According to the National Institutes of Health, most people who experience depression need treatment to get better. Up to 40% of people with Alzheimer’s suffer from significant depression, notes the Alzheimer’s Association. It is particularly common in the early stages of dementia, and for those with vascular dementia or Parkinson’s disease dementia. However, identifying depression in a person with Alzheimer’s can be difficult since dementia can cause some of the same symptoms. Dementia does complicate matters. What is a caregiver to do?
I have a wonderful niece who is currently caring for her mother-in-law who has dementia. She called recently to ask me what to do, as she thought her mother-in-law might be experiencing depression. There were several circumstances that would cause her mother-in-law to be depressed: her husband had died during the previous year; her house was sold and she moved into a new home with her son’s young family; her sister with whom she was close was moving out of state to be with her daughter. These were reasons enough for anyone to become depressed. I commend my niece for suspecting that her mother-in-law was suffering from depression.
How do you know if a person is depressed? Depression is not just a low mood of feeling sad but a complex disease. It is a persistent condition in which feelings like sadness and hopelessness dominate a person’s life and make it difficult for them to cope. Depression has serious effects on one’s physical and mental functioning. Some of the triggers leading to depression include:
- Loss of the ability to do things that you used to do that give you pleasure;
- Loss of loved ones;
- Changes in health;
- Major changes in life circumstances;
- Feelings of low self-esteem, worthlessness, undue guilt;
- Traumatic events.
Depression also has a number of causes common to people of all ages. These include genetic factors, ongoing stress, social isolation, drug interaction, drug and alcohol use. That is why it is so important to get a diagnosis so the depression can be treated. The organization called Alzheimer’s Australia notes: “Dementia can contribute to depression through the slow erosion of confidence and self-esteem as a person’s ability to manage their physical and social environment is affected.” Other changes that can contribute to depression in a person with dementia are:
- Loss of independence and increasing reliance on others;
- Inability to go out alone;
- Loss of ability to undertake enjoyable activities;
- Loss of ability to carry out everyday tasks
- High anxiety and agitation;
- Confusion and loss of memory.
Why can depression be difficult to diagnose? There is an “age bias” that it’s normal for older people to be depressed, so it’s easier to go unrecognized. Persons with dementia can have problems communicating their own symptoms to their caregivers or doctors. If there is a noticeable change in behavior and functioning over a period of a few weeks, depression might just be the reason. If you see signs, discuss this with your loved one’s primary care doctor or a geriatric psychiatrist who specializes in the treatment of depression. Proper diagnosis requires a thorough evaluation, and treatment can improve your loved one’s sense of well-being and daily functioning.
What can be done to treat depression in persons with dementia? Once it is diagnosed, there is a range of treatment options depending how severe and long-standing the depression is. It is important to understand the cause to determine what is most appropriate. If the depression has a physiological basis, an anti-depressant medication may be required. Making a decision about which medication to use is complex. There could be possible side effects, especially if the person is taking a medication for Alzheimer’s or other physical ailments. If the primary cause is psychological or environmental, the person may be more responsive to strategies such as: a reassuring daily routine, regular physical exercise, time spent doing enjoyable activities, regular social contact, reducing exposure to overstimulating or threatening situations, art and music therapy, pet therapy.
Do caregivers experience depression? It is not unusual for you the caregiver to develop mild or more serious depression as a result of the challenges you face in providing care day in and day out. According to the Alzheimer’s Association, one third of caregivers report symptoms of depression. My father, who was caregiver for Mom for several years, took a mild anti-depressant prescribed by his gerontologist. He told me it “took the edge off” his depression. Regardless if you are a caregiver or not, everyone has negative feelings from time to time. However, if you find yourself crying frequently, are easily angered by your loved one or others, are totally drained of energy, have unrelenting negative feelings like unexpressed anger, — these may be warning signs of depression. Please pay attention to them and seek help and support for your own sake and that of your loved one. Silence about depression only makes it worse.
May you find peace, patience, and joy in your caregiving journey today and every day!
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Here is a booklet to read and download: “Depression, what you need to know”: http://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml.
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For more information about depression and dementia check out: https://www.alz.org/care/alzheimers-dementia-depression.asp#symptoms, and
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For information regarding depression in caregivers, please read: https://www.caregiver.org/depression-and-caregiving.
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This song combines the glory of a setting sun and music of ocean waves with a song to calm you, “Happiness Is Here and Now”: https://youtu.be/vTnZVjioahI.
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