Depression & dementia: The unseen pain (Part I)

Nov 11, 2019

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Depression & dementia: The unseen pain (Part I)

Depression & dementia: The unseen pain (Part I)

Posted in : Living with dementia on by : Giulia Melchiorre

Understanding depression in dementia

Abraham Lincoln, Stephen Hawking, Michelangelo, Winston Churchill. Do you know what they all have in common other than being some of the most successful people in history?  The title of this article probably gave away the answer – they all dealt with depression. 

Depression affects people in different ways and can cause a wide variety of symptoms. Before we take a deeper look at depression, let’s first get some facts straight and put away some of the misconceptions about depression:

  • Depression isn’t something in someone’s head, they can’t just “shut it off”  
  • Depression isn’t just brought on from a traumatic life event 
  • Depression isn’t a sign of weakness 
  • Depression is more than simply feeling upset or low for a few days.

What is depression? 

People with dementia can also face depression. In fact, 1 in 5 people with dementia experience depression, particularly those who have Vascular dementia or Parkinson’s disease dementia. It can be experienced through feelings of sadness or hopelessness which tends to affect their everyday life. People may use different terminologies that could describe depression, such as  “nerves,” “feeling blue,” and “low spirits”.

Depression is a mood disorder and you may have heard that these feelings are brought on by an imbalance of chemicals in the brain. This is true, but it’s probably a little bit over simplified. It’s not just too much or too little of certain chemicals, but rather millions to billions of these chemicals reacting in our brains in ways that change our mood, perception and how we experience our life. There are also factors that contribute to this, including damaged mood regulation by the brain, genetic variability, stressful events, medications, and medical problems like dementia. It tends to be a combination of these things that bring on depression. 

It is important to point out that depression is different from apathy and delirium. If someone experiences apathy it means that they can’t care not that they don’t care. This can easily be confused with the lethargy that often accompanies depression. Antidepressants cannot help in this case. The onset of delirium is usually sudden, short lived, fluctuates and the person can either become hyperactive or withdraw and become less (or hypo) active. 

Depression affects people in different ways, to different degrees and at different stages of dementia – making it difficult to understand depression. Regardless, you can help – whether you are the primary carer, a family member or a friend. This article aims to help you identify it, understand it’s impact and potential causes. 

Identifying depression 

A physical injury can be seen and so the injury is attended to immediately by clinicians, family and friends. Mental health issues, like depression, are harder to spot and therefore may not get the care and attention they require. This is coupled with older adults being resistive to actively seeking the support they need.

It can also be difficult to identify depression because it may take lots of different forms and manifest itself through a variety of symptoms. These can include depressive mood, low self esteem, feelings of worthlessness or undue guilt. But they may also include:

  • Sleep disorder (Sleeping too much or not at all)
  • Appetite disturbances (From not wanting food to binge eating)
  • Lack of energy (Struggling to get things done)
  • Fatigue (Tired mind and/or body)
  • Pain (Both physical and emotional)
  • Constipation (Infrequent or difficult bowel movements)
  • Musculoskeletal disorders (Affects joints, bones, muscles & back pain) 
  • Loss of interest (disengaged in activities they once enjoyed or socialising with people)
  • Concentration deficit (Can’t seem to focus) 
  • Agitation (Can’t sit still)
  • In extreme cases, thoughts of self-harm (Dark thoughts)

These are just starting points and if the person you are looking after resonates to any of the above points it is important to share this with your doctor as they have the tools to officially assess depression. 

The Impact of depression

Dementia can be difficult to live with, but add depression to the mix and the person will find it even harder to remember and recollect things. They might even find themselves disoriented and reserved. This is because mental health issues (like depression) have the unfortunate power to affect how our brain works. They can slow down our ability to think and process information. 

The combination of dementia and depression could also affect behaviour. For example, it can affect the way someone eats, sleeps, behaves and acts on a daily basis. As dementia progresses, depression may lead to weight loss, as well as tearfulness. 

But WHY?

A diagnosis of dementia can cause depression. People may struggle with receiving the diagnosis, and the impact it can have on their lives. 

Other potential causes of depression include:

  • Being isolated and distant from family, friends & their community 
  • Loss of independence – no longer being able to do things how they used to
  • Stress from personal challenges, strain on relationships, or work 
  • Reduced self-esteem – feeling bad about yourself or not having the confidence to do things anymore 
  • Big changes in a person’s life like retirement or moving into residential care can also cause depression. 
  • Other causes can include untreated pain, drug or alcohol use, medication side effects or Vitamin D deficiency

If you can understand why someone with dementia is depressed, you then will have a better idea of how you can help! 

If you found this useful, please do share this or leave a comment below. You can find out more about what you can do to help someone who faces depression in next week’s blog.

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