time adjusting to the shortage of sunlight in the specify mental health coverage for inpatient (hospital, winter months. SAD symptoms are most pronounced treatment center) and outpatient (professional’s in January and February, when the days are shortest. office) care, how many visits are paid for, and at SAD is often misdiagnosed as hypothyroidism, what rate of reimbursement. Employed caregivers hypoglycemia, infectious mononucleosis and other may also have access to an Employee Assistance Program, where licensed professionals (usually psychologists and social workers) are available for Phototherapy, using specially designed bright confidential sessions to discuss personal or 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 Caregivers without health insurance or who pay out chemicals, specifically melatonin. Antidepressant of pocket for care will find that fees vary by medication along with other treatments, including professional, with psychiatrists charging at the higher exercise, may be helpful as well. If you experience end of the fee scale and psychologists and social mild depressive symptoms seasonally, experiment workers offering their services at a more moderate with increasing the light in your surroundings, using rate. In some instances, a mental health center will lamps or other sources. If the symptoms are strong apply a fee based on your ability to pay. In any case, enough to impair your day-to-day functioning, seek find out what the fee is up front to avoid any out a mental health professional with expertise in Strategies to Help Yourself
Physical Exercise. Exercise has been found to
reduce the effects of depression. Walking three times
Depressive disorders can make one feel exhausted, a week for 30 to 45 minutes has been linked to helpless and hopeless. Such negative thoughts and reducing or alleviating symptoms of depression. It is feelings make some people feel like giving up. It is unknown whether physical activity prevents the onset important to realize that these negative views are part of depression or just helps modify the effects. of the depression and may not accurately reflect the Arranging time for exercise is sometimes difficult for situation. The National Institute of Mental Health caregivers. It is often seen as a “value added” offers the following recommendations for dealing activity—something to do when everything else is done. You might consider adding it to your “to do” • Set realistic goals in light of the depression 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 • Break large tasks into small ones, set some makes good sense to make time for exercise. priorities, and do what you can as you can. • Try to be with other people and to confide in Psychiatrist (MD): A psychiatrist is a medical doctor
someone; it is usually better than being alone who specializes in the diagnosis, treatment, and prevention of mental illnesses, including substance abuse and addiction. • Participate in activities that may make you feel better, such as mild exercise, going to a • American Psychiatric Association
movie or ballgame, or attending a religious, Provides free information on depression and referrals to psychiatrists in your area. • Expect your mood to improve gradually, not Psychologist (Ph.D.): Licensed to practice
psychotherapy and has special training in
• It is advisable to postpone important decisions psychological testing. Although referred to as “doctor,” a psychologist cannot prescribe deciding to make a significant transition— change jobs, get married or divorced—discuss it with others who know you well and have a • American Psychological Association
(800) 964-2000Visit APA's website for more • People rarely "snap out of" a depression. But information about depression or call the toll- they can feel a little better day-by-day. free number to be referred to a psychologist in Remember, positive thinking will replace the negative thinking that is part of the Licensed Clinical Social Worker (L.C.S.W.): Has
depression. The negative thinking will be 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 Direct assistance in providing care for your loved • National Association of Social Workers
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 Provides free information on depression and depression. Look for classes and support groups referrals to social workers in your area. available through caregiver support organizations to help you learn or practice effective problem-solving Note: Additional professionals may be
and coping strategies needed for caregiving. For your health and the health of those around you, take some local mental health department or hospital in your community for more Sources for online depression screening
checklists:
National Mental Health Association depression
Other resources:
screening checklist
Medicare
National Depression Screening Day website
Call 1-800-MEDICARE (1-800-633-4227) to request a copy of “Medicare and Your Mental Health Benefits.” Finding a Professional in your area:
National Institute of Mental Health

Schultz R., O’Brien A.T., Bookwala J., et al. (1995) Provides free information on depression and other Psychiatric and physical morbidity effects of mental illnesses in English and Spanish. dementia caregiving: prevalence, correlates and causes. Gerontologist. Vol. 35, 771-791. Exercise Guide for Older Adults
Exercise and Your Health: A Personal Guide to
Health and Fitness (Spanish) Exercise: A Guide for the National Institute on Aging Recommended Reading
(NIA). Includes a chapter on exercises to do at home (English). The Caregiver Helpbook: Powerful Tools for
Published by the National Institute of Health. Caregiving by Vicki Schmall, Marilyn Cleland and
Available free of charge. (800) 222-2225 or Marilyn Sturdevant. Published by Legacy Health System. Accompanies a class by the same name. Class information and the book are available by Websites
contacting Legacy Caregiver Services, 1015 NW 22nd Ave., Ste. N300, Portland, OR 97210, (503) 413- American Geriatrics Association
Caregiving: The Spiritual Journey of Love, Loss,
and Renewal by Beth Witrogen McLeod. Published
National Institute for Complimentary and
by John Wiley & Sons, Inc., New York, NY. Alternative Medicine

Caring for Yourself While Caring for Your Aging
Parents: How to Help, How to Survive by Claire
National Institute of Mental Health
Berman. Published by Henry Holt and Company, Inc. 115 West 18th Street, New York, NY 10011, (212) 886-9200. National Alliance for the Mentally Ill

Resources
National Mental Health Association
Family Caregiver Alliance
180 Montgomery Street, Suite 1100 San Francisco, CA 94104 National Library of Medicine
References
Gallagher-Thompson, Coon, Rivera, Powers and Zeiss. (1998). Family Caregiving: Stress, Coping and Family Caregiver Alliance (FCA) seeks to improve Intervention. Handbook of Clinical Geropsychology, the quality of life for caregivers through education, National Institute of Mental Health (2001). Through its National Center on Caregiving, FCA Depression. Publication No. 00-3561, Bethesda, MD. offers information on current social, public policy National Institute of Mental Health (2001). Women and caregiving issues and provides assistance in the Hold Up Half the Sky. Publication No. 01-460,7 development of public and private programs for Ory M., Hoffman R., Yee J., Tennstedt S. and For residents of the greater San Francisco Bay Area, Schultz R. (1999) Prevalence and Impact of FCA provides direct family support services for Caregiving: A Detailed Comparison Between caregivers of those with Alzheimer's disease, stroke, Dementia and Nondementia Caregivers. The head injury, Parkinson's and other debilitating 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. March 2002. All rights reserved. Updated by OCCC 11-2010 For Additional Resources Call:

(714) 446-5030 (800) 543-8312 fax (714) 446-5996 Providing support and assistance to family caregivers in Orange County. Services include Information & Referral, family consultations, support groups, legal clinics, educational seminars and a respite planning. The CAREGIVER RESOURCE CENTER, sponsored by St. Jude Medical Center, is part of a statewide system of Caregiver Resource Centers contracted through the California Department of Mental Health. Additional funding comes from the California Department of Aging funds from the federal Older Americans Act, as allocated by the Orange County Board of Supervisors. Rev. 11-10

Source: http://www.ocagingservicescollaborative.org/wp-content/uploads/2011/09/Caregiving_and_Depression_Fact_Sheet.pdf