A Silent Crisis: Depression and Caregiving

More than feeling sad, Maggie Go-Yu started experiencing depression after her son was diagnosed with myeloid leukemia in 2019. After a bone marrow transplant, her son underwent two rounds of chemotherapy and spent 28 days at the hospital in Stanford, California.

"The ongoing care, constant worry and lack of sleep took a toll on my emotions," says Go-Yu. "My increased stress and anxiety led to depression that was treated by my primary care doctor."

Gordon Krueger also faced depressive symptoms after his wife Robin was diagnosed in 2003 with a non-cancerous tumor that had been growing in her brain for over a decade. 

Despite undergoing brain surgery, Robin experienced short-term memory issues that eventually turned into physical challenges, like needing assistance to walk. "It was so depressing watching my once vibrant and energetic wife slowly deteriorate and rely on me for almost everything," says Krueger.

Caregivers are at higher risk of experiencing depression compared to the general population. "The demands and challenges of caregiving can lead to significant stress, emotional strain, and a sense of burden, which can contribute to the development of depression," says Dr. Richa Bhatia, director of psychiatry at Santa Rosa Community Health in California and author of the book "65 Answers about Psychiatric Conditions."

The prevalence of depression among caregivers ranges from 25% to 70%. The rates may be even higher among specific groups, such as caregivers of individuals with dementia or Alzheimer's. 

"Caregivers who are themselves experiencing health problems or have limited social support networks may be at even higher risk," says Dr. Holly Prigerson, professor of geriatrics and co-director of Cornell's Center for Research on End-of-Life Care in New York City.

Symptoms of depression vary among individuals but commonly include decreased productivity, diminished interest in socializing or activities, fatigue or decreased energy, irritability, decreased appetite, sleep disturbance, and overall feelings of worthlessness and sadness.

"At the first signs of any of these symptoms, talk to your doctor about what might be causing these emotions and whether or not you are experiencing depression," says Bhatia. After an evaluation, your doctor may recommend treatment with antidepressants or talk therapy with a psychologist. 

Cognitive behavioral therapy (CBT) is a common therapy to help people recognize and manage negative thoughts and gradually change their behavior to improve their outlook.

Despite the possibility of developing depression, caregivers show incredible resilience during and after losing a loved one. A New England Journal of Medicine study followed 280 caregivers whose loved ones were admitted to a hospital ICU. Initially, 67% of caregivers were experiencing depression, but within a year, only about 16% still lived with serious symptoms.

A separate study measured depressive symptoms in 661 caregivers of advanced cancer patients. The researchers reported in the Journal of Pain and Symptom Management that the majority of caregivers stopped experiencing depressive symptoms during bereavement, but there was a smaller group of individuals who still experienced depression for a prolonged period of time.

When left unmanaged, depression can worsen and affect your interest in jobs, hobbies and spending time with family and friends. Experts recommend that doing some activity can go a long way toward boosting your mood — physical, mindful, social, spiritual, creative and therapeutic.

For mild depression, doing moderate exercise, stress reduction and mindfulness-based interventions may help improve depression in conjunction with psychotherapy. Having a close family member or friend to talk to about feelings of sadness can make the biggest difference.

In moderate to severe cases, getting help from a professional is the best way to manage depression. To find a psychologist, explore the psychologist locator tool the American Psychological Association developed.

There are several activities to help manage depression and elevate your mood, including exercise, mindfulness, relaxation, socializing, spirituality, music, creativity and talk therapy. Moreover, regular exercise has the greatest impact on depression, according to health experts. "Exercise releases feel-good brain chemicals that change how the body functions and elevates mood," says Bhatia.

Several studies have proven that regular exercise, such as walking, can ease depression and improve mood by taking your mind off your worries. A study published in the Journal of Psychiatric Research reviewed more than 25 studies and found that moderate- and vigorous-intensity aerobic exercise had a significant effect in reducing symptoms of depression.

There are several different exercises to choose from; some examples include walking, jogging, dancing, bicycling, swimming, and weight training. 

Exercise does not have to be all-consuming, but experts recommend picking something you'll enjoy doing so you'll stick with it. To be effective, exercise should be done every day or about five days a week for about an hour. Exercising outdoors combines at least two depression-modifying aspects: physical activity and nature. 

In two separate studies published in the International Journal of Environmental Research and Public Health in 2021 and 2022, researchers found that activities that included exposure to nature, such as walks in natural environments, reduced depressive symptoms in patients with clinical depression and improved various aspects of health and wellbeing, including cognitive function, brain activity, blood pressure, mental health, physical strength and sleep routines.

The exciting news about exercise is that it protects against developing future depression, according to a large, long-term study published in the American Journal of Psychiatry. Researchers followed nearly 34,000 adults for over a decade and found that even small amounts of physical activity bestowed significant mental health benefits that prevented future depression.

Exercise should be complemented by sleep and rest – two of the best depression-prevention activities. "If you can regulate your sleep, mood, hormones, appetite and energy level will be optimized," Bhatia says. "This means going to bed at the same time every night and waking up at roughly the same time every day, regardless of whether it is a weekday or weekend."

One study in Sleep Medicine Reviews examined almost 50 studies for depression symptoms after sleep interventions. The paper showed that healthy sleep practices effectively reduce the severity of depression, especially among those with mental health problems. 

You can do several things to improve sleep quality to help reduce depression, including a regular sleep routine, avoiding late-day or evening caffeine, sleeping in a cool, uncluttered environment, and turning off cell phones.

Mindfulness meditation has become highly popular and is perfect for beginners. "Mindfulness is paying attention to our present experiences with openness, curiosity and a willingness to be part of that experience," says Diana Winston, director of mindfulness education at the UCLA Mindful Awareness Research Center in Los Angeles.

It's normal not to pick up meditation right away immediately. Winston says it may seem impossible to keep your thoughts from racing all over the place, but with time and practice, it becomes easier. "Like anything, you have to stick with it. Affecting your mood in a positive way will take time and persistence."

Paul Wynn has contributed feature and news stories to more than 65 publications throughout his career. He is a graduate of Ithaca College's Park School of Communications. He lives with his family in New York's scenic Hudson Valley. Read More