Fact sheet : caregiving and depression

Fact Sheet
Caregiving and Depression
mental health professional ma help to prevent the Could the sadness, loneliness or anger you feel
development of a more serious depression over time. today be a warning sign of depression? It’s possible. It is not unusual for caregivers to develop mild or Symptoms of Depression
more serious depression as a result of the constant demands they face in providing care. People experience depression in different ways. Some may feel a general low-level sadness for Caregiving does not cause depression, nor will months, while others suffer a more sudden and everyone who provides care experience the negative intense negative change in their outlook. The type feelings that go with depression. But in an effort to and degree of symptoms vary by individual and can provide the best possible care for a family member or change over time. Consider these common symptoms friend, caregivers often sacrifice their own physical of depression. Have you experienced any of the and emotional needs and the emotional and physical experiences involved with providing care can strain even the most capable person. The resulting feelings • A change in eating habits resulting in of anger, anxiety, sadness, isolation, exhaustion—and then guilt for having these feelings—can exact a • A change in sleep patterns—too much sleep Everyone has negative feelings that come and go over time, but when these feelings become more intense and leave caregivers totally drained of • A loss of interest in people and/or activities 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. • Feeling that nothing you do is good enough Unfortunately, feelings of depression are often seen • Thoughts of death or suicide, or attempting as a sign of weakness rather than a sign that something is out of balance. Comments such as “snap • Ongoing physical symptoms that do not out of it” or “it’s all in your head” are not helpful, respond to treatment, such as headaches, and reflect a belief that mental health concerns are not real. Ignoring or denying your feelings will not make them go away. Special Caregiver Concerns
Early attention to symptoms of depression through What do lack of sleep, dementia and whether you are exercise, a healthy diet, positive support of family male or female have in common? Each can contribute and friends, or consultation with a trained health or in its own way to a caregiver’s increased risk for depression. 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 Dementia and Care
Researchers have found that a person who provides • Men who are caregivers deal with
care for someone with dementia is twice as likely to depression differently. Men are less likely to
suffer from depression as a person providing care for admit to depression and doctors are less likely someone without dementia. The more severe the case to diagnose depression in men. Men will more of dementia such as that caused by Alzheimer’s often “self treat” their depressive symptoms disease, the more likely the caregiver is to experience of anger, irritability or powerlessness with depression. It is critical for caregivers, especially in these situations, to receive consistent and dependable female caregivers to hire outside help for assistance w Caring for a person with dementia can be
have fewer friends to confide in or positive all consuming. It is different from other types
of caregiving. Not only do caregivers spend
activities outside the home. The assumption significantly more hours per week providing weakness can make it especially difficult for personal stress, mental and physical health problems, less time to do the things they • Lack of sleep contributes to depression.
enjoy, less time to spend with other family While sleep needs vary, most people need eight hours a day. Loss of sleep as a result of nondementia caregivers. As stressful as the caring for a loved one can lead to serious deterioration of a loved one’s mental and depression. The important thing to remember physical abilities may be for the caregiver, is that even though you may not be able to get dealing with dementia-related behavior is an your loved one to rest throughout the night, you can arrange to get much needed sleep. symptoms of depression. Dementia-related Hiring a respite worker to be with your loved one while you take a nap or finding a care center or scheduling a stay over with another family member for a few nights are ways to a caregiver to get rest or assistance in • Women experience depression at a higher
• Depression can persist after placement in a
rate than men. Women, primarily wives and
care facility. Making the decision to move a
daughters, provide the majority of caregiving. loved one to a care center is very stressful. In the United States, approximately 12 million While many caregivers are finally able to women experience clinical depression each catch up on much needed rest, loneliness, year, at approximately twice the rate of men. guilt and monitoring the care a loved one A National Mental Health Association survey receives in this new location can add new on the public’s attitude and beliefs about stress. Many caregivers feel depressed at the clinical depression found that more than one- time of placement and some continue to feel half of women surveyed still believe it is People assume that once caregiving is over, the stress from providing hands-on care will go away. Yet, also find someone by asking your minister or rabbi, continued to experience depression and loneliness. In 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 What to Do If You Think You Have
Professional in your Area” in this fact sheet.) Depression
It is important to trust and feel comfortable with the Depression deserves to be treated with the same professional you see. It is not uncommon to request a or high blood pressure. If you feel uncomfortable determine if the professional is the right match for using the term depression, tell the professional that you are “feeling blue” or “feeling down.” The professional will get the message. The important insurance will pay and how m ny scheduled sessions therapist. Any treatment should be evaluated regularly to ensure that it continues to contribute depression. If you suspect this is the case with yo towards your improved health and growth. loved one, look for an opportunity to share your concern with him Questions to Expect in a Mental Health
about it with you, encourage a trusted friend to talk Exam for Depression
with them or consider leaving a message for their doctor regarding your concern prior to their next How is Depression Treated?
When did you first notice these symptoms? The first step to getting the best treatment for depression is to meet with a mental health professional such as a psychiatrist, psychologist, or things you don’t or can’t do anymore? 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. 2. How often do you use alcohol or drugs (both prescription and nonprescription) to help Although it’s not unusual for a physician to prescribe antidepressant medication, medication alone may not be the most effective treatment for depression. The 3. Have you had any thoughts about death or guidance of a mental health professional throughout your treatment is strongly recommended. The therapist or counselor will listen to your concerns, 4. Do you have any family members who have screen you for symptoms of depression and assist you in setting up an appropriate course of treatment. 5. If so, did they receive treatment? What type? One way to find a professional is to ask a friend for the name of someone they know and trust. You may 6. Have you experienced any serious loss, Medication and ECT Therapy
difficult relationships, financial problems or other recent changes in your life? n Reuptake Inhibitors
Selective Serotoni
(SSRIs) (Examples: Prozac, Zoloft, Paxil) –
7. Is there anything else you’d like to add to help edications that work by stabilizing levels serotonin, a neurotransmitter. Low levels of serotonin have been linked to depression. Treatment Options
Fewer side effects than tricyclic medications. Upon review of the physical and mental evaluation, a • Tricyclics (Examples: Norpramin, Pamelor,
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 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 dication, which provides relatively quick symptom other medication isn’t effective or tolerated. relief, in conjunction with ongoing psychotherapy, which offers new strategies for a more satisfying life. • Electroconvulsive Therapy (ECT) – A brief
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
therapist will focus on identifying and changing persistent, self-defeating thinking If drug therapy is recommended, a certain amount of and behaviors. The ultimate goal is to help trial and error is necessary to find the right type and dosage of medication for each individual and it m y caregivers recognize and enjoy positive events in their lives and learn practical skills take several weeks before effects are felt. Good communication between patient and doctor is important. Older adults should be especially careful • Interpersonal Therapy – The therapist helps
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 them. 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 reducing or alleviating symptoms of depression. It is and less severe side effects than antidepressant dr unknown whether physical activity prevents the onset of depression or just helps modify the effects. Yet, questions remain regarding whether St. John's Arranging time for exercise is sometimes difficult for wort really does what its promoters claim. For caregivers. It is often seen as a “value added” nonprescription drugs in the U.S. there are no activity—something to do when everything else is established criteria for determining the amount of done. You might consider adding it to your “to do” active ingredient a company puts in their product or list, asking a friend to give you a “walk date” each what dose is right for a given person. The Food and week as a gift, or requesting that your doctor write a Drug Administration issued a warning stating that St. prescription for walking or joining an exercise class. John’s wort may affect the metabolic pathway used All the research shows that for a healthier life, it by many prescription drugs prescribed to treat a makes good sense to make time for exercise. number of conditions, including heart disease, depression, and HIV infections. If you are taking St. Paying for Treatment
John’s wort or considering its use, talk with your health care provider to ensure it will not interfere Private health insurance and Medicare will typically with any other treatment you are receiving. pay for some mental health care. It’s best to call the mental health professional directly to find out if they Seasonal Affective Disorder. Caregivers who feel
accept your insurance for payment. Health insurance “the blues” when confined indoors or in response to providers will usually list mental health professionals winter’s gray days may suffer from Seasonal in the same insurance material that lists health plan medical doctors. Medicare recipients will find the depression.” As seasons change, there is a shift in our booklet titled, “Medicare and Your Mental Health biological internal clocks or circadian rhythms, partly Benefits” a helpful source of information. See the in response to the changes in sunlight patterns. This “Resources” section of this Fact Sheet to find out 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 The “covered services” of the insurance plan will winter months. SAD symptoms are most pronounced specify mental health coverage for inpatient (hospital, in January and February, when the days are shortest. treatment center) and outpatient (professional’s SAD is often misdiagnosed as hypothyroidism, office) care, how many visits are paid for, and at hypoglycemia, infectious mononucleosis and other what rate of reimbursement. Employed caregivers may also have access to an Employee Assistance Program, where licensed professionals (usually 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 Caregivers without health insurance or who pay out medication along with other treatments, including of pocket for care will find that fees vary by exercise, may be helpful as well. If you experience professional, with psychiatrists charging at the higher end of the fee scale and psychologists and social with increasing the light in your surroundings, using workers offering their services at a more moderate lamps or other sources. If the symptoms are strong rate. In some instances, a mental health center will enough to impair your day-to-day functioning, seek apply a fee based on your ability to pay. In any case, out a mental health professional with expertise in find out what the fee is up front to avoid any Physical Exercise. Exercise has been found to
Strategies to Help Yourself
reduce the effects of depression. Walking three times a week for 30 to 45 minutes has been linked to Depressive disorders can make one feel exhausted, and coping strategies needed for caregiving. For your helpless and hopeless. Such negative thoughts and health and the health of those around you, take some 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 Sources for online depression screening
situation. The National Institute of Mental Health checklists:
offers the following recommendations for dealing National Mental Health Association depression
screening checklist
• Set realistic goals in light of the depression National Depression Screening Day website
• Break large tasks into small ones, set some Finding a Professional in your area:
priorities, and do what you can as you can. Psychiatrist (MD): A psychiatrist is a medical doctor
• Try to be with other people and to confide in who specializes in the diagnosis, treatment, and prevention of mental illnesses, including substance • Participate in activities that may ma • American Psychiatric Association
feel better, such as mild exercise, going to a 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 psychological testing. Although referred to as “doctor,” a psychologist cannot prescribe deciding to make a significant transition—change jobs, get married • American Psychological Association
it with others who know you well and have a (800) 964-2000Visit APA's website for more information about depression or call the toll- People rarely "snap out of" a depression. But free number to be referred to a psychologist in they can feel a little better day-by-day. • Remember, positive thinking will replace the Licensed Clinical Social Worker (L.C.S.W.): Has
specialized training in human behavior, fa ily Master's degree in Social Work (M.S.W.) with two years of supervised postgraduate work providing • Let your family and friends help you. • 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 depression. Look for classes and support groups available through caregiver support organizations to help you learn or practice effective problem-solving Gallagher-Thompson, Coon, Rivera, Powers and Zeiss. (1998). Family Caregiving: Stress, Coping and Intervention. Handbook of Clinical Geropsychology, hospital in your community for more information. National Institute of Mental Health (2001). Depression. Publication No. 00-3561, Bethesda, MD. Other resources:
National Institute of Mental Health (2001). Women Hold Up Half the Sky. Publication No. 01-460,7 Medicare
Call 1-800-MEDICARE (1-800-633-4227) to request Ory M., Hoffman R., Yee J., Tennstedt S. and a copy of “Medicare and Your Mental Health Schultz R. (1999) Prevalence and Impact of Caregiving: A Detailed Comparison Between Dementia and Nondementia Caregivers. The National In
te 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) 719- American Geriatrics Association
ourney of Love, Loss,
Caregiving: The Spiritual J
National Institute for Complimentary and
and Renewal by Beth Witrogen McLeod. Published
Alternative Medicine
by John Wiley & Sons, Inc., New York, NY. Caring for Yourself While Caring for Your Aging
National Institute of Mental Health
Parents: How to Help, How to Survive by Claire
Berman. Published by Henry Holt and Company, Inc. 115 West 18th Street, New York, NY 10011. National Alliance for the Mentally Ill
www.nami.org
Resources
National Mental Health Association
Family Caregiver Alliance
785 Market Street, Suite 750 San Francisco, CA 94103 National Library of Medicine
www.nlm.nih.gov/medlineplus/druginformation.html References

and caregiving issues and provides assistance in the development of public and private programs for caregivers. Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer's disease, stroke, Through its National Center on Caregiving, FCA head injury, Parkinson's and other debilitating offers information on current social, public policy 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 Health Care Services. 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. 12-12

Source: http://www.caregiveroc.org/wp-content/uploads/2011/06/Caregiving-and-Depression-Fact-Sheet-Rev-12-12.pdf