- Individuals diagnosed with dementia can present with coexisting depression.
- Several symptoms are common to both dementia and depression: apathy, lack of interest in people or activities, poor sleep, restlessness, memory loss, and difficulty concentrating.
- Distinguishing between dementia and depression, and determining whether each condition exists or if they co-exist is critical to ensure proper treatment.
- The frequency and severity of depression remain fairly constant through most stages of Alzheimer's disease.
- For most individuals with Alzheimer's disease who develop depression, it tends to be mild and moderate in severity, and suicidal behavior or completed suicide is rare.
- Depression may cause or worsen memory loss and other cognitive impairment.
- It appears that Alzheimer's disease is more likely to develop in people who have depression plus cognitive impairment, but that depression occurring without cognitive impairment does not increase the risk of developing the disease.
- Counseling or psychotherapy may be helpful in mild to moderate depression in the earliest stages of dementia, but systematic studies on this issue are lacking.
- Antidepressants are usually indicated for those with Alzheimer's disease who demonstrate persistent or severe depression. However, only half of the published research shows superiority for antidepressant medication over placebo in the treatment of depression in those with Alzheimer's disease or dementia in general.
- If a physician prescribes antidepressant medications, it is important to monitor the choice of medication, dosage, possible side effects, impact on cognition and activities of daily living, and the status of the depression.
Contributed by D.P. Devanand, M.D., a professor of clinical psychiatry and neurology at the College of Physicians and Surgeons at Columbia University in New York.
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