In recognition of National Depression Screening Day today, I shine the light on the dark shadows of caregiver depression. According to authors Elisabeth Kübler-Ross and David Kessler, On Grief and Grieving, depression is one of the five stages of grief. As a caregiver, you may have periods of feeling blue or being defeated about not being able to fix what is wrong with your loved one. Or perhaps it is sadness that leads to depression over the fact that life and your relationship with your loved one has changed forever. While approximately 9 percent of the population suffers from some type of depression according to the Centers for Disease Control (CDC), a survey conducted by Caring.com found more than double the national average – 1 in 4 caregivers of older loved ones – experiences depression.
When do you know if your depression is situational depression versus the more serious clinical depression?
Situational or Serious Depression?
According to the American Psychological Association (APA), depression is more than just sadness or grief – it is the most common mental disorder but it is also treatable. People with depression experience a lack of interest or pleasure in daily activities, significant weight gain or loss, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurring thoughts of death or suicide. The APA also warns social isolation increases the risk of depression. Since caregivers often feel isolated, the slippery slope of grief becoming long-term depression may be a real risk.
Yet depression during the decline and after the loss of a loved one is a normal response during the grieving process – it is called situational depression. It only becomes a serious mental health issue when it continues beyond the normal limits of mourning.
What is normal? The APA identified a spectrum of depression disorders with the most severe type being major depressive disorder. Clinical depression is defined as the inability to defeat depression and get to the last stage of grief – Acceptance – or when depression comes on suddenly for no apparent reason and will not depart.
Sara Honn Qualls, professor of psychology at the University of Colorado at Colorado Springs, says, “A clinical state of depression is different from grief and there is no strong evidence that the stages of grief occur sequentially – they tend to cycle or occur simultaneously.” She goes on to say caregivers who are not getting any pleasure from their lives are at risk for depression. She advises any caregiver who is struggling to care for herself or cannot let go of her loved one even after death needs professional intervention.
How Can Caregivers Get Help Defeating Depression?
Throughout our caregiving journey, we may experience varying degrees of depression. It is hard to watch a loved one suffer or face death, even harder after we lose him to illness. It is difficult to be a parent to a special needs child or be caring for a loved one with an illness or disorder that has social stigma attached such as AIDS, post traumatic stress disorder (PTSD), bi-polar disorder or schizophrenia.
When I recently spoke to former First Lady Rosalynn Carter, a longtime mental health and caregiving advocate, she expressed encouragement that there is more awareness of mental illness but concern that recent events continue the stigma of mental health for those affected and for their family caregiver.
“There was a poll done recently that showed the stigma is lifting around depression but we have a long way to go,” says former First Lady Rosalynn Carter, a lifelong caregiver and mental health advocate. “More people learn about certain issues – schizophrenia, bi-polar disorder, depression – but they become more uneasy about it.”
She expressed her concerned of certain events, such as the shooting spree in summer 2012 in a Colorado theater that killed 12 people followed almost a month later with another shooting at the Sikh temple in Milwaukee, only increases people’s fears about people with mental health issues. This in turn makes it difficult for caregivers of those with mental illness or who may be suffering from their own depression to reach out for help.
While our society struggles with understanding the impact of mental health issues, there are three things caregivers can do to ensure their depression is only a visitor during their caregiving journey who does not take up permanent residence:
- Professional therapy typically provided by a licensed psychologist –Qualls recommends caregivers first get a physical exam from their primary care physician to ensure there are no other health issues impacting emotional health. Your doctor can make a recommendation on seeing a specialist if needed. A psychiatrist is a health care professional with a medical degree who has studied disorders of the brain. Typically psychiatrists will treat patients with medications. In contrast, a psychologist is someone who has studied the pyscho-social behavioral aspects of emotional health. They will be more focused on problem-solving techniques through therapy and counseling. Whichever type of health care professional you choose, ensure he understands caregiving, as this is the core of why you need help.
- Prescription drugs to treat depression – If your doctor prescribes medication, the most common antidepressant pharmaceutical category is SSRI (selective serotonin reuptake inhibitor). The World Health Organization predicts by 2030 more people worldwide will be suffering from depression than any other health disorder. And 1 out of 10 Americans, including many children, are currently taking anti-depressant medications.
- Support group help – It is important to find and join support groups specific to your caregiving situation. For instance, if your loved one has dementia, join an Alzheimer’s Association support group. If you are misusing alcohol to cope with your depression, then perhaps try a group specific to your substance abuse issue such as Alcoholics Anonymous.