Alzheimer's Patients with Depression: More Common than You Think

Did you know that patients with Alzheimer's are more likely to have depression? Experts estimate that clinically significant depression occurs in about 20 to 40 percent of people with Alzheimer’s disease. Unlike regular depression that tends to affect women more often than men, Alzheimer's depression affects both men and women equally. Unfortunately it is quite difficult to detect and identify depression in Alzheimer's patients as symptoms often overlap and fluctuate. Dementia often possesses the same traits that depression does, especially as patients come to terms with their diagnosis and begin to recognize the effects of Alzheimer's on their daily life or near future. Some symptoms overlap and as the disease progresses, patients have an increasingly difficult time expressing and articulating sadness and depression-related feelings like hopelessness, guilt, and apathy. Some patients may experience depression symptoms that come and go while other Alzheimer's cognitive symptoms tend to be pervasive and long-lasting. Often some medications or unrecognized medical conditions can produce depression symptoms in Alzheimer's patients. Evaluations by a doctor (or geriatric psychiatrist) is important, including an interview with primary caregiver(s) and family members who know the patient well.

According to the National Institute of Mental Health, there are specific diagnostic criteria for "depression of Alzheimer's disease." These criteria are a good measure of identification for patients who might have depression in addition to dementia. If a patient has three or more of the following within the same two-week period (*and must include the first two on the list) depression will likely be diagnosed:

• Significantly depressed mood—sad, hopeless, discouraged, tearful*
• Decreased positive feelings or reduced pleasure in response to social contacts and usual activities*
• Social isolation or withdrawmal
• Disruption in appetite that isnot related to other medication
• Disruption in sleep (check out this fact sheet on sleep changes from the Alzheimer's Association)
• Agitation or slowed behavior (check out this fact sheet on agitation from the Alzheimer's Association)
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness or hopelessness or inappropriate or excessive guilt
• Recurrent thoughts of death, suicide plans, or suicide attempts

What does treatment of depression in Alzheimer's patients involve?
The most likely treatment includes a combination of medicine, support, and gradual reconnection to activities and people he or she finds pleasurable. Like other people suffering from depression, telling a patient to "cheer up" or "try harder" will not help as patients with depression cannot usually "snap out of it" on their own without a combination of treatment.

These approaches may help:
• Schedule a predictable daily routine and work around a patient's difficult and best times of day to do certain activities
• Make a list of activities, people, or places that the person enjoys and schedule them more often
• Help the person to exercise regularly especially in the morning
• Acknowledge the person's frustration or sadness and express hope and support that he or she will feel better soon
• Celebrate small successes and occasions
• Find ways for the person to contribute to family life and recognize his or her contributions
• Make sure to express love, respect, and appreciation for the person as a part of the family not just for certain things
• Nurture the person with their favorite foods or soothing activities
• Reassure him or her that you will not abandon them
• Consider psychotherapy and a support group (especially in earlier stages of Alzheimer's) to talk about his or her awareness of the disease and allow them to actively seek help or help others


In addition to these possible treatments, antidepressants like SSRIs are often prescribed. It's important to consider current medications when adding another to treatment.

Learn more about Alzheimer's patients and crying:
Read the discussion: "How can my dad help my mom, who has Alzheimer's, when she has a crying spell?"
Also read through others' experience on MDJunction's Alzheimer's Group discussion "Mom's been Crying for 3 Days"
Alzheimer's Speaks answers a question from a concerned family member on "Hospice, Crying, and Sleeping"

Learn more about Alzheimer's and Depression:
About.com's Alzheimer's Guide Carry Hill writes on "Depression and Alzheimer's"
Read more on symptoms in MayoClinic's article Alzheimer's or Depression: Could it be both?
Check out USC's Fact Sheet: About Depression and Alzheimer's (pdf)

Have you heard about the link between Alzheimer's and Depression?
Do you have any links or information to share with caregivers look to help their Alzheimer's relative with dealing with Depression?

Join WEGO Health's Alzheimer's Group or Depression & Anxiety Group