All About Caregiving
A PLACE TO LEARN ABOUT CARING FOR CAREGIVERS

     Welcome to Dr. Sterling's All About Caregiving Web Site!

    AllAboutCaregiving.org is a division of DearShrink.com, a well-known Internet Mental Health Center created and maintained by Ron Sterling, M.D., a Seattle, Washington, General and Geriatric Psychiatrist. For more information about Dr. Sterling, please go to his Biography Page.

    The mission of the All About Caregiving Web site is to provide information and resources for caregivers and those who care about caregivers. Dr. Sterling starts this page with an answer to a reader question about a co-worker who is struggling with the stresses of caregiving.


Caring for Caregivers


    Dear Dr. Ron:

      I have a friend at work who seems depressed. She has been calling in sick a lot. She is caring for her parents who are both in their 80s and frail. I think she is on the verge of an emotional meltdown. Our employer is small and has very few resources or flexibility. What can I do to help? -- Signed: Worried About a Caregiver.

    Dear Worried:

      Thank you for writing! And, thank you for your concern for your co-worker. Seventy to 80 percent of primary caregivers for older adults are women. Today's typical female caregiver is middle-aged with two children still at home. Women also make up a majority of the workforce. Both working and non-working women provide about the same amount of caregiving, so those who are working clearly have a much longer list of things to do.

      Research has shown that caregiving employees do not fully inform their employers and employers generally do not adequately recognize the problems that such employees experience. Caregivers often feel that they may not be allowed time off for caregiving, so they call in sick when they need to take time off to assist their loved ones. This can lead to an employee jeopardizing their job due to poor work performance.

      Even though your company may be small and your co-worker may have concerns about divulging what is going on in her life, my recommendation is that she be straightforward with her employer about her situation. It is better to be proactive and seek assistance and understanding from employers as early as possible. When an employee is already moderately depressed, it is very difficult for them to take on the stressful task of talking to a supervisor about their problems.

      Your concern about your co-worker's possible depression is well-placed. I don't want to be an alarmist, but about 20% of caregivers for older adults experience moderate to severe clinical depression. One study revealed that about 40% of former caregivers of a spouse with a form of dementia experienced significant depression up to three years after their spouse had died.

      Caregiving, in and of itself, does not cause depression. However, depending upon an individual's vulnerability to depression, the chronic stress of caregiving, especially for a loved one who may be suffering, can be more than enough to "burn" brain cells. I have written about the link between stress and clinical depression before, but it is worth repeating. Stress increases a chemical factor in the brain called corticotropin releasing factor (CRF). CRF is toxic to brain cells in the hippocampus. It damages dendrites which reduces serotonin levels and impedes information processing.

      Each of us has a different vulnerability to CRF-induced damage based on how much our brain produces a protective chemical called brain-derived neurotrophic factor (BDNF). We each produce different levels of BDNF depending on our genetics and on how much we exercise. Although we each experience the feeling of depression in different ways, the main symptoms that likely indicate a biological basis are two or more weeks of: (1) change in eating habits -- loss of appetite or overeating, (2) sleep disorder -- fragmented sleep or early morning awakening without being able to return to sleep, (3) low energy, (4) loss of interest for typical activities and friends or pervasive sadness, (5) increased irritability, or (6) suicidal ideation. The more symptoms that are present, the more likely the depression has a biological basis.

      Once there are significant signs of a biological basis for depression, appropriate antidepressant medication is often required. We generally cannot think ourselves out of a clinical depression. However, caregivers can help prevent clinical depression by utilizing support services, respite care relief, positive self-talk, and exercise.

      I hope this is helpful. For more information about caring for caregivers, please view the links below. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 61 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to DrRon. Please be assured that your questions and identities are completely confidential and protected. For more information about DrRon and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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RON STERLING, M.D.
General and Geriatric Psychiatry
SeniorMentalHealth.org
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Updated October 7, 2007
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