Coping with depression

Recognising the symptoms of depression in someone with dementia may not be as easy as you might expect. 

Many of the symptoms of depression are the same as those of dementia, (and Alzheimer’s disease in particular), and it is not uncommon for people to think they have to just put up with depression as an inevitable part of the disease. This is just not correct however.

Treatment is available AND is proven effective. It can significantly improve quality of life for both the patient and their carers.

Depression is very common among people with dementia, particularly in the early and middle stages of the disease. Estimates suggest that the figure could be as high as 40% so making yourself aware of what to look out for and the possible treatments available is an important step towards seeking help when, and if, needed.

Signs of Depression

• Apathy
• Loss of interest in activities and hobbies
• Social withdrawal
• Isolation
• Trouble Concentrating
•  Impaired thinking

While a diagnosis of dementia can lead to intense feelings of sadness, hopelessness, fear and even guilt, the cognitive impairment caused by the disease often makes it difficult for the person to articulate these feeling adequately. The symptoms of the depression can therefore all too easily easily be masked by the dementia.

The Alzheimer’s Association issues this advice which is helpful in deciding when to seek help:

“For a person to be diagnosed with depression in Alzheimer’s, he or she must have either depressed mood (sad, hopeless, discouraged or tearful) or decreased pleasure in usual activities, along with two or more of the following symptoms for two weeks or longer:

• Social isolation or withdrawal
• Disruption in appetite that is not related to another medical condition
• Disruption in sleep
• Agitation or slowed behaviour
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
• Recurrent thoughts of death, suicide plans or a suicide attempt”

Treatment for Depression

People with depression, whether they have dementia or not, are not able to think themselves out of the condition by sheer force of willpower, so simply telling them to “Snap out of it” or “Cheer up”, is not going to help. Support, reassurance and medical help are all required.

Making an appointment to see your GP is an essential first step. This will allow you to explore the options for drug medications, counselling and complimentary therapies that may prove beneficial.

The most effective treatment is likely to involve a combination of medicine, counselling, and gradual reconnection to people and activities that bring happiness.

Ways for Carers to help

• Seek out local support groups – These can be a huge source of help both for the person with dementia and their carer. It can be a huge source of comfort to know that you are not alone in dealing with this and there are others in a similar position. They provide a valuable source of information and access to other services and support available locally. Groups can provide fun and meaningful activities geared specifically to those with memory and cognitive problems, and are a great way of maintaining social contacts.
• Acknowledge the person’s feelings and frustrations while continuing to express positive messages about how you hope they will feel better soon.
• Plan a predictable daily routine. This can provide reassurance and help schedule activities the person finds challenging at the time of day they are best able to cope.
• Make a list of activities, people and places the person enjoys. Try to visit/incorporate these more frequently into your diary.
• Find ways the person can contribute to family life and remember to recognise his/her contribution.
• Plan in regular exercise, particularly in the mornings, as this can be a fantastic mood enhancer.
• Provide lots of reassurance the person will not be abandonded.
• Celebrate small successes and occasions.

Depression is not inevitable and should definitely not be suffered in silence. Help is available so speak out.

Could Complimentary therapies help you with your dementia symptoms?

Over a quarter of all people living with dementia revealed they had used at least one  complementary therapy in the past year when surveyed by the Alzheimer’s Society in 2013.

With the possible side effects of conventional medicines well documented, and people anxious to find any effective way to treat the effects of dementia, complementary therapies are gaining in popularity fast.

But are they safe? And do they work?

What exactly are complimentary therapies?

“Complimentary” refers to an approach or treatment used alongside (not in place of) conventional medicine. Therapies are numerous and wide ranging in nature but all share the aim of attempting to boost a feeling of wellbeing and enhance quality of life.

It can be helpful to divide them into the following groupings:

• Art, Music and Dance
Art and Music both provide useful tools in dementia care by evoking powerful responses and freeing people up from the need to find the right words. Both provide enjoyable and meaningful activities that have the ability to boost mood, increase attention span, expand social interaction and decrease feelings of anxiety and depression.

• Botanicals, Herbal supplements and Extracts
These include Homeopathy and most commonly, Aromatherapy which uses essential oils extracted from plants and herbs and applies it to the skin through massage, or inhaling by steam inhalation to stimulate the limbic system in the brain. Each essential oil has unique effects (anti-bacterial, diuretic, tranquilising…) and the effect can be hugely relaxing, aiding sleep, calming disturbed behaviours etc.

• Exercise eg. Yoga, walking groups…

• Pets and Dolls

 • Therapeutic Multi-sensory experiences
These include therapies as wide ranging as group therapies such as Reminiscence and Validation therapies to improve cognitive function, Bright Light therapy (which benefits the circadian rhythm to improve sleep patterns, decrease wandering and agitation etc), Physiotherapy and Acupuncture.

Potential benefits

The aims for complementary treatments can be wide ranging.
Some are geared towards stimulation with such aims as:

• Encouraging social interaction
• Boosting cognitive function
• Stimulating memory
• Encouraging physical activity

Others have relaxation as their main function, with such potential benefits as:

• Reducing disturbed and agitated behaviours
• Promoting sleep
• Easing physical discomfort

All therapies aim to boost mood and instil a feeling of wellbeing. The power of this should not be under-estimated. Dementia often leaves people feeling isolated, withdrawn and depressed so group therapies that allow people to get together to promote socialisation or trigger reminiscences are often a great way to lift someone’s spirits and motivate engagement.

As one man in the early stages of Alzheimer’s commented, “I don’t remember what people told me but I remember how they made me feel”. People report emotions of relaxation or happiness lasting well beyond the therapy session.

How effective are these therapies?

The potential of complementary therapies to boost a feeling of wellbeing and enhance quality of life among people living with dementia is becoming increasingly recognised.
The majority of medical professionals, care home staff and dementia charities, now widely support the use of complementary therapies when used alongside conventional medicine.

Despite plenty of anecdotal stories of individual successes however, scientific research has not managed to keep pace with the ever-growing public interest. High quality scientific research is lacking so there is little solid evidence as yet about the effectiveness of any particular therapy.

Will it work for me ?

A few words of caution may be helpful :

• Everyone experiences dementia in a slightly different way so it is important to bear in mind that what works for one person, may well not work for another. A therapy that promotes happiness and increased motivation in one person also has the capacity to confuse and frustrate another.
Any therapy should be targeted at your individual and distinct needs, and its effectiveness based on yourunique response.

• Current regulation remains patchy for the different forms of complementary therapies, so be wary of possibly exaggerated benefits and successes.

• Just because a therapy is touted as “natural” does not necessarily mean it’s safe for everyone. Some herbal and vitamin supplements or essential oils used in aromatherapy and massage can react significantly – and sometimes negatively – with medication.
Always talk to your Doctor before embarking on any form of therapy to check there are no safety concerns for you personally.

Before embarking on any form of complimentary therapy…..
bear in mind the following points:

Talk first to your doctor –he/she will be able to check there are no safety concerns for you, and make sure that any proposed therapy will not react harmfully against any other treatment being undertaken or proposed. Most doctors are now sympathetic to the use of complementary therapies, and may be able to offer advice about good practitioners in the area or even refer you through the NHS.

Be prepared- before starting any therapy, find out exactly what the treatment will involve, how many visits will be required, what are the likely results you can expect, and importantly, how much it will cost.

Be realistic- therapy cannot magically erase the symptoms, but may help with a particular targeted problem or simply help you relax and boost your mood.

So why not choose a therapy you fancy,
give it a go and see if it works for you!

Click on the links below for our further reading suggestions:
• “Dementia Treatments” Alzheimers Research uk

• “Factsheet 434 – Complementary and Alternative therapies and Dementia” Alzheimer’s Society

• “Dementia and Music” Age UK