According to the National Family Caregiver Alliance, caregivers are twice as likely as the general population to suffer from depression; and studies reveal that some caregivers may continue to show signs of depression years after the death of a spouse. Too many of us assume that depression associated with the chronic illness or death of someone we love and care for is inevitable -- now, a widely-available treatment suggests that there may be a potential solution.
The shorter days of winter, coupled with holiday stress, can make people more vulnerable to a range of depression, from mild to severe. And as many of you know all too well, being a caregiver tends to put a person at a higher risk for these conditions. One kind of depression in particular, Seasonal Affective Disorder (SAD) usually receives a lot of attention this time of year, and SAD can affect family caregivers when they least expect it. The exact cause of SAD is unknown, but professionals suggest that it may occur when seasonal changes and reduced levels of sunlight impact levels of serotonin and melatonin in the body, interfering with natural sleep patterns and leading to symptoms of depression. According to the Mayo Clinic, you should suspect SAD if:
- You've experienced depression and other symptoms for at least two years in a row, during the same season each year.
- The periods of depression have been broken up by periods without depression.
- There are no other factors that could account for the mood or behavioral changes.
One effective treatment for SAD is exposure to increased light through a "lightbox," or other specialized light therapy equipment that gives off bright light that mimics outdoor light and appears to cause a change in brain chemicals linked to mood. Researchers are also exploring other uses of light therapy, including treatment of symptoms associated with dementia.
Here's an example of how one family caregiver we work with at the Visiting Nurse Service of New York was able to beat debilitating caregiver depression with light therapy -- and make things a little brighter for her family member, too.
Doreen cares for Martin, her husband of 52 years who was diagnosed with Alzheimer's disease eight years ago. An episode of SAD had a devastating impact on her ability to provide care for Martin.
A retired social worker, Doreen had handled her role as family caregiver quite well for years. But as the holidays approached about three years ago, she began to feel the strain and was almost paralyzed with extreme fatigue. She stopped making the effort to see friends, she gained weight, and eventually started to feel that she "just couldn't get up in the morning."
A good friend, who had suffered similar symptoms herself, suggested that SAD might be the cause. Doreen's friend explained that she alleviated her own symptoms with light therapy, and had found that sitting in front of the box for 30 minutes every day from September through March had helped to keep depression at bay.
Doreen asked her doctor about SAD and soon began using her own lightbox. "I started by reading the newspaper for 30 minutes in front of the light," said Doreen. "I felt a little better after only a few days, and after a week felt that I could once again handle my responsibilities as Martin's caregiver. And thank goodness, because as time would tell, Martin would need me more and more!"
Light therapy has also been found to have a role in ameliorating symptoms of dementia. For Doreen, this turned out to be especially important in her care of Martin.
One common symptom of dementia is a disruption of the patient's circadian rhythms, which normally tell the body when to sleep and when to be awake. For dementia patients this disruption results in erratic sleep patterns throughout the night and often increased arousal and agitation in the later part of the day, also called "sundowning." As Martin's dementia progressed, his ability to fall asleep and stay asleep worsened. "He was always wandering in the middle of night, and one time I found him trying to cook an egg at 3:00 in the morning!" stated Doreen.
These kinds of sleep disturbances can be very difficult for a family caregiver to deal with over the long-term. In Doreen's case, she became increasingly afraid that Martin was doing something dangerous while she was sleeping. Fears like Doreen's can be all-consuming and often are cited as the "last straw" for a family caregiver deciding whether to put their family member in a nursing home.
Once again, Doreen found herself turning to the light box -- this time at the suggestion of Martin's gerontologist, a physician who specializes in aging. According to him, most conventional sleep aids (Ambien, antidepressants and melatonin) have limited effectiveness in helping Alzheimer's patients sleep. But in a 2009 study from the University of North Carolina at Chapel Hill, 66 adults with dementia living in long-term care facilities were exposed for varying amounts of time to bright ceiling lights installed in common areas. Compared with participants who did not spend time under the lights, those who were exposed to light therapy for two and a half hours in the morning slept 16 minutes longer at night. They were also able to fall asleep 29 minutes earlier.
Getting an Alzheimer's patient to sit still in front of a light box can be challenging. Doreen succeeded because one thing Martin enjoys every day is listening to his Frank Sinatra CDs. "He'll sometimes sit for an hour listening," said Doreen. However, she also learned that just keeping the house lights very bright during the day or spending some time outside each morning can have a positive impact on sleeping.
Light therapy is a completely non-invasive treatment for seasonal affective disorder, and its applications for helping with symptoms of dementia are promising. But more research needs to be done in this area. Indeed, Quietmind Foundation in Delaware is currently conducting (and recruiting participants for) a study to determine if infrared light stimulation can slow and perhaps reverse the symptoms of early to mid-stage dementia.
So if you're a family caregiver struggling with an annual recurrence of the "winter blues," or your family member with dementia is suddenly sleepless, don't just brush it off. Ask your doctor if lightbox therapy might be a solution for you. Your ability to provide care depends on your emotional and physical well-being, and these could help you and the person you're caring for keep your spirits bright deep into the winter.
For more by Kathryn Haslanger, click here.
For more on mental health, click here.
For more on caregiving, click here.
For a checklist of Tips for Caregiver Well-being visit our "A Day in the Life" blog from the Visiting Nurse Service of New York.