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A simple but serious equation applies all too often to the experience of family caregiving: daily stress x time = increased risk of depression + lower quality of life. Of course, depression itself is not simple. What’s important to know is that, in many cases, depression is treatable. Knowledge about depression, and the paths by which it can gain the upper hand in life, can be a powerful tool that allows a caregiver to maintain his/her mental health and positive quality of life.

Depression has been described as “living in a black hole.” It may occur as feelings of profound sadness, emptiness, apathy, helplessness, or impending doom that enshroud daily living. Among caregivers generally, depression occurs about 10 times more often than in the general population. Somewhere between 30% and 60% of caregivers are estimated to have some symptoms of depression, and 30% to 40% of them are considered to have major depression. Ten years ago, a study of more than 500 MS caregivers found that 16% were receiving treatment with psychotropic medication or psychotherapy (“talk” therapy), and 21% were judged to have probable mental-health problems. Since then, research has filled in further details on depression in MS caregivers, uncovering key connections in the caregiving milieu. The findings suggest that: 

• “Caregiver burden,” or the stress-induced response to the unrelenting demands of caregiving, increases the risk of depression in MS caregivers.
• Caregiver burden and depression are more likely when the person with MS receiving care is highly depressed, anxious, and stressed.
• In addition to emotional problems, more-advanced physical disability and the presence of dementia in the loved one with MS are predictors of caregiver depression.
• The quality of life of MS caregivers depends heavily on the caregiver’s impression of the loved one’s quality of life.

In other words, MS can weave a web that ensnares the caregiver and loved one in mutual depression. A deeper look at depression can help all parties to identify and confront it.

Causes of Depression

Experts believe that depression is a “nature–nurture” phenomenon: it has both biological (genetic, hormonal) and psychosocial causes that interact to darken one’s mood. This means that even the very worst of caregiving situations might not result in depression unless the caregiver is biologically vulnerable to depression. On the other hand, that vulnerable caregiver would be less likely to become depressed in the absence of triggers like chronic stress and crises, loss of sleep, and fatigue. Women, who provide the majority of caregiving, experience depression at roughly twice the rate of men. Men are apparently less likely to admit to depression and are more likely than women to “self-treat” depression with alcohol or overwork. These differences are not absolute; how biology and psychology may account for these differences is unknown.

Distorted thinking about oneself, one’s environment, and the future may also underlie depression. When negative thinking takes hold of a caregiver under stress, patterns of self-criticism, expectation of failure, magnification of minor events, denial of positive events, and irrational beliefs can become cyclical and deeply ingrained. Because feelings follow thoughts, negative thinking is able to trigger, worsen, or maintain depression.

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