Never underestimate the extreme mental and physical effort that goes into caregiving. Don’t ignore your depression and exhaustion because you feel ashamed that you are even thinking about yourself, when what they are going through is so much worse. Caregivers often bottle up their feelings and put on a brave face. Commendable, but it can add to the feelings of depression and isolation. Many caregivers say they feel very alone and apart from the world. Caregiver depression is real, common, and dangerous.

Caregiving does not cause depression, nor will everyone who provides care experience the negative feelings that go with depression. But in an effort to 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 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 exact a heavy toll.

Unfortunately, feelings of depression are sometimes seen as a sign of weakness rather than a sign that something is out of balance. Comments such as “get over 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.

Researchers have found that a person who provides care for someone with dementia is twice as likely to suffer from depression as a person providing care for someone without dementia. The more severe the case 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 these situations, to receive consistent and dependable support.

Statistics indicate that one in four U.S. households provide care for aging loved ones, and some studies indicate as many as half of these caregivers experience some degree of depression.

Depression occurs among caregivers about 10 times more often than in the general population. About 60 percent of caregivers present with some symptoms of depression, and 30 to 40 percent of them are considered to have major depression.

The following are the nine classic symptoms a physician looks for when considering a diagnosis of depression. A major depressive episode is present if five or more of the following nine symptoms are present during the same two-week period. At least one of the five symptoms must be either a depressed mood or loss of interest or pleasure.

  • Persistent sadness or unhappiness
  • Fatigue or loss of energy
  • Loss of interest in previously enjoyable activities
  • Irritability or agitation
  • Sudden change in appetite or weight
  • Disruption of normal sleep pattern
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Difficulty thinking clearly or concentrating
  • Thoughts of suicide or death

In addition to the personal anguish that depressed individuals experience, high rates of depressive symptoms put people at serious risk with their physical health as well. Depression is a significant risk factor for chronic medical conditions such as heart disease, cancer and diabetes. One study found that older caregiving spouses who reported strain due to caregiving experience a 63 percent higher mortality rate than older spouses who were not caregivers.

Depression is the second highest risk factor for death among heart patients, second only to a weak ejection fraction. Thirty to 50 percent of heart patients suffer from depression, and they are six times more likely to die than heart disease patients who are not depressed.

Patients who are being cared for by depressed individuals are also at risk. They may not be given medications regularly, and they are more likely to be placed in nursing homes and other institutionalized settings, which costs society an estimated $200 billion each year.

Research has shown us that certain patient characteristics increase the caregiver’s risk of depression. Those who care for people younger than 65 years old who suffer from multiple medical problems resulting in their inability to perform two or more activities of daily living such as feeding themselves or personal hygiene are at the greatest risk. Additional risk factors include angry or aggressive behavior on the part of the patient.

The good news is that effective treatment is available. Counseling and/or medication is effective in treating 90 percent of those suffering depression, but early intervention is important. The longer and more severe the depression, the greater the health risk to the individual and the less likely they will recover. “Family members should be alert to signs of depression among the caregivers in their families and urge people to seek treatment as soon as possible”

Oftentimes, caregivers don’t seek help for their depression because they assume it is a natural consequence of caring for chronically ill loved ones and can’t be helped. Family members should be alert to signs of depression among the caregivers in their families and urge people to seek treatment as soon as possible.

Respite programs that give family members a break from their caregiving responsibilities helps as well. Families should come up with a plan to regularly relieve caregivers so they have time to take care of themselves and enjoy other activities. Research has found that caregivers who use adult day care services decreased their own care-related stress and depressive symptoms significantly.

There are also several national programs directed at supporting those who care for patients at home. The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation has funded a demonstration project in three states that issues monthly cash allowances for Medicaid recipients to hire their own caregivers, including members of their families and friends.

Older caregivers are often difficult to diagnose because they may not present with these typical symptoms of depression. They may visit their doctor with complaints of backaches or headaches and general fatigue. Experts estimate primary care physicians miss between 30 and 50 percent of the cases of depression among their aging caregiver patients.

According to Teresa Deshields, PhD, director of psycho-oncology services at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, women seem to be more programmed to be caregivers than men. Because of this programming, women are more reluctant to ask for help, believing that they should be able to do it all. Unfortunately, this isn’t the case and depression can set in.

Women, primarily wives and daughters, provide the majority of caregiving, although the number of male caregivers has risen sharply and continues to grow. Men who are caregivers deal with depression differently. Men are less likely to admit to depression and doctors are less likely to diagnose depression in men. Men will more often “self treat” their depressive symptoms of anger, irritability or powerlessness with alcohol or overwork. Although male caregivers tend to be more willing than female caregivers to hire outside help for assistance with home care duties, they tend to have fewer friends to confide in or positive activities outside the home. The assumption that depressive symptoms are a sign of weakness can make it especially difficult for men to seek help.

Whether an ill relative has been diagnosed with Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, Lou Gehrig’s disease, or a stroke, male caregivers often find their new role to be daunting and all-consuming. Most men have grown up in a household — and certainly a culture — in which females have been perceived as the primary family nurturers. Yet often by necessity, more men than ever are rolling up their sleeves and helping an ill loved one with day-to-day tasks such as dressing, toileting, bathing, eating, changing dressings, and managing medications.

Kathleen O’Brien, vice president of program services for the Alzheimer’s Association, says that many men may not have the same comfort or confidence level as women in handling the tasks of caregiving. “Some have a particularly difficult time with the more intimate care, such as a son bathing and dressing his mother,” she says.

To compound the stress in their lives, baby-boomer men may find themselves sandwiched between elder care and child care, and as they juggle work, family, and the needs of an aging parent, their stress and frustration can often turn into anger, despair, exhaustion, and burnout.

In confronting the responsibilities before them, men are more likely than women to delegate some of the caregiving responsibilities to others — either to other family members, or to outside help who they’ve hired to handle many of the home-care duties.

“Some men feel that they don’t have to do it all on their own, and they’re better than women at saying, ‘I need some help with this — you do this part, and I’ll do that part,'” says Carole Cohen, MD, associate professor of psychiatry at the University of Toronto. “In the work world, they may have become accustomed to this kind of delegating, whereas women of the same generation may be less likely to feel that it’s OK to get help.”

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