Mental Health Month: Depression and Alzheimer's Disease
Depression is the second most common psychiatric problem in people with a dementia such as Alzheimer's (first place goes to agitation and psychosis). Diagnosing symptoms of depression in someone with Alzheimer's can be difficult. People with limited power of expression, cognitive problems and confusion may show symptoms of depression through, for example, pain and other bodily complaints, or by changes in behavior such as withdrawal, irritability, anger, and preoccupation with dead loved ones. Other common symptoms of depression are;
- Change in appetite and/or weight loss
- Fatigue or loss of energy
- Feelings of guilt
- Decrease in ability to think or concentrate
- Sleeping too much or not sleeping nearly every day
Things Depressed People Think and Say
They may feel there is nothing to live for.
They feel hopeless, angry, upset.
Sometimes people with Alzheimer's who feel depressed have thoughts about suicide.
Sometimes they may think about harming themselves or others.
Brain Damage, Depression and Alzheimer's Disease
Brain damage that results from dementia like Alzheimer's creates a vulnerability to depression. In vascular dementia depression is more common after damage to the left frontal regions of the brain. Depression is also associated with medical conditions that are common in people with dementia and with medications including antihypertensives (drugs for high blood pressure), antiparkinsonian medications, sedatives and hypnotics, analgesics and hypoglycaemic agents.
Treatment of Depression Associated with Alzheimer's
Treatments will depend on the dominant symptoms. There are a numbers of factors that make treating people with Alzheimer's and other types of dementia more difficult.
Theraputic activities, must always be included in the treatment of depression. These include:
Psychotherapy: Cognitive impairment, communication difficulties and the inability to retain insights through talk therapies make psychotherapy of limited use as skills deteriorate. Supportive individual and group therapy and improving problem solving skills can be helpful in mild stage of Alzheimer's
Structured Activities: Effective and helpful.
Recreational Therapies: Also very helpful and effective.
Behavioral Therapies can be adapted to benefit people with mild to moderate Alzheimer's.
Antidepressants: Medication can be used if therapeutic approaches fail and if depression is severe and/or life threatening. Antidepressants can be very effective in people with dementia but as with all elderly people they must be used with care, intitially in small doses and not increasing the dosage too fast. Response time is usually 6 to 8 weeks. Different antidepressants may need to be tried before one is found that achieves a improvements in their mental state.
Psychostimulants: Amphetamines are used in the elderly to treat apathy and failure to thrive in people with depression. Treatment of depressive symptoms with psychostimulants are now less popular and have mostly been replaced by the SSRI type antidepressants.
Medical treatment may also be required for poor appetite, weight loss and sleep disturbances that accompany other depressive symptoms.
Preventing Suicide in Depression and Alzheimer's
Caucasian males over 80 years and are four to five times more at risk of suicide in the U.S. than younger people. Depression represents the most significant cause of suicide in this age group and people newly diagnosed with dementia represent a higher risk still. This risk of suicide does decrease in people with severe dementia because they lack the cognitive abilities to carry out a suicide plan. Interestingly this group of people may instead involve themselves, indirectly, in life threatening behaviors through self harm. Examples include refusing food, medications, medical tests or treatments. They may also involve themselves in unsafe behaviors such as swallowing foreign objects or harmful substances or walking in unsafe areas.
More About Depression in People with Alzheimer's and other Types of Dementia