Alzheimer’s and Depression Among Caregivers: An Interview with Dr. Deborah Serani

Merely Me Health Guide November 03, 2011
  • Last year President Barack Obama declared that November be recognized as National Alzheimer's Disease Awareness Month. November is also National Family Caregivers Month. Check both the National Alzheimer’s Association  and the National Families Caregiver’s Association for local Alzheimer’s awareness events and activities in your area. To do our part Health Central is asking writers from our various sites to join in on promoting awareness of Alzheimer’s disease and overlapping conditions. Depression is one of the possible co-morbid conditions of Alzheimer’s disease. It is also extremely common for caregivers of the individual with Alzheimer’s to suffer from depression. In this post we are going to focus on the mental health of friends and family members who take care of their loved one with Alzheimer’s.

     

    As expert Jacqueline Marcell reports, depression can be prevalent in caregivers of loved ones with dementia.  She cites a statistic that shows that caregivers of loved ones suffering from dementia are twice as likely to suffer from depression as those providing care for non-dementia patients. If you are such a caregiver there is help and support. We have invited Dr. Deborah Serani, author of Living with Depression: Why Biology and Biography Matter Along the Path to Hope and Healing and practicing psychotherapist, to answer questions about how caregiver’s can combat depression.

     

    To find out more about Dr. Deborah Serani please visit her blog, Dr. Deb: Psychological Perspectives.

     

    Q: Why are so many caregivers and especially those who care for a loved one having Alzheimer’s Disease more at risk for developing depression than the general population?

     

    Dr. Serani: Over 65 million people in the United States are caregivers to someone 50 years of age or older. Caring for another person, in addition to your own self and household, presses heavily on the caregiver’s life. In fact, The National Family Caregiving Association found that 61% of caregivers providing at least 20 hours of caregiving per week suffer from depression. Moreover, caregivers who look after adults with Alzheimer’s are at a significantly greater risk for depression than those who are caregivers to those with other chronic illnesses. Studies remark that it’s not the cognitive decline in Alzheimer’s that is difficult for caregivers to deal with, but rather the anger, aggressiveness, agitation and behavioral changes they experience on a daily basis. The trauma of seeing a loved one become a “different” person is hard for the caregiver to endure. As a result, many caregivers mourn the loss of their loved one long before they die. For these reasons, caregivers who tend to adults with Alzheimer’s are prone to depression.

     

    Q: Are there early warning signs and symptoms of depression that caregivers need to know about?

     

    Dr. Serani: Any disruption in your daily routine can be a tip off that depression may be creeping in. These include changes in sleeping, eating, or avoiding activities or people socially. Sadness and melancholy are easy to register as possible depressive threads, but also keep in mind that depression can shorten your tolerance for things. So being more irritable, short tempered or overly tired should set off alarms that you may be struggling with depression. Another way depression presents is by lodging itself in your body. Physical symptoms like headaches, backaches, stomach pains or malaise should be checked out medically as well as emotionally.

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    Q: Are there any strategies or techniques that caregivers can use to prevent becoming depressed?

     

    Dr. Serani: There are a number of things you can do to help inoculate yourself from depression.

     

    1. Get the Help You Need: Take advantage of community programs for Alzheimer’s Patients or Seniors Citizens. Not only can local agencies and outreach programs provide you with emotional support, they can be great resources for activities, educational classes and medical/health information that you may not be aware of (Visiting Nurse Services, Ambulatory Transportation, etc.)

     

    2. Learn About Your Loved Ones Experience: By educating yourself about Alzheimer’s grounds you in what you can expect both for the progression of the disease and what you can and cannot do as a caregiver. The more you know, the more effective you’ll be - and the better you’ll feel about your approach to caregiving.

     

    3. Communicate Clearly. Be realistic about how much of your time and yourself you can give – and be mindful that not doing so can lead to burn-out. Set clear limits, and communicate them to family members, friends, doctors, nurses and all others involved.

     

    4. Can Somebody Else Do It? Sometimes you need to figure out if you’re truly the only one who can take of an issue regarding the care for your loved one. This may mean delegating, relinquishing control or spending money to get the help you need.

     

    5. Accept a wide range of feelings. Caregiving for an adult with Alzheimer’s can trigger a host of difficult emotions, including anger, fear resentment, guilt, helplessness, and grief. As long as you don’t compromise the well-being of your loved one, give yourself permission to feel whatever it is that you’re feeling.

     

    6. Take Scheduled Breaks: Don’t forget to build time away from your caretaking responsibilities. Make having fun a chief goal so you can hold onto a sense of hope and optimism.

     

    7. Confide in Others: Talk to people about what you feel. Caregiver support groups are invaluable, but so too, are trusted friends and family members. Remember, troubles shared are troubles halved. If you cannot find relief and refueling by these means, you may benefit from talking to a mental health professional.

     

    Q: When should an individual seek professional guidance for symptoms of depression? At what point does feeling low become clinical depression?

     

    Dr. Serani: The range of human experiences as a caregiver is one where feeling sad, frustrated and even irritable is expected. When those negative emotions become chronic and persist to the point where you feeling nothing *but* them, it may be time to seek help. Also, if your emotional state is preventing you from caring effectively for your loved one, you should immediately reach out for help. Clinical depression can be treated so it’s wise for caregivers to become familiar with the early symptoms as mentioned above.

     

    Q: What are the most common worries or issues that caregivers with depression wish to discuss in treatment?

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    Dr. Serani: Most caregivers feel a sense of guilt about not being able to do enough – despite the fact that they are often doing way too much to begin with. Another issue is the frustration of bearing the responsibility. It can be overwhelming to say the least. Helping to set realistic goals and deal with the emotions that come from caring for a loved one with Alzheimer’s are the most important aspects in treatment. Generally speaking, once we set limits, delegate and create time for relaxation away, most caregivers report a significant reduction in their depression.

     

    Q: What can be done to help the caregiver who suspects that they are suffering from depression?

     

    Dr. Serani: First and foremost, don’t be ashamed to ask for help. Contacting a mental health professional is a good start, but if you don’t have any idea how to find one, call your physician. They can provide a referral for you. Secondly, call family or friends and share that you’re emotionally overwhelmed. Research shows that confiding with others bolsters your immune system and preserves your well-being. Also, don’t be afraid to entrust others with caregiving responsibilities while you recover from your depression. Remember, delegating will help lessen the stress load which will reduce your depressive symptoms. Lastly, take care of yourself. Caregiving is often a selfless role, but in order for you to feel better, you’ll have to be more self-centered. Tending to your needs will enable you to bounce back and resume caregiving again.

     

    Q: Any last thoughts or comments?

     

    Dr. Serani: I tell every caregiver that they need to take time to be proud and honor themselves. It’s also important for family members, friends and the community to celebrate those who make the commitment to care for individuals with any chronic illness. In fact, it would be great to get the word out that since 1994, November has been designated as National Caregivers Month.

     

    Thank you Dr. Deb for sharing your time and expertise!

     

    For more information about Alzheimer’s Disease, depression, and caregiving please refer to the following resources:

     

    Alzheimer’s Association Information for Caregivers

     

    National Families Caregiver’s Association

     

    Health Central’s OurAlzheimer’s Caregiver Center

     

    Health Central’s MyDepressionConnection