Feeling depressed/having depression
Changes in mood
John had thought that it was natural for his wife to look constantly sad and to have lost interest in knitting in view of the disease and the difficulties she was experiencing. But staff at the day centre suspected that she might be depressed. It turned out to be the case and several months later after treatment, she looked much happier and had even started to knit again.
The doctor asked Jim about signs of depression, such as loss of appetite and interest, sleeplessness and feeling worthless. Jim answered no to everything, but I thought to myself, "That's me he just described". I spoke to the doctor afterwards and he put me in touch with someone who could help.
If the person with dementia looks sad and has no interest in doing anything, you might think that this is natural, and to a certain extent you may be right. After all the person is faced with many losses and may feel despondent about having to rely on other people so much. You may also feel sad about the changes and losses which have occurred as a result of the illness, be pessimistic about the future and feel alone. However, although a certain amount of despondency can perhaps be expected, it is important to realise that this general feeling can develop into depression (sometimes referred to as clinical depression). Depression is a medical condition, but one which is treatable. People with dementia who suffer from depression may start to have more behavioural problems such as aggression. You may find it difficult to tell the difference between depression and some of the symptoms of Alzheimer's disease. Nevertheless, there are signs to look out for which, if detected, can be treated and may relieve unnecessary suffering. For this reason, this chapter describes first how to recognise possible signs of depression and then how to cope with it. Finally, don't overlook the possibility that you too might suffer from depression.
How to cope with depression
Consult a doctor
If your doctor diagnoses depression, he or she may prescribe medication. The use of medication need not be considered as a “last resort” when everything else has failed, nor should it be considered as a “cure all”. On the contrary, if carefully prescribed, medication can provide the person with dementia with enough relief from the symptoms for you both to tackle some of the underlying causes. There is no need to worry about using antidepressant drugs as they are not addictive. Although side effects are possible, they should not occur with the latest kind of medication if the right drug is used with the correct dosage. You might not notice an improvement straight away. The complete effect can take up to two months. If successful, your doctor might advise you to continue treatment for a fairly long period of time, even for several years.
Provide support and understanding
Some people with dementia find that having the opportunity to speak about their problems gives them some relief. If the person you are caring for is in the early stages of the disease, they might find counselling helpful. Even if they speak about their problems and how they feel and then completely forget, it might nevertheless provide temporary relief. However, due to language problems, any kind of therapy which relies on verbal communication will only be suitable for a small number of people suffering from dementia or those in the early stages. Other forms of therapy include those based on music and art. Your doctor might be able to put you in touch with a therapist, but it is important to find a therapist who understands the particular needs of people suffering from dementia.
Try to break the cycle of depression
People suffering from depression tend to get caught up in a vicious circle and when they also have dementia, it tends to be even worse. They lose the ability to do many things they enjoyed doing before and become over dependent on others. If others fail to recognise this and do not initiate and maintain activities on their behalf, the cycle continues. It may therefore be up to you to actively encourage the person with dementia to take part in activities they once enjoyed, giving assistance if necessary, and even finding new activities and interests. (Please see chapter on recreation, activities and exercise.) You might also find that encouraging the person to play a more active role in decisions which concern their life gives them a feeling of being more in control and has a positive impact on mood.
How to recognise depression
People with dementia who are depressed may find it difficult to express complex feelings such as sadness, despair and worthlessness. They may make simple statements such as “I’m finished” or “I don’t care” in an attempt to express how they feel. In those who hallucinate (please refer to chapter on hallucinations and paranoid delusions), hallucinations may involve the themes of guilt and death or voices saying that they are bad. There are common signs (the core symptoms) to look for. A person does not have to have all these symptoms to be classed as suffering from depression. Other symptoms such as tearfulness and headaches sometimes occur alongside depression, but they do not signify depression on their own. When looking for signs of depression, try to notice marked changes in the behaviour of the person with dementia, e.g. changes in appetite, sleep or energy. A sudden lack of interest in activities that were previously enjoyed may also be a sign of depression.
Common signs to look out for
Possible contributing factor
Depressed mood, loss of interest or pleasure, altered appetite, sleep disturbance, inability to think or concentrate, fatigue, agitation or retardation, feeling of worthlessness, inappropriate guilt and recurrent thoughts of suicide or death, restlessness, negative thought content, reduced level of activity and withdrawn behaviour
tearfulness, anxiety, physical symptoms (headaches, pains) and chronic unhappiness depressed personality)
Previous depression, bereavement, loss of job, dementia itself, lack of reinforcement, social isolation, feelings of being abandoned and helplessness, other diseases of which depression is a symptom: cardiovascular (heart) disease, stroke, thyroid deficiency, metabolic upsets, vitamin B12 deficiency, cancer and Parkinson’s disease
Last Updated: Thursday 06 August 2009