Depression and anxiety not only affect the person with the disorder. These illnesses also have far-reaching effects on family and friends of those who are diagnosed. In particular, those who are primary caregivers for a person with anxiety or depression will experience the greatest impact. If you are considering taking on this role or it has been thrust upon you, it can be helpful to understand what is expected of you and how to not overlook your own mental health along the way.
According to the National Institute of Mental Health (NIMH), in 2015, it was estimated that 16.1 million adults, or 6.7 percent of the population 18 or over in the United States had one or more depressive episodes in the past year. In addition, we know that about 18 percent of the population lived with an anxiety disorder in the past year, or about 40 million adults. If your loved one falls into one of these groups, you may feel helpless or wonder how you can help.
Who Is a Caregiver?
While we might typically think of a caregiver as a spouse or child of a person with mental illness, siblings, parents, friends, and other supporters may take on this role. The support that they provide is aimed at helping the person with depression and/or anxiety manage various aspects of life such as emotional and physical well-being, social interaction, and even financial matters.
Recognizing Mental Illness: Anxiety
During the earliest stages, caregiving for depression or anxiety may involve simply determining whether a problem exists. Perhaps you sense that something is not right with a loved one but aren’t sure how to proceed.
Anxiety symptoms are grouped by the type of diagnosis your loved one receives. Obsessive-compulsive and trauma-related disorders have anxiety as a central component; however, they now have their own diagnostic categories. According to the current classification, the five main types of anxiety disorders include panic disorder, agoraphobia, generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobia. Below are brief descriptions—see if any ring true for your loved one.
- Panic Disorder: Individuals with panic disorder may experience sudden and intense panic attacks that seemingly come out of the blue, and involve physical and cognitive symptoms such as shortness of breath, heart palpitations, and feelings of impending doom.
- Agoraphobia: Agoraphobia may or may not be diagnosed along with panic disorder when your loved one becomes afraid of going certain places due to the fear of having a panic attack and that escape might be difficult or help not available. This may even involve an inability to leave the house.
- Generalized Anxiety Disorder: People with generalized anxiety disorder experience chronic worry about various areas of their life that interferes with relationships, work, and just about everything that they do.
- Social Anxiety Disorder: If your loved one has social anxiety disorder, he or she may fear embarrassment or being judged by others. This fear may prevent your loved one from establishing social relationships, finding employment, and performing in front of others.
- Specific Phobia: People with specific phobia are an irrational fear of a specific thing such as heights, needles, or snakes. The fear is excessive to the point that it interferes with the person’s life.
In its most general form, anxiety is a response to perceived threat. An anxiety disorder is different from the normal worry that everyone experiences because it is intense and persistent, to the point that it interferes with a person’s daily thoughts and actions.
Recognizing Mental Illness: Depression
If you have a friend or family member who seems sad or depressed, you might not be sure if the symptoms he or she is experiencing are severe enough to warrant a diagnosis. While everyone becomes sad from time to time, a mood disorder involves ongoing sadness or an inability to experience pleasure or enjoyment in life. A diagnosis of depression is made when those feelings are consistent for a period of at least two weeks and are accompanied by other physical, cognitive, and emotional symptoms.
Other symptoms of depression include problems with sleeping (too much or too little), changes in eating habits (weight gain or weight loss), irritability, fatigue, trouble concentrating, feelings of guilt, hopelessness, or worthlessness, and even thoughts of suicide.
Talking to a Loved One About Anxiety or Depression
Whether you are wanting to talk to a friend or family member about symptoms of anxiety or depression, many of the same best practices will apply. Below is a sample dialogue that you could have with a loved one.
Step 1: Choose a time and place that you can be alone to talk.
Caregiver: Would you like to come over for coffee sometime? I noticed that you’ve been under a lot of stress lately and thought it might help to take some time and chat. I’m free Saturday morning if that works for you.
Feel free to gauge the situation based on how well you know the person and what makes the most sense in terms of meeting to talk. The goal here is to create a time and place in which you won’t be rushed, won’t feel like others are listening, and that allows you both to feel relaxed.
Step 2: Approach the topic in a gentle way.
Caregiver: I noticed you seem to be under a lot of stress lately, or not feeling like yourself. Is there anything you’d like to talk about?
Here, you’ll want to tailor what you say to the situation of the person and his or her particular symptoms. Spend more time listening than talking to offer your support. Rather than give advice, your goal here is to provide an open space to allow the other person to share what he or she is feeling.
It can help in this process to use open-ended questions rather than those that can be answered with a simple “yes” or “no,” to get the other person talking. Remember, some people may feel uncomfortable talking about how they feel and may even become agitated. Try to stay calm regardless of how things go. Just being there and offering your support may be all that you can do at the moment.
If the other person does share troubling symptoms, offer to help that person by making an appointment with a health professional, going with them to the appointment, or checking up to see how things went. Whether or not your loved one agrees to seek help, encourage habits that may help mitigate symptoms, such as eating healthy food and exercising.
Remember that not everyone is ready or willing to admit to having a problem. Some individuals may not even be in a position to recognize that what they are experiencing is mental illness. Do your best to encourage that person to visit the doctor, and continue to offer support to make it easier for that to happen.
If, during the conversation with your loved one, he or she expresses any indication of being a threat to themselves or others, call his or her doctor, a crisis line, or 911. In the case of threat of suicide, try not to leave the person alone.
Preparing to Be a Caregiver
Once you’ve helped your loved one identify a problem with depression or anxiety and enter treatment, you may find yourself shifting into a support role. This type of support is not directly related to relieving the person’s anxiety or depression—that is the job of the treatment that is being received, whether it is cognitive-behavioral therapy (CBT), medication, a combination of the two, or another form of treatment.
Prepare yourself for this role, first by learning everything you can about anxiety or depression. If you have misconceptions about these disorders, take time to clear these up. If you’ve been the type in the past to expect others to “get over it” when dealing with mental health issues, you will need to shift your thinking.
How Caregivers Can Help
In your role as caregiver, there are many ways that you can offer support. Below is a brief list of areas of support that a person with anxiety or depression may need:
- Structure: Help your loved one develop a routine to allow him or her to feel more of a sense of control over his or her life. Develop an activity plan with specific activities for the person to engage in each week. Have the person keep track of activities that are completed and whether they brought joy. Ensure that regular exercise is a part of the weekly plan, as well as some form of stress reduction such as meditation exercises or an artistic pursuit.
- Goal Setting: Help your loved one to set goals during the recovery process. Encourage him or her to revisit these goals regularly to acknowledge progress that is being made. Examples might include giving a presentation at work for someone with social anxiety disorder, or exercising each morning for someone with depression.
- Skill Building: Rather than enabling your loved one to become dependent on you for support, gradually move toward building skills so that he or she can become independent of you at some point. Skills that may help in this process could include social skills and basic life skills such as managing finances or keeping a clean house. If these are not skills you feel capable helping your loved one to develop, consider bringing in other friends or acquaintances who may be able to offer advice or support to build these skills.
- Medication Management: Individuals with anxiety or depression may be taking medications to help overcome symptoms. There are many issues related to medication that may create havoc in their lives, such as dealing with side effects, keeping track of potential medication interactions, remembering to take medication as prescribed, and following the doctor’s recommendation regarding discontinuation. Offer your support in managing these issues and make sure that your loved one does not abruptly stop taking any prescribed medication.
Once your loved one has finished treatment, he or she will enter a maintenance phase in which the potential for setbacks or regression may be high. You can help support your loved one by talking about situations that may cause problems or trigger old symptoms to come back. For example, a person who previously lived with generalized anxiety disorder may recognize that having too many different overlapping responsibilities causes stress and anxiety as a result. While it might be tempting for your loved one to think of treatment as a cure—it’s more likely that he or she will continue to face obstacles and need to be constantly vigilant when it comes to managing the recurrence of anxiety symptoms.
In addition to reporting any imminent danger, there are steps you can take as a caregiver to help mitigate the risk of suicide.
If your loved one is depressed, talk to him or her about a safety plan that can be used in times of distress. This plan might involve things such as engaging in a distracting activity or contacting a friend, family member, or health professional. While you might worry that bringing up the topic of suicide could encourage your friend or family to consider it, this is not the case. Always take any talk of suicide seriously, and offer your support by finding out more about what your loved one is thinking.
Also, be aware of silent risk signs for suicide, such as withdrawal from people and activities, previous attempts, jokes about suicide, talking about death, giving away possessions, or risky behavior.
What About the Caregiver?
- If you find yourself caring for someone with anxiety or depression, you may start to spend less time caring for yourself—don’t fall into this trap.
- First, realize that you alone don’t have the power to save your loved one. Your job is not to help him or her recover from mental illness, but rather support that person during the process. Don’t take too much upon yourself, and don’t feel guilty in the event of relapse.
- Second, tell your loved one what you need. Caring for someone with anxiety or depression is a monumental task—acknowledge that. You may experience a range of emotions including anger and resentment. If you feel yourself becoming burnt out, tell your loved one that you need time to yourself to do things that you enjoy. While in the moment it may feel like abandonment, it is better to take care of yourself so that you can come back refreshed, than to completely burn out and be of no help to anyone.
- Finally, consider joining a support group for caregivers of those with anxiety or depression. You will meet other people going through the same circumstances who may be able to offer advice or just a listening ear.