Mood disorders are especially hard on caregivers. Take care of yourself.
At its worst, depression can put a person in bed. But if you feel a stigma attached to mental illness among the people you know, you may be keeping the issue private — and that means you as the caregiver (and your loved one) won’t get the same outpouring of support you’d expect if your family had survived an obvious tragedy like a car accident.
Depression isn’t an occasional fit of listening to sad music: it can be a daily burden of sadness, hopelessness, worthlessness, and emptiness that stretches over at least two weeks. You may see a loss of interest in her usual pursuits and pleasures, fatigue, sleeping a lot or too little, unintentional weight gain or loss, mood swings, anxiety, restlessness, irritability, headaches, and digestive upsets and drug or alcohol use.
People with bipolar disorder (sometimes called manic depression) move between highs and lows. In the high “manic” state, they may feel elated and come up with grandiose schemes, spend too much money, or take unwise risks. Mania can end up producing psychosis. Bipolar disorder requires medication for recovery.
Be patient. A depressed person often speaks more slowly and less clearly than before. You’ll need all your listening skills. Although your loved one will probably think that her depression will never lift, even untreated depression tends to end after about eight months. With treatment — cognitive behavioral therapy to change negative thinking, medication, and more exercise and a healthier diet are all options to combine — you can expect improvement within about three months. Your loved one may have to leave a demoralizing job or make other big changes — but it’s important to put off major decisions while her symptoms are peaking.
If it feels endless, remember that the problem may have been building for some time beforehand, and dragged you down as well. One study found that taking care of someone with a mood disorder is more draining than if your loved one had schizophrenia. Your best answer is to find people to confide in and to keep up your own life without guilt.
How to get started: Tell her you think she has a mental illness and that she’s loved, deserves to feel better, and will feel better with appropriate treatment. If she’s not sure she’s ill, suggest that she take an online screen for depression, anxiety, or bipolar disorder. If she’s willing but unable to function, make an appointment with a psychiatrist and go with her, acting as a go-between as long as you’re needed. You may need to make sure she is keeping her appointments and taking her medication.
If she resists treatment, ask other people to speak with her. Depressed people sometimes need to hear from more than one person, more than once, that they deserve to feel better and need treatment.
If you’re living together, you’ll probably find yourself doing most or all of the household tasks, big and small. This isn’t selfishness or laziness. Remember when you had a wicked flu and could barely get out of bed to go to the bathroom? That’s how depression can feel, for days and weeks on end.
As a spouse or partner, understand that sexual drive is one of the first casualties of a depressive spell. Offer hugs, massage, and whatever else feels natural.
Be alert for any talk of suicide. It’s essential to ask direct questions and get permission to speak to your loved one’s psychiatrist, psychotherapist, or doctor. You need to know whether she has made a plan. Ask, “Have you thought about how you would do it? Do you know when you would do it? Do you have the tools?”
Depression is often expressed as hostility, rejection, and irritability, so people in the near vicinity need to develop a thick skin. But don’t let anyone cross the line into abuse. Leave the room if she’s become unbearable or is hurting you. You may feel lonely in her company, since she’ll be self-absorbed: people who are consumed by despair or anxiety don’t have much left to give. Remind yourself of the good times and her better self. Your loved one may be indecisive, but it can help her focus if you let her make minor decisions, saying, “What movie would you like to see?” rather than suggesting one. Notice and praise any significant improvement. Be sure to respond to any signs of renewed interest in your life or her favorite activities.
In your own mind, be clear that you didn’t cause your loved one’s depression even if she’s troubled by your relationship. Keep up with at least some of your own enjoyable activities and talk to confidantes or a therapist about your anger and frustration. Remember that there is an end in sight, even if it doesn’t feel that way.
Resources for depression
- Depression and bipolar support alliance offers discussion forums and online or face to face support groups.
- Mental Health America offers online screening tools and advocacy.
- National Alliance on Mental Illness has an information helpline (1-800-950-NAMI (6264)) and structured in-person support groups for family members.
- National Mental Health Information Center is a government-maintained database of mental health services, including suicide prevention and substance abuse programs.
Resources for bipolar disorder
- International Bipolar Foundation (IBPF) also offers forums and an e-newsletter.
- BipolarCaregivers.org offers information and links to a variety of organizations.
- Bipolar World has an “Ask a psychiatrist” feature and chat rooms for people with bipolar disorder, people with concurrent alcohol or drug problems, veterans, parents, and significant others.
- Harbour of Refuge Organization, Inc., has online discussions and useful links for people on medication for bipolar disease and their caregivers.
- McMan’s Depression and Bipolar Web is the website of a mental health journalist and survivor that makes new research easy to understand.
April 22, 2016
Janet O’Dell, RN