Caregiver Stress and Depression
By Daniel Wimer, RN, PLC
Overview
Depression is normal in life changing moments. Whether trauma is physical or emotional it is normal to have temporary depression during and following trauma in our life. The problem can be grief, losing one’s job, finding out your loved one has Alzheimer’s, a heart attack, cancer, or a stroke, the list is endless yet has a huge impact on the affected. Depression affects both the caregiver and the receiver of care.
The National Institute of Mental Health (NIMH) estimated that 14-17 million people, in the USA, have a form of depression. Mostly the depression is short lived less than 3 months and lifts by itself. The American Psychiatric Association (APA) uses a manual called the “Diagnostic and Statistical Manual of Mental Disorders, 4th, Edition, Text Revision,” or simply DSM-IV-TR. In truth the manual is written by the American Psychology Association (APA) for the APA under contract. DSM-IV is the source for making diagnoses about mental problems.
The most common types of depression disorder include major depression disorder. Dysthymia is less severe but with chronic symptoms that do not completely disable, but preventing one feeling well or good about them. Bipolar disorder has cycling mood swings from depression to mania. Psychotic depression is coupled with psychosis. Postpartum depression goes with childbirth which strikes 10-15% of new mothers in about one month after childbirth.
Depression is a Real Problem
While statistics show that women have more depression, I think that the stats are skewed because men try to hide their depression. They think that it is not manly to show depression they think that it is a sign of weakness to have psyche problems.
What are the signs of depression? According to the DSM-IV, depression is diagnosed when five or more of the following symptoms of depression are present for most of the day for least two weeks. The following are the usual symptoms:
Continual sad, anxious, or empty mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in activities that were once enjoyed
Decreased energy, fatigue, being slowed down
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss, or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment
Mania (severe highs-abnormal or excessive excitement)
Mania including unusual irritability, grandiose notions, racing thoughts, etc.
Survivors and their caregivers often suffer depression but not at the same time. The caregiver usually lags behind the survivor. They often suffer, especially survivors, a long term form of depression called, Dysthymia. In an article appearing in Stroke Connection Magazine-Sep/Oct 2003 titled “Depression trumps Recovery.”, Dr. Mark Huang of the Rehabilitation Institute of Chicago writes:
“Some survivors who are depressed may not find the motivation to work in rehabilitation. They feel discouraged and hopeless. Hey may feel fatigue, sleep poorly, and they don’t eat well… Their thinking skills are also affected by depression. They have a hard time concentrating in rehabilitation. Their attention to detail is affected was well. Treating depression can improve thinking skills. The rehab team needs to be on the lookout for depression. They need to notice the survivor’s mood and participation level.”
Dr. Robert Robinson in the same article writes:
“Several studies demonstrate that most (emphasis mine) patients who suffer depression after a stroke do not receive treatment for it. Many doctors, as well as family members, tend to explain away depression as an understandable response to the loss and impairment stroke produces.
Depression can be effectively treated whether it is the result of biochemical change in the brain or it is psychological reaction to the stroke. He stresses, ‘It is so important for family members and caregivers to make sure that survivors do not explain away their depression and deny they need treatment because is ‘understandable.’”
Treating depression not only improves the survivor’s mood, it improves their physical recovery and their cognitive or intellectual recovery as well.
The sad fact is that most MD’s rely on information from drug representatives on the prescribing of antidepressants. The results are ‘Me-To-Drugs’ that are sold to doctors as the new cure. ‘Me-To-Drugs’ are basically the same but with minor changes in the chemistry so that the drugs can be patented. The MD-Family Practice or Internist does not have the time to study all of the new drugs and they rely on the drug reps’ to inform them what is what. The drug reps do not lie but they do not tell the whole story either. The results are that most depression symptoms are misdiagnosed or they are given the wrong medicine or the wrong dosage. Even worse often they do not stay on the medicine long enough to do any good. Then the caregivers pressure the MD’s to try a new medicine, and thus the cycle start over.
Help is on the Way
The caregiver and the survivor need to understand the depression is normal following life changing events. It is better to ask for help that you do not need rather than ‘toughing it out.’
The survivor needs to be honest in his or hers thoughts and feelings
The time to seek a Psychiatrist is at the start of the event, if his thinks one does not need his services, to much the better.
Psychiatrist’s goal is to eventually not need him
Caregivers should try to recognize the signs of depression not only in the survivor but in themselves.
Dysthymia can slowly slip upon you
Ask for ask for help from friends and family
Medicare and most insurances provide respite care for the caregiver, use it
You are not alone blog for support groups
Afterword
1. You should be able to recognize the signs of Depression
2. You should be able to recognize the signs of Dysthymia
3. Have a understanding of how that Depression affects the course of treatment
4. Seek professional help sooner rather than later
5. “Depression Trumps Recovery
Reprint Permission-If this article was helpful you are invited to share it with you own list at work or church, forward it to friends and family, or post it on your blog. Just leave intact and do not alter this in way. Please include the following paragraph in your reprint.
“Reprinted with permission from D.E .Wimer, RN and Associates, Inc (copyright @ 2009 by D.E. Wimer, RN and Associates, Inc, in Florida 813-997-6564)”
About the Author-Daniel “Dan “Wimer is dedicated to helping you achieve the maximum results in your personal and professional life. He is a Registered Nurse with over 20 years of experience in Psychiatric Nursing, and Professional Life Coach, with a BA in Psychology. Dan is a Communicator and a member of the National Speaker Associates of Central Florida. Dan is a “3 Time Stroke Survivor” who specializing in motivational survival skills for business and the individuals. His blog is Daniel Wimer- Professional Life Coach.
