Caregiving: Stress And Depression

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Caring for someone you love can lead to a lot of extra stress in your life. Although you have responsibilities to your loved one, it's especially important for you to remember not to neglect yourself. If left unchecked, stress can lead to or be a symptom of depression.

A depressed mood is a normal reaction to loss, life's struggles, or an injured self-esteem. Sometimes, though, depression becomes intense, lasts for long periods, and can prevent a person from leading a normal life. Depression that has these characteristics is a treatable condition called major depressive disorder, one of a number of depressive illnesses.

If you suffer from depression, it's important to remember that depression is a medical disorder that can be successfully treated. It is not a personal weakness, nor a sign that you are unable to care for your loved one. Early treatment is important for many reasons, including:

• Without treatment, depression can become worse.
• Untreated depression can lead to suicide.
• Without treatment, people who suffer from episodes of depression often do not fully recover.
• Treatment can prevent depression from coming back.
• Your depression may be the sign of another illness that, without treatment, can get worse.

Symptoms of Depression

Here's a list of common signs of depression. If these symptoms last for more than two weeks, see your doctor.

• An "empty" feeling, ongoing sadness, and anxiety.
• Mental or physical tiredness or lack of energy.
• Loss of interest or pleasure in activities that were once pleasurable.
• Decreased sex drive or sexual dysfunction.
• Change in sleep patterns, including very early morning waking, insomnia, or increased need for sleep.
• Problems with eating and weight (gain or loss).
• Recurrent episodes of crying.
• Aches and pains that just won't go away.
• Difficulty focusing, remembering, or making decisions.
• Feeling that the future looks grim; feeling guilty, helpless or worthless.
• Feeling irritable or stressed.
• Thoughts of death or suicide; a suicide attempt.
• Stomach ache and digestive problems.

Treatment for Depression

More than 80% of people with depression can be treated successfully with antidepressant medication, psychotherapy, or a combination of both.

There is not just one cause of depression. It is a complex disease that can occur as a result of a multitude of factors. Depression is believed to be associated with chemical imbalances of the brain. These chemicals, called neurotransmitters, are responsible for helping to communicate messages from brain cell to brain cell. Antidepressant medicines work by increasing the amount of neurotransmitters that are available. This ultimately results in improved communication between the brain cells, called neurons. There are many antidepressant medicines available to treat depression.

Psychotherapy involves talking to a licensed professional who helps the depressed person focus on the behaviors, emotions, and ideas (including negative thought patterns) that contribute to his or her depression. Through therapy, patients learn to understand and identify the problems, events, or situations (such as caring for an ill or elderly loved one) that may contribute to depression, and understand which aspects of those problems they may be able to solve or improve. Therapy also helps the patient regain a sense of control and pleasure in life.

When Should I Get Professional Help?

Seek professional help if you experience one or more of the following:

• Symptoms of depression that last more than two weeks.
• A noticeable decline in work or school performance.
• Excess anxiety.
• Alcohol or drug abuse.
• Inability to cope with demands of daily life.
• Irrational fears.
• Obsessive preoccupation with food and fear of becoming obese with no relationship to actual body weight.
• Significant change in sleeping or eating habits.
• Persistent physical ailments and complaints.
• Suicidal thoughts or urge to hurt others.
• Self-mutilation, self-destructive or dangerous behavior.
• Sustained withdrawn mood or behavior.

Preventing Depression

There are a few practical steps you can take to prevent depression. Being physically fit and eating a balanced diet are ways to help avoid illnesses that can bring on disability or depression. By following your doctor's directions on using medicines, you may lower the risk of depression as a drug side effect. It also is important to seek help when you first begin to feel overwhelmed by your caregiving responsibilities or notice any changes in your health, thinking, or behavior.

Reviewed by The Cleveland Clinic Department of General Internal Medicine.

Reviewed by Celia E. Dominguez M.D. WebMD, January 2008.