Depression is not the easiest thing to detect in someone especially when they don’t want to let you in.
The typical symptoms of depression are:
- Eating too much or too little
- Sleeping too much or too little
- Change in mood
- Loss of interest in activities they were previously involved in
- Difficulty concentrating
- Difficulty performing daily tasks
- Difficulty making decisions
Many of these symptoms are also symptoms of Dementing illnesses . I have seen people with Dementia forget to eat or forget that they ate and eat again. I have seen someone with Dementia lose interest in activities that used to define who they were. Withdrawal often occurs in Dementia because the person is aware that they are not able to keep up with social demands and it is easier and less stressful to stay where they feel safe in a familiar place.
Depression signs and symptoms in someone with Dementia are even more difficult since all behavior is communication when a person struggles with memory loss. Misinterpreting the behaviors of the person with Dementia by those around them is common. It is really important for you to consider this as a possibility if all other options have failed to decide the cause of behaviors. Unresolved anger, agitation, restlessness, sadness or lethargy just might be from depression they cannot express.
There was a woman in the Dementia unit I worked on that most of the staff did not want to care for. The staff reported that she was consistently nasty and uncooperative. Unfortunately this woman came from another facility where she had been over-medicated for such behaviors using antipsychotics and anti-anxiety meds that she was no longer on. When I suggested having our Psychiatric provider see her there was a lot of pushback from the family, understandably so after their previous experience that had left her sleeping almost continuously. It took months to work with this family and talk about limits for the medications and reassurance that we would “start low and go slow”, the mantra of Geriatric psychiatry. We finally started her on a low dose antidepressant and both the staff and family could not believe how different she was. This woman who was nasty and difficult to deal with had a much improved mood which made her more cooperative and easier to work with. She rapidly became a much-loved favorite of the staff.
Not all stories go this way. Sometimes a medication is tried and doesn’t work or has an unintended side effect that makes it an undesirable option. This happens with all medications, not just psychiatric medications, for all treatments. Often even blood pressure, diabetic or pain medications also are best-managed through trial and error. We start out and assess the results and adjust medications as indicated based on what is observed. I do want to urge you to consider the use of antidepressants for your loved one if their behaviors have changed significantly simply because they often improve the quality of life for the person.
How do you tell if a person with dementia is depressed?
For a person to be diagnosed with depression in Alzheimer’s, he or she must have either depressed mood (sad, hopeless, discouraged or tearful) or decreased pleasure in usual activities, along with two or more of the following symptoms for two weeks or longer:
- Social isolation or withdrawal
- Disruption in appetite that is not related to another medical condition
- Disruption in sleep
- Agitation or slowed behavior
- Fatigue or loss of energy
- Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
- Recurrent thoughts of death, suicide plans or a suicide attempt
Things that you can do to help relieve depression that do not involve medicines:
- Counseling – especially in the early stages of the disease. It can help to “get things off your chest”.
- Exercise – known to reduce depression because of the release of Endorphins
- Maintain a routine – we are creatures of habit and that is comfort for almost all of us
- Healthy Diet – good food makes us feel better, processed foods make us sluggish
- Sunshine! – Go outside – everyday if possible – even if it means bundling up.
- Maintain a Spiritual Connection through prayer or music
But most of all keep positive and hang in there!