Depression and Alzheimer’s Disease
When we think about someone with Alzheimer’s disease (AD), the first symptoms we think of are due to changes in thinking or cognition. Memory loss and decreased concentration are common examples. Unfortunately, in addition to the cognitive symptoms, 40 percent of people with Alzheimer’s disease suffer from significant depression and other symptoms commonly associated with the condition, including apathy, loss of interest in activities and hobbies, social withdrawal, isolation, and irritability.
These symptoms represent a significant threat to the quality of life for both individuals with AD and their caregivers. It is vital for family caregivers to be aware of this likelihood, to know when to get help and have strategies to help their loved one face this additional challenge.
Family caregivers are in an excellent position to monitor for mood changes in their loved ones.
This is important because identifying depression in someone with Alzheimer’s disease can be challenging if the cognitive changes to the brain make it difficult for a person to articulate their sadness, hopelessness, guilt, and other feelings associated with depression. Men and women with Alzheimer’s disease experience depression with about equal frequency, and will demonstrate similar symptoms.
While many people with Alzheimer’s disease will have variable moods that can include “downtimes,” anxiety, and upset, when key symptoms are persistent, major depression becomes more likely.
Key symptoms include depressed mood (sad, hopeless, discouraged, or tearful) or decreased pleasure in usual activities, along with two or more of the following over a two week period:
Social isolation/withdrawal from family and friends
Disruption in appetite unrelated to another medical condition or medication
Disruption in sleep
Agitation / Irritability
Fatigue, loss of energy, or slowed behavior
Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
Recurrent thoughts of death, suicide plans, or a suicide attempt
Seeking a Diagnosis & Treating Depression
If you are concerned about your loved one being depressed, seek help from their primary care provider. If need be, they will refer you to a specialist. Often the primary care provider can assist with the diagnosis and initial treatment. Since your loved one may have difficulty expressing the full range of symptoms you have observed, it is likely best for you to participate in the medical evaluation. There are some question-based assessments used for depression. You may be needed to assist with that since some medical conditions can mimic depression. The primary care physician may want to perform several blood tests. If no other explanation is found, treatment should be offered.
The ideal treatment for anyone suffering from depression is a combination of counseling and medication. Treatment of depression in Alzheimer’s disease can improve a person’s sense of well-being, quality of life, and individual function. Some people with Alzheimer’s disease will not be able to benefit from counseling, given their poor memory and processing ability. Medications should be just as effective. Several good options reduce symptoms without negatively impacting cognitive ability.
Caregiver Tips for Helping a Loved one with Depression
For patients in the early stages of Alzheimer's who are aware of their diagnosis and prefer to take an active role in seeking help or helping others, have them consider the course of supportive psychotherapy and a support group.
Help manage the medication:
Encourage your loved one to follow through with treatment and take medication as instructed.
Help your loved one keep up with their treatment plan as depression usually recurs when treatment is stopped too soon.
If it isn’t helping, look into other medications and therapies depending on your loved one’s ability to participate in “talk” therapy.
If your loved one is an ALF/nursing facility, beware of symptoms such as
apathy
social withdrawal
weight loss
agitation
prolonged physical rehabilitation
Suicide:
Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.
While a person with Alzheimer’s, particularly in the middle to later stages of the disease, may not plan a suicide, there is always a possibility that a person could injure or kill themselves.
Remove or limit access to lethal means such as firearms, knives, power tools, solvents, matches, lighters, ropes/cords, medications, or car keys.
Statements of suicide should always be taken seriously.
If a person is engaging in suicidal behavior, seek urgent professional help—call 911.
Drug and Alcohol Use
People may use drugs and alcohol to mask their feelings caused by emotional and physical pain. Alcohol and other drug use can make symptoms of Depression, irritability, and anxiety worse and impair brain function. Alcohol also interacts in harmful ways with numerous medications, including antidepressants.
The impairment to the brain caused by Alzheimer’s may also make it impossible for your loved one to limit or stop their alcohol or drug use.
The caregiver may have to limit or stop the use of alcohol and or other drugs. You should seek medical advice.
Please talk with your own/loved one’s healthcare provider before using any of this information.