How to Be a Caregiver for Someone With Depression

But getting someone there can be tricky, he and other experts say. That’s partly because of the stigma that still surrounds mental illness, especially in older generations.

So, Emery-Tiburcio says, “It typically is not so helpful to start the conversation with, ‘Dad, I think you're depressed.’ ” Instead, she says, you might talk about the changes you see, like oversleeping or irritability, and suggest a doctor’s visit. Offer to come with them, she suggests, so you can share your observations.

Duckworth suggests listening carefully for the symptoms, like poor sleep or memory lapses, bothering your loved one most. Urge them to see a doctor about those problems, he says.

Also, keep in mind that what looks like depression is sometimes something else. A good workup should rule out “medical mimics,” such as anemia, low thyroid hormone and sleep apnea, that can cause fatigue, sluggishness and other symptoms common in depression, says Eran Metzger, M.D., medical director of psychiatry at Hebrew SeniorLife, Boston.

Dementia and depression also can mimic each other, notes George Dicks, a geriatric mental health specialist at Harborview Medical Center in Seattle. “People with dementia appear to be depressed when they aren’t,” he says. “People with depression appear to be demented when they aren’t.”  

In addition to physical tests, the doctor will likely give your loved one a questionnaire, Metzger says. A commonly used one, the Geriatric Depression Scale, includes questions such as, “Do you feel that your life is empty?” and “Do you often feel helpless?” Answers to those questions can help point to a depression diagnosis.

Learn about treatments

If your loved one is diagnosed with depression, they’ll have several treatment options. “Older adults benefit from all of the same treatments that younger adults do,” Emery-Tiburcio says. Even those with relatively mild depression can benefit, she says.

The main treatments are talk therapy (psychotherapy) and medication. Either can be effective alone, but “if you get both, it’s likely to be even more effective,” Emery-Tiburcio says.

Still, she says, older adults often prefer psychotherapy to pills. Talk therapy alone can be a reasonable choice for many people, she says.

Metzger says: “I have both types of patients…. I have patients who say, ‘Just give me a pill. I don’t want to talk about my stuff,’ ” and others who don’t want drugs. But if your loved one has severe depression, he says, they may need medication to get relief.

Talk therapy comes in several forms, with names like cognitive behavioral therapy, interpersonal therapy and problem-solving therapy, Emery-Tiburcio says. These therapies, which can be effective in eight to 16 weeks, aren’t about “laying down on a couch and telling your life story,” she says. For example, she says, cognitive behavioral therapy involves “helping somebody understand how thoughts, behaviors and emotions are related to each other, and what you can do with thoughts when they come into your head, and what kinds of behaviors you can engage in to help yourself to feel better.”

Ideally, your loved one will find a therapist trained to work with older adults, especially if they have multiple chronic conditions and other complications that become more common with age, she says. “A generally healthy 65-year-old who doesn’t have a lot of complicating factors” probably would do fine with any good therapist who works with adults, she adds.

When medications are prescribed, the first choice is usually one of the antidepressants known as SSRIs (selective serotonin reuptake inhibitors), Metzger says. These have fewer side effects than alternative medications, and are generally safe, he says.

SSRIs commonly prescribed to older adults include escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor), according to the American Psychological Association.

But some side effects are more common in older adults. For example, Metzger says, SSRIs can lower blood sodium levels and may increase bleeding risks for people taking blood thinners.

Other drug options for older adults include drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), and norepinephrine/dopamine reuptake inhibitors (NDRIs), such as bupropion (Wellbutrin), according to guidelines from the psychological association. Metzger says he often prescribes bupropion for depressed older adults “lacking energy.” For those with insomnia or poor appetite, he says, he might try mirtazapine (brand name Remeron), which is in another class of drugs called tetracyclic antidepressants.

Because antidepressant doses may be raised slowly and take weeks to work, caregivers should encourage loved ones to keep taking them long enough to get relief, Metzger and Emery-Tiburcio say.

Sometimes, treatments don’t work or stop working. When that happens, it’s important to “keep trying to find the right therapist, to find the right medication, to find the right environment, because there is help, there is hope,” says Parrish’s wife, Huppert, a former executive director of NAMI Iowa.

For Parrish, the treatment that finally worked was a form of brain stimulation, called transcranial magnetic stimulation (TMS), approved by the Food and Drug Administration for treatment-resistant depression. He and Huppert say that since his first round eight years ago, he’s had several booster courses of TMS, which uses magnets to influence electrical activity in the brain and requires daily treatments over several weeks.

Important to know: Medicare and other insurers usually cover depression treatment. And some community mental health centers base fees on the ability to pay, according to the National Institute on Aging.

Support your loved one

One way to help a depressed person is to help them rediscover life’s pleasures — “what turns them on, what distracts them, what tastes good, what makes them smile,” Dicks says.

For one 86-year-old client, he says, sharing silly TikTok videos with him is a balm: “For the time we’re together, she’s smiling.” The idea, he says, is to “make good chemicals in your brain, as opposed to making bad chemicals.”

Encouraging people to socialize might help, or it “might be just too much” at first, Emery-Tiburcio says. Getting someone out for a walk or a trip to the grocery store could be a good first step, she says.

Exercise of any sort can help, Metzger says.

So can regular, nutritious meals and a consistent sleep routine, Dicks says. Alcohol, he says, generally makes things worse: It’s a depressant and interferes with good sleep and should not be mixed with SSRIs.

Once someone is doing better, caregivers often play another role: noticing if signs of depression creep back.

Parrish says he counts on Huppert to notice when he’s “starting to slide,” getting lethargic and irritable and oversleeping. “That’s when she says, ‘Maybe you need to talk to your doctor.’ ”

Take care of yourself

It’s not unusual to get emotionally burned out caring for a depressed loved one, the experts say. 

Building a broader support network is crucial, Duckworth says. If your loved one doesn’t want to share their diagnosis, he says, ask them if it’s OK to tell people they “need help with coping” and would welcome visits, calls or other contact.

You can also find help through a mental health support network, such as NAMI, Huppert says. The group offers family educational programs and support groups, online and in person.

Other resources include the Depression and Bipolar Support Alliance, Mental Health America, and the Substance Abuse and Mental Health Services Administration.