Depression

Introduction

Depression-and-ConfussionExperts estimate that up to 40 percent of people with Alzheimer’s disease suffer from significant depression. Fortunately, there are many effective non-drug and drug therapies available. Treatment of depression in Alzheimer’s disease can improve a person’s sense of well-being, quality of life and individual function.

Symptoms of depression

Men and women with Alzheimer’s experience depression with about equal frequency. But identifying depression in someone with Alzheimer’s can be difficult. There is no single test or questionnaire to detect the condition, and diagnosis requires careful evaluation of a variety of symptoms. Dementia itself can lead to certain symptoms commonly associated with depression, including

  • apathy
  • loss of interest in activities and hobbies
  • social withdrawal
  • isolation

The cognitive impairment experienced by people with Alzheimer’s often makes it difficult for them to articulate their sadness, hopelessness, guilt and other feelings associated with depression.

Depression in Alzheimer’s doesn’t always look like depression in people without the disorder. For example, depression in Alzheimer’s is sometimes less severe and may not last as long or recur as often.

Also, people with Alzheimer’s and depression may be less likely to talk openly about wanting to kill themselves, and they are less likely to attempt suicide than depressed individuals without dementia. What’s more, depressive symptoms in Alzheimer’s may come and go, in contrast to memory and thinking problems that worsen steadily over time.

Diagnosing depression in Alzheimer’s disease

The first step in diagnosis is a thorough professional evaluation. Side effects of medications or an unrecognized medical condition can sometimes produce symptoms of depression. Key elements of the evaluation will include

  • A review of the person’s medical history
  • A physical and mental examinations
  • Interviews with family members who know the person well

Because of the complexities involved in diagnosing depression in someone with Alzheimer’s, it may be helpful to consult a geriatric psychiatrist who specializes in recognizing and treating depression in older adults.

To facilitate diagnosis and treatment of depression in people with Alzheimer’s, the National Institute of Mental Health established a formal set of guidelines for diagnosing the condition. Although the criteria are similar to general diagnostic standards for major depression, they reduce emphasis on verbal expression and include irritability and social isolation.

For a person to be diagnosed with depression in Alzheimer’s, he or she must have either depressed mood (sad, hopeless, discouraged, or tearful) or decreased pleasure in usual activities, along with two or more of the following symptoms over a two-week period:

  • Social isolation or withdrawal
  • Disruption in appetite that is not related to another medical condition
  • Disruption in sleep
  • Agitation or slowed behavior
  • Irritability
  • Fatigue or loss of energy
  • Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
  • Recurrent thoughts of death, suicide plans, or a suicide attempt

Treating depression

The most common treatment for depression in Alzheimer’s involves a combination of medicine, support and gradual reconnection to activities and people the person finds pleasurable. Simply telling the person with Alzheimer’s to “cheer up,” “snap out of it,” or “try harder” is seldom helpful. Depressed people with or without Alzheimer’s are rarely able to make themselves better by sheer will, or without lots of support, reassurance, and professional help.

Non-drug approaches

  • Schedule a predictable daily routine, taking advantage of the person’s best time of day to undertake difficult tasks, such as bathing
  • Make a list of activities, people or places that the person enjoys now and schedule these things more frequently
  • Help the person exercise regularly, particularly in the morning
  • Acknowledge the person’s frustration or sadness, while continuing to express hope that he or she will feel better soon
  • Celebrate small successes and occasions
  • Find ways that the person can contribute to family life and be sure to recognize his or her contributions
  • Provide reassurance that the person is loved, respected and appreciated as part of the family, and not just for what she or he can do now
  • Nurture the person with offers of favorite foods or soothing or inspirational activities
  • Reassure the person that he or she will not be abandoned
  • Consider supportive psychotherapy and/or a support group, especially an early-stage group for people with Alzheimer’s who are aware of their diagnosis and prefer to take an active role in seeking help or helping others

Medication to treat depression in Alzheimer’s patients

Physicians may prescribe antidepressants for people with Alzheimer’s who have depression. Examples include

  • bupropion (Wellbutrin®)
  • citalopram (Celexa®)
  • fluoxetine (Prozac®)
  • mirtazapine (Remeron®)
  • paroxetine (Paxil®)
  • sertraline (Zoloft®)
  • trazodone (Desyrel®)
  • venlafaxine (Effexor®)