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Caring for those who care for others Fact Sheet:
Caregiving and Depression
Could the sadness, loneliness or anger you Unfortunately, feelings of depression are feel today be a warning sign of depression? often seen as a sign of weakness rather than It’s possible. It is not unusual for caregivers a sign that something is out of balance. to develop mild or more serious depression Comments such as “snap out of it” or “it’s as a result of the constant demands they face all in your head” are not helpful, and reflect a belief that mental health concerns are not real. Ignoring or denying your feelings will Caregiving does not cause depression, nor will everyone who provides care experience the negative feelings that go with Early attention to symptoms of depression depression. But in an effort to provide the through exercise, a healthy diet, positive best possible care for a family member or friend, caregivers often sacrifice their own consultation with a trained health or mental health professional may help to prevent the emotional and physical experiences involved development of a more serious depression with providing care can strain even the most capable person. The resulting feelings of anger, anxiety, sadness, isolation, Symptoms of Depression
exhaustion—and then guilt for having these feelings—can exact a heavy toll. People experience depression in different ways. Some may feel a general low-level Everyone has negative feelings that come sadness for months, while others suffer a and go over time, but when these feelings more sudden and intense negative change in become more intense and leave caregivers totally drained of energy, crying frequently symptoms vary by individual and can change or easily angered by their loved one or other people, it may well be a warning sign of depression. Concerns about depression arise experienced any of the following for longer when the sadness and crying don’t go away or when those negative feelings are unrelenting. A change in eating habits resulting in unwanted weight gain or loss San Diego Main Office: 3675 Ruffin Road, Suite 230 • San Diego CA 92123
(858) 268-4432 • (800) 827-1008 • (858) 268-7816 Fax • E-mail: [email protected] El Centro Office: 119 South Fifth Street • El Centro CA 92243
A change in sleep patterns—too much sleep time to do the things they enjoy, less time to spend with other family members, and more family conflict than nondementia caregivers. As stressful as the deterioration of a loved one’s mental and physical abilities may be A loss of interest in people and/or activities for the caregiver, dealing with dementia- contributor to developing symptoms of depression. Dementia-related symptoms Feeling that nothing you do is good enough such as wandering, agitation, hoarding and embarrassing conduct makes every day Thoughts of death or suicide, or attempting respond to treatment, such as headaches, Women experience depression at a higher
rate than men. Women, primarily wives
and daughters, provide the majority of
Special Caregiver Concerns
caregiving. In the United States, approximately 12 million women experience National Mental Health Association survey way to a caregiver’s increased risk for on the public’s attitude and beliefs about clinical depression found that more than one-half of women surveyed still believe it Dementia and Care
is "normal" for a woman to be depressed during menopause. Researchers have found that a person who provides care for someone with dementia is twice as likely to suffer from depression as a not seek treatment for depression because person providing care for someone without dementia such as that caused by Alzheimer’s surveyed cited embarrassment or shame as disease, the more likely the caregiver is to experience depression. It is critical for Men who are caregivers deal with
caregivers, especially in these situations, to depression differently. Men are less likely
receive consistent and dependable support. to admit to depression and doctors are less Caring for a person with dementia can be
likely to diagnose depression in men. Men all consuming. It is different from other
will more often “self treat” their depressive types of caregiving. Not only do caregivers Although male caregivers tend to be more mental and physical health problems, less outside help for assistance with home care duties, they tend to have fewer friends to What to Do If You Think You
confide in or positive activities outside the Have Depression
home. The assumption that depressive symptoms are a sign of weakness can make Depression deserves to be treated with the it especially difficult for men to seek help. same attention afforded any other illness, such as diabetes or high blood pressure. If Lack of sleep contributes to depression.
While sleep needs vary, most people need depression, tell the professional that you are eight hours a day. Loss of sleep as a result of “feeling blue” or “feeling down.” The caring for a loved one can lead to serious remember is that even though you may not be able to get your loved one to rest Those with chronic illnesses also may suffer throughout the night, you can arrange to get from depression. If you suspect this is the much needed sleep. Hiring a respite worker to be with your loved one while you take a opportunity to share your concern with him nap or finding a care center or scheduling a or her. If they are reluctant to talk about it stay over with another family member for a with you, encourage a trusted friend to talk few nights are ways to keep your caregiving with them or consider leaving a message for their doctor regarding your concern prior to Depression can persist after placement in
How is Depression Treated?
a care facility. Making the decision to move
a loved one to a care center is very stressful.
The first step to getting the best treatment While many caregivers are finally able to catch up on much needed rest, loneliness, health professional such as a psychiatrist, guilt and monitoring the care a loved one psychologist, or social worker. At the same receives in this new location can add new time, schedule a physical exam with your stress. Many caregivers feel depressed at the doctor. Certain medications, as well as some time of placement and some continue to feel medical conditions such as viral infection, can cause the same symptoms as depression, People assume that once caregiving is over, the stress from providing hands-on care will go away. Yet, researchers found that even lab tests and an interview that tests for 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, Although it’s not unusual for a physician to former caregivers may need to seek out help 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. How often do you use alcohol or drugs (both prescription and nonprescription) to help 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 Have you had any thoughts about death or 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 If so, did they receive treatment? What type? information for mental health professionals in your community. (See “Finding a Professional in your Area” in this fact sheet.) difficult relationships, financial problems or other recent changes in your life? It is important to trust and feel comfortable with the professional you see. It is not Is there anything else you’d like to add to help me understand your situation better? phone or in-person meeting to help determine if the professional is the right Treatment Options
match for your particular needs and style. It is appropriate to clarify what the cost will be, how much your insurance will pay and evaluation, a course of treatment will be are psychotherapy (also referred to as mental therapist. Any treatment should be evaluated health therapy) and antidepressant regularly to ensure that it continues to medication. These treatments are used alone contribute towards your improved health and (Electroconvulsive therapy or shock therapy is used for severe cases of depression and is Questions to Expect in a Mental
recommended only when other approaches Health Exam for Depression
have not been effective.) The most frequent treatment for depressive symptoms that have antidepressant medication, which provides relatively quick symptom relief, in When did you first notice these symptoms? which offers new strategies for a more satisfying life. Following are the most How do they affect you? Are there things Have you ever experienced these feelings Psychotherapy
neurotransmitters in the brain. They are most often used when other medication isn’t Cognitive & Behavioral Therapy – The
therapist will focus on identifying and changing persistent, self-defeating thinking Electroconvulsive Therapy (ECT) – A
and behaviors. The ultimate goal is to help brief pulse of electricity is delivered through electrodes on the scalp over a period of events in their lives and learn practical skills several days to produce changes in the brain to deal with the problems they are facing. function. ECT is used only for serious (possibly life-threatening) depression and Interpersonal Therapy – The therapist
helps the caregiver self-evaluate problems in their communication, or lack of If drug therapy is recommended, a certain amount of trial and error is necessary to find caregiver will come to better understand his the right type and dosage of medication for or her own communication style and learn how to improve relationships with others. weeks before effects are felt. Good communication between patient and doctor Psychodynamic Therapy – Although
sometimes used to treat depression, this especially careful to watch for medication therapy is thought to be less effective than side effects caused from too high a dosage or the other two therapies already mentioned. Its goal is to surface deeply held conflicted feelings to better experience and understand Complementary and Alternative
Therapies
Medication and ECT Therapy
St. John’s wort. One of the most studied
alternative treatments for depressive
Selective Serotonin Reuptake Inhibitors
symptoms is St. John’s wort (Hypericum (SSRIs) (Examples: Prozac, Zoloft, Paxil) –
perforatum). It is an herb used extensively in Medications that work by stabilizing levels the treatment of mild to moderate depression of serotonin, a neurotransmitter. Low levels in Europe and is now undergoing studies in of serotonin have been linked to depression. the United States. St. John's wort extract is sold “over the counter” in the U.S. as a Tricyclics (Examples: Norpramin, Pamelor,
It is promoted as a "natural” way to improve antidepressant drugs, tricyclics increase levels of neurotransmitters in the brain. May studying it for possibly having fewer and less severe side effects than antidepressant drugs. Monoamine Oxidase Inhibitors (MAOI)
(Examples: Nardil, Parnate) – These
Yet, questions remain regarding whether St. therapies are not often used today. MAOIs John's wort really does what its promoters claim. For nonprescription drugs in the U.S. If the symptoms are strong enough to impair determining the amount of active ingredient a company puts in their product or what dose mental health professional with expertise in is right for a given person. The Food and Drug Administration issued a warning stating that St. John’s wort may affect the Physical Exercise. Exercise has been found
to reduce the effects of depression. Walking prescription drugs prescribed to treat a three times a week for 30 to 45 minutes has disease, depression, and HIV infections. If you are taking St. John’s wort or whether physical activity prevents the onset considering its use, talk with your health care provider to ensure it will not interfere with any other treatment you are receiving. sometimes difficult for caregivers. It is often seen as a “value added” activity—something Seasonal Affective Disorder. Caregivers
who feel “the blues” when confined indoors might consider adding it to your “to do” list, or in response to winter’s gray days may 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 depression.” As seasons change, there is a joining an exercise class. All the research shift in our biological internal clocks or shows that for a healthier life, it makes good circadian rhythms, partly in response to the changes in sunlight patterns. This can cause our biological clocks to be out of sync with Paying for Treatment
our daily schedules. People with SAD have a difficult time adjusting to the shortage of Private health insurance and Medicare will typically pay for some mental health care. and February, when the days are shortest. professional directly to find out if they accept your insurance for payment. Health hypothyroidism, hypoglycemia, infectious insurance providers will usually list mental mononucleosis and other viral infections. health professionals in the same insurance material that lists health plan medical doctors. Medicare recipients will find the bright fluorescent lights, has been shown to booklet titled, “Medicare and Your Mental Experts believe that the light therapy works information. See the “Resources” section of this Fact Sheet to find out how to obtain a Antidepressant medication along with other treatments, including exercise, may be The “covered services” of the insurance plan depressive symptoms seasonally, experiment inpatient (hospital, treatment center) and outpatient (professional’s office) care, how surroundings, using lamps or other sources. many visits are paid for, and at what rate of Expect your mood to improve gradually, not also have access to an Employee Assistance Program, where licensed professionals (usually psychologists and social workers) are available for confidential sessions to decisions until the depression has lifted. discuss personal or professional problems. Before deciding to make a significant transition—change jobs, get married or Caregivers without health insurance or who divorced—discuss it with others who know pay out of pocket for care will find that fees you well and have a more objective view of vary by professional, with psychiatrists charging at the higher end of the fee scale and psychologists and social workers People rarely "snap out of" a depression. But offering their services at a more moderate they can feel a little better day-by-day. rate. In some instances, a mental health Remember, positive thinking will replace center will apply a fee based on your ability the negative thinking that is part of the to pay. In any case, find out what the fee is depression. The negative thinking will be Strategies to Help Yourself
Direct assistance in providing care for your loved one, such as respite care relief, as well negative thoughts and feelings make some as positive feedback from others, positive people feel like giving up. It is important to self-talk, and recreational activities are realize that these negative views are part of linked to lower levels of depression. Look the depression and may not accurately reflect for classes and support groups available the situation. The National Institute of 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 Set realistic goals in light of the depression and assume a reasonable amount of responsibility. Sources for online depression
Break large tasks into small ones, set some screening checklists:
priorities, and do what you can as you can. National Mental Health Association
Try to be with other people and to confide in depression screening checklist
someone; it is usually better than being National Depression Screening Day
Participate in activities that may make you feel better, such as mild exercise, going to a movie or ballgame, or attending a religious, social or community event. Finding a Professional in your
Other resources:
Medicare
Psychiatrist (MD): A psychiatrist is a
to request a copy of “Medicare and Your mental illnesses, including substance abuse National Institute of Mental Health
American Psychiatric Association
Provides free information on depression and Provides free information on depression and referrals to psychiatrists in your area. other mental illnesses in English and Spanish. Psychologist (Ph.D.): Licensed to practice
psychotherapy and has special training in
Exercise Guide for Older Adults
psychological testing. Although referred to Exercise and Your Health: A Personal as “doctor,” a psychologist cannot prescribe Guide to Health and Fitness (Spanish) Exercise: A Guide for the National Institute on Aging (NIA). Includes a chapter on American Psychological Association
more information about depression or call Available free of charge. (800) 222-2225 or the toll-free number to be referred to a Licensed Clinical Social Worker
Websites
(L.C.S.W.): Has specialized training in
American Geriatrics Association
www.americangeriatrics.org/education/foru Master's degree in Social Work (M.S.W.) with two years of supervised postgraduate National Institute for Complimentary and
Alternative Medicine
nccam.nih.gov
National Association of Social Workers
www.naswdc.org
National Institute of Mental Health
Provides free information on depression and referrals to social workers in your area. National Alliance for the Mentally Ill
www.nami.org
Note: Additional professionals may be
licensed to practice psychotherapy in your
National Mental Health Association
state or county. Check with the local mental health department or hospital in your community for more information. National Library of Medicine
and the book are available by contacting Ave., Ste. N300, Portland, OR 97210, (503) 413-7706. References
Caregiving: The Spiritual Journey of
Love, Loss, and Renewal by Beth Witrogen
Gallagher-Thompson, Coon, Rivera, Powers McLeod. Published by John Wiley & Sons, and Zeiss. (1998). Family Caregiving: Stress, Coping and Intervention. Handbook of Clinical Geropsychology, Chapter 21, Caring for Yourself While Caring for
Your Aging Parents: How to Help, How
to Survive by Claire Berman. Published by
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. Resources
Ory M., Hoffman R., Yee J., Tennstedt S. and Schultz R. (1999) Prevalence and 3675 Ruffin Rd. Ste. 230, San Diego, CA 92123 (858) 268-4432; (800) 827-1008 (in CA) Nondementia Caregivers. The Gerontologist Schultz R., O’Brien A.T., Bookwala J., et al. offers services to family caregivers of brain- (1995) Psychiatric and physical morbidity impaired adults or of the frail elderly, and is effects of dementia caregiving: prevalence, correlates and causes. Gerontologist. Vol. counties. Services include: information and referral, counseling, family consultation and case management, legal and financial Recommended Reading
consultation, respite care, education and training, Caregiver-to-Caregiver Network 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 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.

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