Thursday, February 4, 2010

Caregiver Burnout Series: Part Three: Treating Depression

In this Blog Series, we've discussed the role and requirements of the Caregiver, and signs and symptoms of Caregiver Burnout. We've noted that burnout and depression have important similarities, the latter usually being more severe and prolonged -- and not responding as easily to breaks and self-care measures.

Today, we will focus on depression and how it can be treated. This is an enormous topic, and cannot be adequately covered in a blog post! But, hopefully, this "Depression in a Nutshell" post will give the reader a brief overview, and a place to start if this is an issue for you.

Depression is characterized by a "down" mood, and other symptoms including low energy, irritability, loss of interest in usual pleasures, a sense of hopelessless, sleep disturbances, involuntary weight change, excessive worry and/or guilt. Depression generally lasts for at least two weeks, and may be accompanied by thoughts of suicide.

So what do you do if you think you may be depressed?

First of all, get some help. Your Primary Care Provider, i.e. family doctor or nurse practitioner, the Social Worker at your Kidney Center are good places to start. Naturally, your local E.R. or Crisis Clinic are appropriate if you feel you may be in danger of self-harm.

Years ago, there was a study that took a group of people with depression and divided them into four subgroups (I do not have the reference for this). The groups received treatment as follows:

1..    Exercise
2.     "Talk Therapy"
3.     Antidepressant Medications
4.     No therapy, i.e. "Control Group"

The important observation was this: the people in each of the first three groups improved; the "Control Group" which received no treatment did not improve.

Let's look at each approach:

You don't have to be a jock to appreciate that simple exercise -- even a short walk -- helps us to feel better. And regular exercise, done several times a week or even daily, is even more powerful. We feel stronger, we work off stress, we feel more capable of dealing with life's challenges. Which exercise is best? In my opinion, the best exercise is the exercise a person will do!

Talk Therapy:
If you've never been to therapy, you might want to give it a try. Think of it this way: appproximately one hour per week, a trained and compassionate person focuses on you and your concerns. A psychiatrist friend of mine used to say, "It's the heathy people who go to therapy!" I'm convinced that he was correct. Remember, we aren't talking about years of psychoanalysis here. We're talking about short term cognitive therapy, lasting a few weeks to months.

We have many antidepressant medications from which to choose, and their risks and side effects have been greatly reduced over the years. That said, it may take a few tries to find the proper antidepressant -- or combination of medictions -- for a particular person. I tell my patientts,

"Antidepressants don't change the facts of your life. But they can change the way you respond."

Here's a good tip: if a close relative of yours is using a specific antidepressant and has had a particularly positive or negative response, tell your Health Care Provider. This information may be useful in selecting the right medication for you. Another important consideration: antidepressants can take two to four weeks to "kick in." So, don't wait until you're at the end of your rope. Get help soon if you see depressive symptoms lingering on.

My favorite approach to depression for patients in my practice? The triple combination of physical exercise, cognitive therapy, and antidepressants!

Depression can be frightening and unpredictable; it feels awful to be depressed. For Caregivers, depression may make us concentrate less effectively and make more errors. Keep in mind also that a severe depression may require hospitalization; this is where we need professional help to sort this out.

What else can you do to help yourself?

1.     Avoid alcohol and other recreational drugs. This is critical, as alcohol is actually works as a depressant! Experts claim that it takes only four drinks per week for a woman and six drinks per week for a man to cancel out the effect of an Antidepressant!

2.     Keep yourself safe. Be attentive to your driving and other activities which place you at risk. Pay attention to your prescription medications; take them correctly and do not combine with alcohol. Remove articles from your home which place you at added risk (e.g. firearms). If you feel you cannot guarantee your own safety, tell someone! Go to the ER or call the Crisis Clinic.

3.     Focus on self-care. Tomorrow's blog will focus on the many Self-Care Tricks that help us nuture ourselves. Please join me tomorrow and examine many of the ways we can help ourselves.

Take care. Linda Gromko, MD     


  1. thank you for the much required Caregiver view into depression managment.

  2. Some really perceptive pointers and sage advice. Thanks for sharing.

    Jay Drayer
    CareFlash "Community when it matters most"

  3. Thank you for your messages. Jay, I will check out your website. Linda