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Posted: July 05, 2007

Spousal Caregiving

Recognizing and Coping with Caregiver Stress, Depression

Bill Andrew

At a recent Alzheimer's support group meeting I facilitate in Winter Haven, Florida, attendees were treated to a short course on recognizing and coping with caregiver stress and depression. It was a great time, and I thought the information was so valuable that I wanted to share it with readers of this column.

Aryn L.H. Bush, PhD, tutored the short course. Bush carries an very interesting title -- cognitive aging psychologist and is affiliated with the University of South Florida (USF) in Lakeland and the USF Rath Senior ConNEXTions and Education Center in Bartow. What follows is the gist of Bush's presentation.

While this tends to focus on Alzheimer's family caregivers, it also applies to family caregivers of loved ones with other disabilities and illnesses. Much of what is discussed below is common to all family caregivers. The bottom line is: "caring for the caregiver."


Unfortunately, all too often, primary caregiver health and well-being is inadvertently compromised due to the demanding responsibilities associated with caring for another individual. The caregiver’s physical and mental health typically takes a back-seat to the physical and mental health of the care recipient -- often with dire results.

Even "moderate" caregiving for a relatively independent loved one has the capacity to produce unhealthy levels of stress and anxiety that render the caregiver susceptible to a host of physical and mental health conditions. Physical, psychological, emotional, social, and financial stressors associated with caregiving can spiral out of control if not immediately and effectively addressed.

Effects of stress on brain and general health

Research clearly indicates that healthy levels of stress can have positive effects on various types of human functioning. However, prolonged or chronic stress can actually kill the brain, particularly areas of the brain associated with learning and memory. Further, chronic stress can lead to depression which has been shown to have similar adverse effects on the brain.

Interestingly, depression actually stimulates the production of additional stress hormones. Both stress and depression also weaken the immune system, thereby rendering a caregiver more susceptible to undesirable physical and mental health conditions. So, when does healthy stress become unhealthy? 

Warning signs of stress and depression

Oftentimes chronic stress (defined as stress experienced over a long period of time) is more difficult than acute stress (high stress over a short period) to detect and label as "unhealthy". This is largely because caregiver stress is insidious -- that is, it starts out at a reasonable level and slowly grows until it is out of control -- often unbeknownst to the caregiver.

It is not until the caregiver is in "crisis" that he or she realizes the extent of the stress itself and the negative repercussions caused by it. It is important to be proactive and monitor stress and depression levels so that potential crises may be avoided or diminished in severity. What are some common warning signs of stress and depression? Note that warning signs of both conditions tend to be quite similar.

Stress warning signs 

* Denial

* Anger

* Anxiety

* Depression

* Exhaustion

* Sleeplessness

* Irritability

* Social withdrawal

* Health problems

* Lack of concentration

Depression warning signs 

* Feelings of sadness/emptiness/hopelessness

* Anxiety, nervousness, feeling overwhelmed

* Feelings of worthlessness

* Excessive or inappropriate feelings of guilt

* Fatigue or lack of energy

* Loss of interest or enjoyment

* Lack of concentration

* Irritability or restlessness

* Digestive problems

* Change in appetite or sleep patterns

* Weight loss

* Dizziness

* Headache

* Back pain 

If you are experiencing several of the above symptoms of stress and/or depression, it is important to speak with your healthcare professional about appropriate treatment.

Effective ways to manage stress and depression

Caregiving is extremely demanding. Therefore, it is crucial to emphasize the importance of social networks and resources in the alleviation of stress and depression. The first thing one can do is ask for, or agree to accept, assistance. Often, caregivers feel guilty for not being able to do everything themselves. This view is unrealistic. Caregivers cannot reach their full potential if they do not take care of themselves. Caregiver personal neglect is unfair to both the caregiver and the loved one.

Certainly, proper nutrition and exercise can help guard the body from the adverse effects of stress and depression. Few caregivers, however, seem to find the 30 minutes a day to devote to exercise. It also seems that microwaving a TV dinner demands "too much time" given the responsibilities associated with caregiving! Once again, it is important to accept assistance from family, friends, or other outside resources.

How aging resource centers can help alleviate stress

Another avenue a caregiver can take is to contact a local aging resource center. The USF Rath Center is one example of a one-stop location for older adult educational programs, services, resources, and referrals. The Rath Center can assist with anything from financial and insurance issues to transportation issues. The center has established trusted relationships with numerous agencies within the community. Therefore, the center can readily offer information and referrals related to issues of concern to the caregiver and loved one in generally a fraction of the time it would take a caregiver to do so on his or her own. Caregiver support groups are also offered at the center.

By utilizing outside resources, caregivers will have more time to focus on caring for themselves -- even if this is only five minutes of time per day. "Caring for the caregiver" will diminish stress levels and lessen the likelihood of spiraling into depression. Check out your local aging resource center.

Other locally available support programs

Another way to proactively and effectively manage and cope with stress associated with caregiving may be to utilize locally available programs such as the Alzheimer’s Rural Care Healthline (ARCH). The ARCH program, provided by Florida State University, connects caregivers to education and support. The beauty of the ARCH program is that a caregiver can participate from the privacy of his/her own home via telephone! This component is truly important for caregivers who have no one to care for their loved one in their absence.

The ARCH classes include, for example, reducing stress, increasing relaxation, managing behavior, and solving care problems. All caregiver telephone classes are confidential, free of charge, and coordinated by professional staff. The ARCH program is not intended to replace an existing support group, rather, the program is intended to supplement an existing support group by providing additional caregiver support and services on a more individualized, personal basis. Perhaps similar programs are available in your area -- check them out.

As readers of this column know, I highly recommend support groups for any and all family caregivers. The "sharing and caring" that comes from your peers in the support group is often the key to reducing caregiver stress and avoiding caregiver depression.

Just remember . . . By taking care of yourself, you will better be able to care for your loved one!


Hopefully, Dr. Bush's thoughts, as expressed above, will help family caregivers everywhere in being able to address their personal battles with the stress and potential depression that they face each and every day. Dr. Bush can be reached at

Your thoughts and comments about the above would be appreciated. Drop me a line at and I will share them with other readers in a future column. Please provide your full name and address. In the column, I will only use your first name and the last initial of your last name as well as your city and state. Thank you.


"I hear and I forget;

I see and I remember;

I do and I understand."

Confucious (551-479 BC)


Bill Andrew identifies himself as a former “nutritionally-empowered Alzheimer’s caregiver” who attributes the slow-down in progression of Alzheimer’s disease in his wife, Carol – and the growth of his own personal emotional, mental, physical, and spiritual capability and strength to provide quality 24/7 care for her in their own home – to the targeted nutritional supplements they both took on a daily basis. Carol went to her Heavenly reward on June 9, 2008 – Bill continues on to advocate for family caregivers. Contact Bill with your caregiving questions and comments via email at

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