Caregivers and Depression

Life feels so heavy.  It's as if there is a gray cloud that hovers over everything I do." 
Decision making has become so frightening  for me. I think I'm losing my mind." 
"I wish I could sleep forever."

If you recognize these feelings in yourself, and if you've been feeling this way day after day, month after month, even year after year, you may be suffering from something more than a simple case of "the blues." You may have a mood disorder - and you may be suffering from depression.

Many caregivers, whose lives have been radically and unexpectedly changed by caring for an ill or disabled loved one, slip into depression disorders. In fact, virtually half of the respondents to the NFCA caregiver survey said they have experienced prolonged depression because of their caregiving responsibilities.  So you're definitely not alone. That in and of itself may not make you feel any better, but here's something that will.  Depression is an illness, and it can be cured. You don't have to go through the rest of your life feeling sad and miserable. Here is a look at the types of depression you may experience as a caregiver, and how you can get help.

Depression: Types and Symptoms 
The word depression is a handy catch-all and most people use it to describe anything from a bad mood to severe psychological disorders. Caregivers are likely to experience two general types of depression.

The first is a mild form of depression that just won't go away. It's called dysthymic disorder (DO) and is characterized by feelings of sadness, anxiety, and lack of energy.

If you are suffering from DO, you are likely to find it difficult to concentrate, your sleep may be disturbed, and you might either have a poor appetite or compulsively overeat. You may develop feelings of hopelessness, and the sense that nothing you do can make things better.  What transforms these symptoms from a temporary case of the blues into a true mood disorder is their duration.  DO sufferers do not see their sadness diminish as time goes by; instead these bleak feelings persist unremittingly, year after year, affecting every area of their lives.

The second type of depression is far more serious. Known variously as unipolar depression, major affective disorder, or major depression, this form of clinical depression is truly debilitating. The symptoms are similar to those of DO and include hopelessness, sleep and appetite disturbances, loss of energy and concentration, feelings of worthlessness, lack of self-esteem and, not uncommonly, recurrent thoughts of suicide. The difference is they occur with such severity and force that, unlike DO sufferers, victims of major depression may be completely robbed of their ability to function.

"When I was suffering from severe depression," recalls one caregiver, "I didn't want to get out of bed. I would lie there and drift in and out of sleep, wishing my life away."

To help gauge what feelings you may be experiencing and if they relate to depression, take this depression self-assessment screening.

Why Us?
It's not surprising that so many caregivers get depressed. As a caregiver, you are in a uniquely difficult position. Often the sympathy and concern of friends and healthcare providers is focused on the care recipient.  Little or no attention is paid to how you may be affected by the very upsetting changes that have occurred in your life. You become progressively caught up in the web of an illness not your own, and as time goes on you may begin to feel lonely and unappreciated. Sound familiar? These feelings, coupled with the knowledge that your caregiving duties might well last a lifetime, set you up as a prime target for mood disorders. Add to this the fact that women are more prone to depression than men, and that the majority of caregivers are women, you can begin to feel like a walking time bomb.

“The tragedy of a debilitating illness goes far beyond the patients themselves," explains Dr. Karl Hawver.  "Caregivers suffer the loss of their dreams, just the way the patient does, and this can make them angry and resentful." These feelings of loss and disappointment can manifest in different ways.

Some caregivers don't acknowledge how upset they are but they develop physical symptoms, such as headaches, back pain, and chronic fatigue. "These are real physical ailments," agrees Dr. Hawver, "but they're due to the underlying sadness. They won't be cured until the true emotional problem is faced and dealt with."

For other caregivers, there is an insidious, steady sapping of their energy and enjoyment of life.  Slowly but surely their lives become marked by unhappiness, and it all happens so gradually they're not even sure how or when they became so sad. "Caregivers can spend so much time giving care that they neglect tending to their own needs," Dr. Hawver cautions. "The result is that their lives become devoid of gratification, and they sink into a profound despair."

Not All Caregivers Get Depressed
Of course, just because you are a caregiver doesn't mean you will automatically be afflicted with a mood disorder.  Remember, only half of the survey respondents said they had experienced prolonged depression; the other half had not.

A number of elements are thought to influence a person's susceptibility to forms of depression. Genetic predisposition, family history, childhood history of parental loss, and recent stressful life events (other than those associated with caregiving) all may play a causal or exacerbating role. Individually these circumstances may not cause you to have depressive episodes, but in concert they just may be enough to bring on those feelings of sadness and inadequacy that afflict depression sufferers.

If you are one of the millions of people who have suffered from depression, you can ask "why me?" but you may never truly know the answer.  The more important question to ask, and the one for which there is an answer, is what can you do about depression once it has seemingly taken over your life?

The Most Important Step: Seeking Help
Seeking treatment is often complicated by a number of factors. The very symptoms of depression, such as lethargy and hopelessness, can strip you of your will and determination to get help. You may be embarrassed by what you believe is the stigma of depression, and simply deny that anything is wrong. Or perhaps you've been blue for so long that you think it's only normal to feel bad. These can all keep you from taking that most important first step - seeking help.

Realize that even the simplest act can set you on the road to recovery, and that may be all you are up to at first. Just telling a friend or family member about your feelings or making a list of all the things that are bothering you can start the process.  Talking to your boss about removing work pressures can also help.  These first steps can be catalysts in moving you toward the professional support you need.

Getting Professional Help
Once you do begin to look for professional help, whom do you call? There is no single right answer for everyone, but there are some general points to keep in mind. First, it is wise to seek help from a mental health professional who is used to dealing with depression. The three main types of licensed therapists are psychiatrists, psychologists, and social workers.

A psychiatrist is a medical doctor specializing in the diagnosis and treatment of mental illness. A clinical psychologist has an advanced degree in psychology (an MA or PhD) and has experience working one-on-one with patients in psychotherapy sessions. A clinical social worker usually has a master's degree in social work and is likely to have the initials MSW or LCSW after their name. They too may have done extra training in psychotherapy. Of these, only a psychiatrist is trained and licensed to prescribe medication. Keep in mind that anyone can call himself a "psychotherapist." That's why it's best to stay within the three specialties mentioned here because they are all licensed and regulated by the state.

The type of treatment you need will vary with your condition, and the type of treatment you receive will vary with the methods of your therapist. Two short-term therapies designed specifically for depression have gained some prominence in recent years. Cognitive therapy, developed by Dr. Aaron Beck, is based on the theory that your thoughts and ideas determine your moods and emotions.  By modifying your ideas, your moods will also be changed.  Interpersonal psychotherapy, developed by Drs. Gerald Klerman and Myrna Weissman, puts the emphasis on your social relationships as well as developmental, biochemical, and genetic factors, to improve your self-concept and, ultimately, your mood. Many people respond best to psychoanalytic psychotherapy,  which may be longer term but which provides a much deeper understanding of the root causes of the depression. It may take some trial and error to find the therapy that is right for you. Depression disorders involve a complex combination of factors, and unfortunately there is no single magic treatment for everyone.

If you are suffering from clinical (major) depression you may require medication to counteract the chemical imbalance that has occurred in your body. The good news is that antidepressant medications are effective 70% of the time. However, not everyone responds to these medications in the same way, and what works for one person will not necessarily help another. "The first medication my doctor prescribed didn't help much at all" recalled a longtime caregiver with severe depressive symptoms. “The second one, however, worked like a charm. In three days I started feeling like my old self again."

If the thought of trying to figure out how you'll ever find exactly the right treatment seems too daunting, don't be discouraged. "The most important thing is to realize you need help and reach out to get it," says Dr. Hawver. "Once you've started, keep seeking help until you find the answer for you. It does exist."

Life After Depression
If there is one overriding point to be made it is that you don't have to live with depression. Dr. Hawver explains, "You can restore balance to your life. Through therapy you can grieve for what you have lost, and come to replace your anger and sadness with acceptance." Freed from the draining effects of depression, you can accept not only the realities of your life as a caregiver, but its possibilities as well.

Dr. Jean Robinson believes that overcoming your adversity can give you a sense of purpose. "Often it's the people who have weathered these difficult times who are best able to help others," she says. Dr. Robinson speaks from personal experience. The mother of a daughter with a dual diagnosis of epilepsy and severe learning disabilities, she went through the anger, anguish, and pain of caring for a child whose problems strained all of her resources.

“I learned that finding a way to contribute is a way of transcending your misfortune," she states. "You may just touch one other person, or many, but your effort is worthwhile and your help is invaluable. In reaching out to help others, you discover a part of yourself you might otherwise never have known."

If you think you are suffering from depression, or know someone who is, get help. Depression is curable, but you can't do it alone. There are resources that can start you down the path to recovery and a happier life.