When my children were small, I wanted to be the best parent I could be. One day, while caring for my daughters, ages 2 and 5, I thought I can be a good parent. Six hours per day. Maximum.

Winnicott in the 1950s introduced the concept of “good enough” parenting.¹ He argued no child needs a perfect parent and that being good enough is better than trying to be perfect.

The same holds for those thrust into the role of caregiving for a depressed person: being good enough is better than trying to be perfect. Too much caregiving can dehumanize the one we’re caring for, and for the caregiver, it can lead to resentment and depression.

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Caregiving for someone who is depressed

Depression sucks all the oxygen out of the room. Depression preoccupies a person to a point where they often lack sensitivity to the needs of others. The needs of caregivers are often overlooked. The relationship with the caregiver suffers.

The depressed person doesn’t intend this to happen; it’s the nature of the illness.

 

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Loving without limits does not mean that the caregiver does not have limits to their capacity to provide care. The burden of managing the family alone feels unfair. Just as a child doesn’t need a perfect parent, the depressed person needs a decent, well-intentioned caregiver who loves them without limits but is sometimes grumpy.

Capacities to be a good caregiver vary from person to person. It also changes for an individual from one day to the next. Some are more inclined to caregiving than others; some never wanted that role.

The crucial role of a “good enough” caregiver is to advocate for the depressed person to receive the care they deserve.

The changing dynamics

Caregiving changes the fundamental dynamics of a relationship. The depressed person vacillates between wanting to be nurtured and feeling frustrated about the loss of control. He or she wants to get their caregiver off their back. They want to be in control of the recovery narrative, but at the same time, they feel incapable of taking control.

It is a confusing situation for the caregiver. It’s like wondering when it is safe to turn over the keys of the car to an adolescent. We want to raise them to be independent, but we also fear the consequences.

Caregivers can become frustrated, especially when they don’t understand how difficult things can be for the depressed person.

The dynamic shift persists into recovery. Everyone wants to believe that healing is complete and permanent, but it rarely is. The caregiver may ask: Did you keep your appointment? Are you taking your medication? These questions may make the depressed person feel defensive, and they often don’t respond truthfully.

It is common for depressed people to miss a few doses of medication and feel that nothing has changed. They then may decide the medication isn’t necessary and discontinue it altogether. The caregiver may see an insidious re-onset of the depressive symptoms that the depressed person doesn’t see and denies.

Inquiring about a symptom may be more helpful: How’s your appetite today? How have you been sleeping the last few nights? Stating an observation may be better than asking questions, e.g., "You don’t look like you feel good today."

Depression can distort a person’s thinking. They think they always say the wrong thing or can never do the right thing. Depressed people should be encouraged to remove words like sorry, always, and never from their vocabularies. Caregivers should avoid those words, too.

Burnout

Each of us has a limited capacity to care for another. We want our relationship to be 50/50. For short periods, we can accept that it may be 80/20, or even 90/10. We knew that entering the relationship. It was for better or worse, in sickness and health. But the tenacity of depression means this imbalance lasts too long.

 

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The urgency and delays for some quick improvement can frustrate both the depressed person and the caregiver. They may burn out and feel cheated. Their needs may go unmet. Anger and resentment follow exhaustion. All can lead to poor treatment of the loved one and guilt about not being perfect.

Signs of caregiver stress include:

• Eating too much or too little.
• Sleeping too much or too little.
• Loss of interest in activities previously enjoyed.
• Feeling hopeless, depressed, or alienated.
• Loss of control, either physically or emotionally.
• Excessive use of alcohol or drugs.

When caregivers experience these things, they need to ask others for help.

Advocacy

The depressed person has difficulty concentrating and organizing their thoughts. People with depression receive better care when they have a companion who accompanies them to their appointments. Attending these visits also helps the caregiver understand the nature of depression.

The companion can provide useful information and record information received. They may ask important questions that the depressed person is incapable of asking. A caregiver can be more effective by preparing for the appointment.³

The depressed person and their caregivers should be included as members of the treatment team.

I believe in teaching people to care for themselves; educating the caregiver is an important part of that. I want everyone to understand their illness, its treatments, the reasons for treatment decisions, and the warning signs of relapse.

I want them to understand:

• What to do to reduce risks.
• The importance of honesty with their provider.
• Treatment will be slower than anyone would like.
• The risks and benefits of the internet.

Professional ethics prevent therapists from speaking with a care provider without the depressed person’s permission. But they can listen. Leaving a message for the therapist about a struggling loved one may be useful, but most therapists will share that information with the loved one.

The caregiver is often concerned about suicide, but predicting suicide is fundamentally impossible. We can categorize people by their degree of risk, but we cannot predict when or if an individual might attempt suicide.

I want to give the depressed person and their caregivers this message of hope: I know that you don’t have to feel this way. I don’t know what it will take or how long. Depression is a treatable illness. I ask them to work with me to find some answers.

If they have no hope, I suggest they borrow some of mine and then pay it forward after they recover.