GUEST COLUMN: Depression and Dementia

Depression and Dementia: What If I Can't Tell You I'm Sad?

By Dr. Jason Holland

What if you were hurting deeply inside but didn’t know how to tell anyone? Would you want someone to come along and attend to that wound?

Many patients with dementia find themselves in this very predicament. Depression goes unnoticed simply because the person cannot fully articulate what they’re feeling or behaviors consistent with depression are interpreted as “normal.”

If you’re caring for someone with Alzheimer’s disease or another form of dementia, here’s how to identify depression and a few tips on how to address it. 

Identifying Depression 

When identifying depression in dementia, we have to focus our attention on what we can observe, namely the person’s behavior. Have you noticed any sudden changes in the way they’re behaving or reacting to others? Some potential signs of depression include:

  • Irritability
  • Agitation
  • Slowed movements
  • Lack of energy
  • Loss of interest in usual activities
  • Appetite loss
  • Variation in mood across the day
  • Sleep disruption
  • Tearfulness 

Addressing Depression

If you believe that someone you care about with dementia might be suffering from depression, the good news is that treatments exist that can improve their quality of life. Two common treatments include antidepressant medication and behavior therapy: 

  • Antidepressant medication. One option is to talk to the patient’s physician about starting on an antidepressant. This is perhaps the least work-intensive solution, but it has the drawback of potential side effects (e.g., tiredness, dry mouth, headache). Plus, the research on antidepressant’s efficacy with dementia patients is limited.  
     
  • Behavior therapy. Another option to consider is behavior therapy. A behavior therapist can work with a patient and their caregiver to identify what’s contributing to low mood and work with them to develop an action plan to address the problem. 

For example, it may be that low mood is primarily a problem during a specific time of day, during specific types of activities, or with specific caretakers. This information can inform behavioral interventions, which might include increasing pleasant activities, limiting negative influences (e.g., conflict, loud noises), or developing a predictable and calming routine. Of course, the downside to behavior therapy is that it can be time-intensive and require significant effort.

Other therapies may also be considered, including transcranial magnetic stimulation (a noninvasive procedure that uses magnetic fields to stimulate brain cells) as well as alternative medicine (e.g., aromatherapy, acupuncture, breathing exercises). However, antidepressant medication and behavior therapy may be considered a best first line of defense.  

Dr. Jason Holland is a licensed clinical psychologist with expertise in geriatric mental health. He maintains a private practice in Gallatin called TN Wellness Center. For more information, call (615) 675-0025.

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