Mental Health Support For A Loved One With Depression And Dementia

The relationship between depression and dementia is complex and still not fully understood. Depression is common among dementia patients; evidence suggests that 30–40% of those diagnosed with dementia will also qualify for a depression diagnosis, especially in dementia’s early and middle stages. 

In contrast, only about 7% of all adults in the United States meet the criteria for a diagnosis of depression. The substantially higher depression prevalence among those with a dementia diagnosis has significant implications for individuals with dementia and their caregivers. Below, we’ll explore how dementia and depression are related and how you can support a loved one with both conditions. 

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Understanding dementia and depression: Side effects and risk factors

The mechanisms of interaction between the two conditions are still being examined. Current research suggests that, in addition to dementia’s ability to increase the likelihood of depression or worsen existing symptoms, depression may also worsen dementia. 

Furthermore, evidence indicates that the link between dementia and depression may go much deeper than previously thought. One recent study found that those who are diagnosed with major depression early in life are twice as likely to develop dementia later in life. The results of that study suggest a substantial and complex connection between the two conditions that may offer clues as to the underlying causes of both. 

Unique features of depression in dementia patients

There are significant challenges associated with accurately identifying depression symptoms when a person has dementia. The cognitive impairment that results from dementia can often make it difficult for individuals to express their feelings and articulate what’s causing their mood. In addition, there is a significant overlap between dementia symptoms and those caused by a depressed mood.

Symptoms of depression and mental health risk factors for dementia

Some symptoms common to both include: 

• Apathy and loss of interest in hobbies and activities previously enjoyed
• Withdrawal from friends and loved ones
• Difficulty concentrating 
• Impaired decision-making

Furthermore, depression in patients who have dementia caused by a condition like Alzheimer’s disease might not appear the same as depression in those without a diagnosis of dementia. For example, symptoms of depression are often less severe in patients with dementia than in those without. The symptoms may come and go and not last as long. In addition, those with dementia are less likely to talk about and attempt suicide.

Diagnosing depression in dementia patients

Evaluations for depression in dementia patients typically include:

• A review of their medical history
• Physical and mental examinations
• Interviews with friends, family, and other caregivers about their moods and behaviors
• Standardized assessments designed for patients with dementia 
• Other medical tests as needed to rule out other underlying conditions 

Ways to support a loved one with depression and dementia

Supporting a person with dementia and depression is typically best as a team effort. Friends, family members, medical providers, and other caregivers can all offer positive contributions to someone experiencing these conditions. You may also want to consider reaching out to support groups or advocacy organizations for help maintaining your own mental health as you care for your loved one. 

Conventional treatments for symptoms of depression & dementia

Treating depression is complex no matter who is being treated, but its complexity increases substantially for older adults and even more so for those with dementia. Because of this, it’s typically highly beneficial to ensure that your loved one’s depression is being managed by their medical team. Conventional treatment for depression in dementia patients is typically broken into two categories: pharmacological and non-pharmacological. 

Pharmacological interventions for depression and dementia

Pharmacological interventions may involve the use of antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). While SSRIs and other antidepressants are common components of treatment for depression in most populations, evidence suggests that they aren’t as effective in older people with dementia. As treatment guidelines improve, antidepressants are becoming less frequently prescribed, but medical providers may still utilize these or other medications to treat primary or secondary symptoms of depression in individuals with dementia. 

Non-pharmacological interventions for the mental health conditions

Non-pharmacological therapies are those that do not involve medication. For example, a promising type of behavioral therapy called problem adaptation therapy (PATH) utilizes behavioral techniques to help those with dementia and depression manage their symptoms. Therapists meet with the patient in their home weekly for 12 sessions to teach them how to solve problems contributing to sadness, often involving caregivers to help bolster the patient’s problem-solving abilities. They’ll also work with the individual to develop a plan to avoid negatively charged situations and identify stimuli that trigger positive emotions. 

PATH therapists usually teach their patients compensatory strategies too, such as using calendars, checklists, and other tools to bypass cognitive limitations. The results of a recent PATH study are encouraging: At the end of the trial, participant depression scores had decreased by 43% on average and disability scores had decreased by 93%. 

Research-based strategies: Support from caregivers and loved ones with depression and dementia

The results of the PATH study cited above and other research initiatives indicate that likely some of the best ways to support a loved one with dementia and depression are to help them find positivity and encourage them to use compensatory strategies regularly. Talk to your loved one’s medical team and ask questions to better understand their capabilities and the strategies that might help. If they recommend specific compensatory strategies, you can help your loved one set up those strategies and encourage them to continue using them. 

It will also likely be helpful to set up a system of reminders to help your loved one remember to take their medication or complete other tasks essential to their health. You might also want to help the person engage with pleasant memories to boost their mood, such as by creating a photo album they can flip through.

Some other common strategies that caregivers often find helpful for supporting individuals with dementia and depression include: 

• Schedule a predictable daily routine
• Make a list of people, places, and activities your loved one enjoys and schedule them frequently
• Prepare your loved one’s favorite foods when possible 
• Encourage physical activity within their capabilities
• Celebrate special occasions and victories, even if they’re small
• If your loved one expresses sadness or frustration, practice active and empathetic listening to validate their feelings
• Reassure your loved one that they will not be abandoned

One final and crucial way caregivers may support their loved ones is by taking good care of themselves. Those with dementia are typically more responsive to negative emotions, so it can be important to present a calm, positive demeanor when assisting them. However, caregivers are often faced with substantial emotional and mental challenges as they support their loved one with dementia, which can sometimes make it challenging to maintain a calm attitude of positivity and empathy. 

Therapy for caregiver support: Managing stress and mental health

Caregiver stress is extremely common in those caring for loved ones with dementia, and it may be further increased by helping them manage depression as well. Caregiver stress, if unmanaged, often leads to burnout. A burned-out caregiver typically struggles to engage with their loved one, may not have the energy to assist them, and may struggle to empathize with them. 

Caregiver stress can be prevented or managed by ensuring adequate self-care, engaging with your support network, and seeking therapy with a mental health professional. Many people are now turning to online therapy as their chosen method for receiving mental healthcare, though you can typically choose in-person care instead if desired, depending on your preference. Online therapists generally use the same evidence-based methods as traditional therapists and carry the same credentials. 

Research on online therapy: Effectiveness and benefits for mental health concerns like cognitive impairment and mood disorder

Online therapy has the advantage of allowing you to attend sessions remotely from anywhere you have an internet connection; you don’t need to travel to your therapist’s office to meet with them. Recent research suggests that, in most cases, online therapy is just as effective as in-person therapy. Online therapy can be an effective intervention for cognitive impairments like dementia, as well as mood disorders such as depression.