Depression: Exploring its reach

 

By Kaye Spector

Plain Dealer Health and Medical Reporter

Terri Miller, whose sister and daughter suffered from major depression, can pinpoint her lowest point as a caregiver.

One night, the North Olmsted resident sat on her couch, trying to comfort her suicidal daughter, the crying teenager's head in her lap. The phone rang: it was her sister, also voicing suicidal thoughts.

Two wrenching cries for help. One strained, emotionally stressed and ready-to-collapse person shouldering their pain.

Like many caregivers of people with depression, Miller suffered a high degree of unrelenting stress.

“You end up living and breathing the illness,” Miller says.

Miller's story has a happy ending, thanks to counseling, education, a support group and an understanding boss.

Her daughter, now 23, was able – with her mother's help – to manage her illness enough to graduate from high school and become a dental assistant. She is now working full-time, raising a toddler and is doing very well, Miller says.

But, like Miller, many caregivers of people with major depression struggle. Much of the strain comes from the depressed person becoming the main focus of the caregiver's life.

In addition to fatigue, the caregiver deals with sadness, guilt and anger, says Karan Osowski, a social worker with the Visiting Nurses Association. And there's burnout.

“It's hard on caregivers,” says Debbie Stambaugh, a mental health nurse with the Visiting Nurses Association. In particular, an elderly, nonmobile person with depression can be a drain on the caregiver.

“The caregiver really becomes their eyes and ears,” she says. “Depression can develop just in trying to manage chronic conditions.”

A recent Harris interactive poll for the National Alliance on Mental Illness showed that nearly half of caregivers who responded said they had been diagnosed with depression.

Miller is among that group. After going through a stressful episode with her sister or her daughter, she often would experience painful migraines, withdraw from social contact and become irritable, self-critical and overreacting, she says.

“Depression is always there and gets worse with stress,” Miller says.

Bridget Montana, chief operating officer for the Hospice of the Western Reserve and an advanced practice nurse, says in the last 18 months – perhaps because of the recession and increased demands in the workplace – she has seen an increasing number of caregivers who are stressed because they believe they can't get away from work to take care of family members.

“Then they feel they come home and start the second shift,” she said.

On her home visits, Stambaugh does a lot of education and support for the caregiver. She asks whether the caregiver is eating and sleeping. She makes sure the caregiver is staying busy outside the home. And she watches out for loss of pleasure in formerly loved activities.

She also tells the caregivers not to personalize what the patient says: “They'll be angry, they'll be negative and the caregiver thinks it's their fault. You don't want them to own it.”

Montana says caregivers need to give themselves permission for two things: let others help you; and take care of yourself.

“They're trying to do it all,” Montana says. “Caregivers need a support system.”

That means not only someone to share the duties of caring for the depressed person, but someone to talk to, a safe place to vent.

Caregivers also need to make sure they connect with the outside community. “That caregiver can get as housebound as the patient,” Stambaugh says.

She likes to encourage caregivers to get outside and enjoy a cool breeze or a ray of sun – “anything that takes them away from the hopeless helplessness of the moment.”

Osowski, the social worker, says she tries to remind caregivers that they can't make the patient better. And she urges them to become educated about depression and to get support for themselves.

Miller is now a program coordinator at the Cleveland chapter of NAMI and teaches a family education class. She says finding support and education at the nonprofit played an important role in her and her daughter surviving the daughter's depression.

“It was so reassuring to find someone to finally tell me what I was experiencing as a caregiver was normal,” she says. “It was like a blessing.”