Depression is very common among people with Alzheimer's, especially during the early and middle stages. Treatment is available and can make a significant difference in quality of life.
Causes of depression
Although caregivers often feel that the fact of an Alzheimer's diagnosis must be creating depression in the affected person, there is little or no evidence that this is true. In fact, it is not clear how many people are capable of comprehending an Alzheimer's diagnosis at the time it is made. The symptoms of Alzheimer’s depression can arise at any point during the course of Alzheimer's disease, sometimes, at a stage quite late in cognitive decline.
Numerous neurological studies have found correlations between abnormalities in the brain and depression in dementia. For Alzheimer’s Depression in particular, positron emission tomography (PET) studies have found alterations of metabolism in the right superior frontal gyrus.
Symptoms of depression
Experts estimate that up to 40 percent of people with Alzheimer's disease suffer from significant depression.
Identifying depression in someone with Alzheimer's can be difficult, since dementia can cause some of the same symptoms. Examples of symptoms common to both depression and dementia include:
* Loss of interest in activities and hobbies
* Social withdrawal
* Trouble concentrating
* Impaired thinking
In addition, 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 does not always look like depression in people without Alzheimer's. Here are some ways that depression in a person with Alzheimer's may be different:
* May be less severe
* May not last as long and symptoms may come and go
* The person with Alzheimer's may be less likely to talk about or attempt suicide
As a caregiver, if you see signs of depression, discuss them with the primary doctor of the person with dementia. Proper diagnosis and treatment can improve sense of well-being and function.
Diagnosing depression with Alzheimer's disease
There is no single test or questionnaire to detect depression. Diagnosis requires a thorough evaluation by a medical professional, especially since side effects of medications and some medical conditions can produce similar symptoms.
An evaluation for depression will include:
* A review of the person's medical history
* A physical and mental examination
* 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.
The National Institute of Mental Health established a formal set of guidelines for diagnosing the depression in people with Alzheimer's. 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 for two weeks or longer:
* Social isolation or withdrawal
* Disruption in appetite, which is not related to another medical condition
* Disruption in sleep
* Agitation or slowed behavior
* 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
Getting appropriate treatment for depression can significantly improve quality of life. The most common treatment for depression in Alzheimer's involves a combination of medicine, counseling, and gradual reconnection to activities and people that bring happiness. 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.
* Support groups can be very helpful, particularly 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; counseling is also an option, especially for those who aren't comfortable in groups.
* 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 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.
* Medication to treat depression in Alzheimer's.
There are no official clinical guidelines yet about the use of antidepressant medication for Alzheimer’s Depression in particular. Medication may be justified for people with diagnosed with it, who are suicidal, violent, not eating or drinking, or who score high on the Cornell scale.
The evidence would seem to suggest similar efficacy for SSRIs and tricyclic antidepressants in initial treatment for Alzheimer’s depression. If these treatments do not address the symptoms, it would be reasonable to try noradrenergic drugs, secondary amine tricyclic antidepressants, or a monoamine oxidase inhibitor.
Sources and Additional Information: