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What is Caregiver Depression?

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Could the sadness, loneliness, or anger you feel today be a warning sign of depression? It is not unusual for caregivers to develop mild or more serious depression as a result of the constant demands you face in providing care. Some caregivers experience a return of depression that they had when they were younger.

Caregiving does not cause depression, nor will everyone who provides care experience the negative feelings that go with depression. The stress of caregiving may trigger depression. 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 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 take 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, crying, fatigue, negative thinking, and even problems with memory don’t go away.

Symptoms of Caregiver Depression

People experience depression in different ways. Some may feel a general low-level sadness for months, while others experience a more sudden and intense negative change in their outlook, sleep, memory, and other changes. The type and degree of symptoms vary by individual and can change over time.

Consider these common symptoms of depression. If you have experienced any of the following for longer than two weeks, it may indicate depression.

Coping with Caregiver Depression

Feelings of depression can sometimes be 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 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.

What to Do If You Think You Have Depression

Depression deserves to be treated with the same attention afforded to 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.

How is Depression Treated?

The first step to getting the best treatment for depression is to rule out any medical conditions. Schedule a physical examination 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 a discussion or assessment on mental status to determine if speech, memory or thought patterns have been affected.

The next step, increasingly recommended by physicians, is to meet with a mental health professional such as a psychiatrist, psychologist, licensed counselor, or clinical social worker. Most psychiatrists prescribe and manage medications to treat depression and anxiety and do not provide therapy. (For this post we will use the terms counselor or therapist and generally they provide the same mental health counseling.)

Although it is not unusual for a physician to prescribe antidepressant medication, medication alone may not be the most effective treatment for depression. 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. Many studies and scholarly articles suggest that the most effective outcomes for treating depression are a combination of antidepressants and therapy, especially CBT (Cognitive Behavioral Counseling).

How do I find a mental health professional?

Your health insurance will probably have a phone number for behavioral health or mental health on your insurance card or in your benefits package. If you are employed, look in your benefits package or online to see if your benefits include free EAP (Employee Assistance Program) counseling. These sessions may be from 1 assessment to 6 sessions. If you have health insurance you may be able to continue counseling with the same or another therapist.

Both insurance companies and EAP providers will have a list of mental health professionals that they refer to. You choose someone from the lists provided. A good way to learn about someone you are considering is to go online to the “Find a Therapist” section of psychologytoday.com. You can search by name or enter a zipcode or city and will see a list of all providers in that area. You can then read a profile that will provide information about them, including a statement that they write which gives you a better idea of the person beyond their professional credentials, education, and experience.

Other ways to find a professional is to ask your doctor, a friend, or co-worker for the name of someone they know and trust. You may also find someone by asking your minister or rabbi.

It is important to trust and feel comfortable with the professional you see. During the first session, you can determine if the counselor can meet your needs and that you can work with that person. Generally, you will determine the cost to you before you even schedule an appointment, including who will pay for the service and how many sessions are approved, especially with EAP referrals. Evaluate your progress to ensure that it continues to contribute towards your improved health and well-being. Are you feeling better?

Treatment and Coping Options

Exercise has been found to reduce the effects of depression in some people. 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.

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.

Following are the most common treatments used today:

CBT – Cognitive and Behavioral Therapy — The therapist will focus on identifying and changing persistent, self-defeating thinking and behaviors. The ultimate goal is to help caregivers recognize and enjoy positive events in their lives and learn practical skills to deal with the problems they are facing and improve the quality of their lives.

Medications – The most common antidepressant medications are Selective Serotonin Reuptake Inhibitors (SSRIs) (Examples: Prozac, Zoloft, Paxil) — These medications work by stabilizing levels of serotonin, a neurotransmitter. Low levels of serotonin have been
linked to depression. SSRIs have fewer side effects than other antidepressants, such as Tricyclics or Monoamine Oxidanse Inhibitors (MAOI). If your physician prescribes an antidepressant, ask doctors and pharmacists or go online and do your own research.

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 by too high a dosage or interactions with other medications.

Complementary and Alternative Therapies – Although research is ongoing and these therapies need to be verified for their effectiveness and discussed with a physician before using them, you may read or know someone who uses these therapies. It is highly recommended that medical care and therapy be the priorities in treating depression.

Mindfulness, meditation, and guided imagery – ongoing research is suggesting that these techniques can have an on treating depression, anxiety, and stress. The techniques involve deep breathing and shifting the person’s attention from their thoughts and experience causing their distress. See more about it by clicking here.

Meditation is a technique taught in Stress Busting Program for Family Caregivers (SBP). SBP is an evidence-based education program through the WellMed Foundation. An evidence-based program means that there is research that individuals experience positive outcomes. SBP may be provided through your local area agency on aging. Call 2-1-1. Go to this link for more information: http://www.caregiverstressbusters.org/. A 9 class series is starting in Farmer’s Branch, Dallas County, on January 11. Click here for the flyer.

Phototherapy, using specially designed bright fluorescent lights for Seasonal Affective Disorder (SAD) has been shown to reverse SAD’s depressive symptoms. This is one of the more researched therapies with evidence that it works. 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.

Experts believe that 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, talk to a doctor, and a mental health professional with expertise in treating SAD.

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.

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 to your physician to ensure it will not interfere with any other treatment you are receiving.

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 but the data is not yet confirmed that it helps.

Paying for Treatment

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. Medicare recipients will find the booklet titled, “Medicare and Your Mental Health Benefits” a helpful source of information. Veterans can call the VA.

The “covered services” of the insurance plan will specify mental health or behavioral 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.

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, social workers, and licensed counselors offering their services in the range of $100-$150 per session. Most counselors have a sliding scale and may work with you to find an affordable rate.

Community mental health options funded by federal or state money may be limited, have waiting lists, require evidence that someone cannot pay usual fees, or be non-existent. Call 2-1-1 or contact your local ADRC (Aging and Disability Resource Center).

See Part 2 next month for information about what to do for yourself, special caregiver concerns including dementia and Alzheimer’s disease, differences in men and women as caregivers, sleep and caregiving, and what may happen after placement in a facility.

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. Medicare recipients will find the booklet titled, “Medicare and Your Mental Health Benefits” a helpful source of information. Veterans can call the VA.

The “covered services” of the insurance plan will specify mental health or behavioral 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.

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, social workers, and licensed counselors offering their services in the range of $100-$150 per session. Most counselors have a sliding scale and may work with you to find an affordable rate.

Community mental health options funded by federal or state money may be limited, have waiting lists, require evidence that someone cannot pay usual fees, or be non-existent. Call 2-1-1 or contact your local ADRC (Aging and Disability Resource Center).