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24 November, 2009

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Dementia and depression

Depression is usually described as feelings of extreme sadness. It describes both a mood and a syndrome.

A depressed mood may be:

A normal reaction to an event, such as the death of a loved one.
A symptom of another disorder, such as hypothyroidism.
Part of a syndrome of depressive disorder, such as major depression.

A syndrome is a collection of several symptoms and, in the case of a depressive syndrome, will usually consist of depressed mood or loss of interest in previously enjoyed activities, together with other symptoms. These may include:

Loss of interest
Lack of energy
Poor sleep
Loss of appetite
Feelings of guilt.

Depression is not a normal part of ageing.

Depression and dementia
Depression is very common among people with dementia. Depressive symptoms have been reported to occur in approximately 40 to 50 per cent of people with Alzheimer’s disease. People in long term residential care appear to be particularly at risk of depression. Other things that may contribute to a person’s depression include:

The side effects of medication

Reaction to diagnosis and perceived impact on lifestyle

Physical illness
Social isolation
Fatigue
Environmental factors, such as the inability to screen out unwanted stimulation like loud noises and crowds.

Depression may make it harder for a person with dementia to remember things and enjoy their life. It can also add to the difficulty of caring for someone with dementia.

Signs of depression
It can be very difficult to know if a person with dementia is depressed. Many of the symptoms of dementia and depression are alike. It can be difficult to tell the difference. Some of the typical signs of depression are:

Loss of interest and pleasure in previously enjoyed activities
Lack of energy
Poor sleep
Loss of appetite and weight
Expressing feelings of worthlessness and sadness
Being unusually emotional, crying, angry or agitated
Increased confusion.

Where to begin
If a carer suspects that depression may be affecting for the person with dementia, it should be discussed with the person’s doctor. The doctor will be able to carry out a thorough medical examination to rule out other medical problems. Medication, such as an antidepressant, may be prescribed and can be very helpful in improving the symptoms of sadness. It may also improve appetite and sleep problems. The doctor can also arrange for any appropriate referrals, such as to the Aged Care Assessment Team (ACAT), or for specialised psychiatric assessment.

Significant improvements can be made by treating depression. Treatment can improve the person’s mood and their ability to participate in activities. It is important that, where depression is suspected, it is treated.

Treatment - medication may have side effects
Treatment with antidepressants often improves depression in people without dementia. Antidepressants can have side effects, which should be discussed with the doctor before treatment is started. Generally, newer more modern antidepressants have fewer side effects and are less likely to cause difficulty to the person with dementia than older drugs, such as tricyclic antidepressants. If drug treatment is ineffective, it should be ceased. If it causes side effects, the treatment may need to be changed. Usually, a trial of at least two weeks treatment is necessary to tell how useful the medication is going to be.

Things you can try

Some suggestions for dealing with depression include:

Try to keep a daily routine for the person with dementia.
Limit the amount of noise and activity in the environment if this causes a problem. This will help avoid over stimulation.
Large group situations can make some people feel worse, while others may benefit from the stimulation of a busy, active gathering. It is important to know what the person has enjoyed in the past, as it is likely that similar activities will still appeal now.
Have a realistic expectation of what the person can do. Expecting too much can make both the person with dementia and the carer feel frustrated and upset.
Be aware of when the person is least fatigued and do any important tasks at that time.
Be positive. Frequent praise will help both the person with dementia and the carer feel better.

Remember - carers need respite
Carers should try to make sure they get adequate breaks from caregiving, so that they do not become worn down by demanding behaviour. Use of day care centres, in-home respite, and regular residential respite are helpful ways to achieve breaks so that carers can continue in their role.

Based on:

Depression and dementia, an article by Associate Professor David Ames, Associate Professor of Psychiatry of Old Age, University of Melbourne.
Depression and Dementia - A double jeopardy, an article by Associate Professor E Chiu, University of Melbourne.
Information from your family doctor: Depression and Alzheimer’s disease, American Academy of Family Physicians.

Where to get help

Your doctor
Your local community health service
Your local council
Alzheimer’s Australia Vic, National Dementia Helpline Tel.1800 100 500
Carers Victoria Tel 1800 242 636
Carer Support and Respite Coordination Centre Tel. 1800 059 059
Carers Resource Centres Tel. 1800 242 636
Aged Care Assessment Services - contact your regional Department of Human Services office
The Aged Care Information line Tel. 1800 500 853.

You might also be interested in:
Dementia - carers and activities.
Dementia - changed behaviours.
Dementia - communication issues.
Dementia - diagnosis and early signs.
Dementia - different types.
Dementia - how to encourage healthy eating.
Dementia - support services are available.
Dementia and memory loss.
Dementia and sleeping problems.
Dementia explained.
Depression - an overview.
Depression - coping and recovering.
Depression and ageing.

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