Battling Depression

Treatment can improve quality of life

By Karen Shugart

Living with Alzheimer’s disease brings a multitude of challenges. Untreated depression shouldn’t be one of them.

Prevalence rates vary in studies, but experts believe that depression in those diagnosed with Alzheimer’s disease is not uncommon. Moreover, depression is thought to be underdiagnosed and undertreated, as symptoms can overlap with those found in Alzheimer’s disease.

Spotting the Symptoms

The social withdrawal, trouble concentrating and apathy found in Alzheimer’s disease are just a few of the symptoms that are also frequent hallmarks of depression. “You’re going to see some overlap in some cognitive complaints, such as tiredness, loss of motivation,” says Guy Potter, an associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University.

“Guilt and some of the more anxious kinds of symptoms, you’re not going to see as much in Alzheimer’s disease.”

While the affected person may recognize ongoing sadness, sometimes it falls on the caregiver or loved one to pick up on signs of depression. Particularly as Alzheimer’s disease becomes more advanced, an affected individual may not recognize depression. “They may not be aware of their changes in mood or their responsiveness to other people,” says Lisa Gwyther, an associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University.

The Importance of Intervention

Recognizing the signs, however, is important for a couple of reasons. For one, recognition can be the first step to intervention—and potential happiness. “It’s important to improve quality of life, to make sure that the person’s lived experience is as pleasant as possible,” says Gwyther.

And research also shows that depression hastens the course of Alzheimer’s disease, Potter says. “It is important because there’s research showing that individuals with mild cognitive impairment and depression at the same time are going to have a more rapid decline,” Potter says. “Evidence does show that it’s a risk factor for a steeper rate of cognitive decline. So you want to get it treated.”

So how can one best help someone showing signs of depression? For starters, don’t ignore the problem or attempt to brush it aside. “What you don’t want to do for someone who has dementia or depression is say, ‘Just snap out of it.’ Nobody can do that,” Gwyther says.

Sorting out what’s what can be difficult, and well worth an expert opinion. “Sometimes figuring out what is depression and what is dementia itself can be tricky, so it’s worth it for the family and for the person to be evaluated,” Gwyther says.

Effective Treatment

Treatment can include a variety of measures: therapy, lifestyle changes and medication. Choosing the latter correctly for someone with depression and Alzheimer’s disease can be a delicate matter, however, as possible side effects must be considered. “You want to be careful,” Potter says.

In the early stages of depression, people may benefit from group therapy to manage depression. This could take the form of a support group for people with an Alzheimer’s diagnosis or for people with depression. Individual therapy sessions also could help.

Approaches that don’t necessarily require expert assistance may also provide benefits. Exercise (particularly in the morning), increasing social interaction and engaging in pleasant activities are just a few ways that—when done in a sustained manner could help jump-start the mood, a process Gwyther describes as “behavioral activation.”

“I think it’s important to recognize that there’s more than one way to treat depression,” Gwyther says. “I’m a big fan of a non-drug approach to treating mild depression in people with dementia.”

One method she likes builds upon research by academics Rebecca Logsdon and Linda Teri, who developed the Pleasant Events Schedule-AD, a tool used to identify enjoyable activities for Alzheimer’s patients. With a care partner, a person with Alzheimer’s disease makes a list of entertaining activities and events. The two find ways to incorporate more of the enjoyable events over time.

“Many families are able to take that and use it with their relative and come up with a way to gradually increase the amount of time they spend doing things that are more pleasant and less frustrating, and that has an effect on their overall mood,” Gwyther says.

“Getting people going and getting them engaged in things they enjoy makes a big difference. If they can feel purposeful and engaged, it makes a big difference in their mood, even without any medication treatment.”

Sticking to the Plan

Potter recommends that caregivers should be involved in evaluations and, ideally, some treatment sessions. Encouraging their loved ones to adhere to treatment recommendations is important, too.

In all these efforts, it’s important to remain mindful of the need to care for themselves. Sometimes that can get lost amid worrying about someone dealing not only with Alzheimer’s but depression as well. When caregivers struggle, the strain can be felt by those around them, including those who depend on them most.

“People with dementia are very responsive to the mood of the people they’re spending the most time with,” Gwyther says.

That’s why it’s important to seek out respite care, call upon support systems and seek mental health treatment as needed.

“If they’re worn out by caretaking responsibilities, they’re not going to be effective as caretakers, and that’s bad for the patient in the long run,” Potter says.