Depression and dementia share many of the same symptoms. This can make
it difficult to identify when people with dementia become depressed.
This information sheet looks at depression and how it can affect people
with dementia. It also suggests ways to help.
What is depression?
We all feel low or down from time to time but this is not the same
as experiencing depression. Depression is a more persistent condition
in which a number of feelings, such as sadness, hopelessness or lack
of energy, dominate a person’s life and make it difficult for
them to cope.
Depression is a common condition. At least one in five people in the
UK will experience depression at some time in their lives. Depression
is also common among people at all stages of dementia. It causes additional
distress, making it even harder for people with dementia and those caring
for them to cope.
Anyone with depression should see their doctor as soon as possible.
The sooner depression is diagnosed, the easier it is to treat.
What are the symptoms?
Depression affects people in different ways and to different degrees.
Doctors may talk about mild, moderate and severe depression. Some of
the more common symptoms include:
-
A sad, hopeless or irritable mood for much of
the time
-
Increased anxiety
-
A loss of interest or pleasure in activities that
were once enjoyed
-
Feelings of low self esteem, worthlessness or
undue guilt
-
Feelings of isolation and of being cut off from
other people
-
Sleep disturbance, such as early waking
-
Problems with remembering, concentrating or making
simple decisions
-
Slowing down in mind and body, or increased agitation
and restlessness
-
Eating too little or too much, and weight loss
or gain
-
Aches and pains that appear to have no physical
cause
-
Thoughts of death and suicide.
Some of these symptoms are similar to those experienced by people with
dementia.
What causes depression?
There can be many different causes of depression, and they vary from
person to person. There are often several contributory factors, including:
-
Stressful or upsetting events, such as bereavement,
a move or a disability
-
The effects of certain illnesses or the side-effects
of medication
-
Feelings of loneliness and isolation
-
Lack of activities, with feelings of boredom and
aimlessness, and little control over situations
-
Worries over issues such as money, relationships
or the future.
-
In addition, some people may have a genetic predisposition
to depression.
What treatment is available?
The main treatments for depression include antidepressant medication
and psychological therapies (see Treatment, below).
Depression or dementia?
Because the symptoms of depression and dementia are often so similar,
an older person with dementia may sometimes be wrongly thought to have
depression, and vice versa. It is important to ensure that the person
sees their doctor as quickly as possible so that an accurate diagnosis
can be made, and appropriate treatment prescribed. If the doctor is
uncertain, they may consider treating the person for depression and
also referring the person to a dementia specialist.
Differences in symptoms between depression and dementia include:
-
A depressed person’s powers of reasoning
and ability to orientate themselves as to time and space usually remain
intact, although they can be impaired by the depression, while a person
with dementia’s are likely to be impaired
-
A depressed person will usually complain of an
inability to remember things but will remember when prompted, whereas
a person with dementia will be forgetful but often try to cover up
memory lapses.
Dementia accompanied by depression
Depression frequently co-exists with dementia. If people with dementia
also become depressed they will be struggling with two lots of difficulties.
The depression will exacerbate the effects of dementia making it even
harder for people to remember things and making them more confused,
more anxious or more withdrawn. It may also cause behavioural changes,
such as walking around aimlessly, aggression, or refusal to eat.
It can be difficult to diagnose depression in dementia because some
of the symptoms of depression and dementia are so similar, and because
people with dementia may have difficulty explaining how they feel.
The causes for depression in dementia are likely to be similar to those
for depression in general (see above). However, in the early stages
they may also include worrying about memory loss and about no longer
being able to cope as they had in the past. Chemical changes in the
brain, caused by the dementia, may also lead to depression. People living
in care homes seem to be particularly at risk of depression.
Consulting the doctor
It is important to let the doctor know straight away if the person
with dementia is behaving in an unusual or worrying way, or has deteriorated
more rapidly than you would have expected.
Since such changes could also be caused by an illness or by the effects
of medication, the doctor will want to examine the person in order to
rule out this possibility.
In order to try to diagnose whether or not the person is depressed,
the doctor will talk to the carer and the person with dementia, where
possible, to assess the person’s mood and any changes that have
occurred. For example, does the person seem more agitated or lethargic?
Do they complain of feeling tired or hopeless? Do they look more depressed
or cry more frequently? Are there changes in their sleeping or eating
patterns or other behaviour? Do they still seem to enjoy the things
they used to enjoy?
Treatment
Studies have shown that depression may respond to increased social
support and attention to the person’s environment (Teri, 1997
and 2003). This can be achieved by, for example:
-
Pleasant activities that the person can still
enjoy, such as short walks or outings.
-
Making sure there is a reassuring daily routine
-
Protecting the person from unwanted stimuli, such
as bright lights, loud noises and too much rush and bustle, or from
feeling isolated and bewildered in a large group
-
More one-to-one interaction, such as talking,
hand holding, or gentle massage, if appropriate
Psychological therapies
Talking about feelings may be a helpful way of treating depression
for people in the earlier stages of dementia. Increasingly, GP surgeries
provide a counsellor or a counselling service. Counsellors are trained
to listen and can provide a supportive environment for their clients.
There are many different types of counselling therapies, and their suitability
will depend on the person and the stage of their dementia.
Cognitive behavioural therapy can help to overcome the negative feelings
that can sometimes be the cause of depression.
In psychotherapy, clients are encouraged to look deeper, uncovering
the roots of their depression in their childhood experiences. There
is now a small but growing body of evidence that people with dementia
can be receptive to psychotherapeutic techniques .
Support groups may also be helpful. People usually find talking to
others going through a similar experience immensely supportive.
Antidepressants
Antidepressants work by increasing the level of neurotransmitters
(chemical messengers) in the brain. An imbalance or dysfunction of neurotransmitters
can lead to depression.
Most antidepressants are not addictive and work well for the majority
of people. They are usually taken for at least six months and often
longer.
There may be side-effects to begin with, but these should lessen as
the body adjusts to the drugs. The doctor may decide to change the dose
or provide an alternative antidepressant if the side-effects continue.
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