Depression in Dementia

During this pandemic, many have had to reflect on how this has impacted their mental health. However, our residents, patients or loved ones with dementia aren't able to reflect like this and need us to really help them through this. 

I wanted to share an excerpt from my upcoming book on dementia care directed towards families about how to help those who have dementia and are experiencing depression.

"Depression is very common for individuals living with dementia. Although the exact causes of depression in Alzheimer Disease are unknown, it is clear that changes in brain chemistry play a role. Changes to brain chemistry may be triggered internal by aging, genetics, or another disease, such as Alzheimer disease. External factors such as experiencing the death of a family or friend, work or troubles, or other traumas and stressors may also trigger changes to brain chemistry leading to depression.

            With this understanding of depression, it is not that surprising that up to 40% of people with Alzheimer disease have depression. We know their brains are changing because of degeneration and atrophy of the brain that is part of Alzheimer disease. People with Alzheimer disease also experience changes in their lives as their abilities change. Symptoms of depression can include sadness, tearfulness, loss of pleasure in activities that used to be enjoyable, feelings of guilt, difficulty concentrating, weight loss or gain, sleep disturbances, and thoughts of death.

            If the person you care for appears to be experiencing depression, they should have a visit with their physician. Your loved one's health care provider can carefully assess if depression or something else is going on and refer you to other specialists if needed. It is important to be clear and straightforward with the physician about what you are observing in the person you care for so that proper treatment can be started.

Tips for Helping with Depression

            You can use...positive and affirming sensory stimulation to help improve mood for both of you. Here are some strategies that may be particularly useful.

  1. Encourage or assist your loved one to engage in exercise and physical activity routinely. Endorphins, our natural mood elevator, are released in the brain during exercise. Additionally, physical activity is a type of tactile stimulation. If exercise includes going outside for a walk or other physical activity, other senses (sight, smell, and hearing) will also be stimulated. Research shows that exercise can improve cognition in people with Alzheimer disease and is protective against depression.
  2. As discussed in chapter 3 and incorporated into the tips in many other chapters, playing music that your loved one enjoys can reduce anxiety and improve mood. Singing along may be especially beneficial and so is using music from the era when your loved one grew up.
  3. Art therapy has been shown to have benefits for both Alzheimer disease and depression. This cathartic activity has been shown to relieve symptoms of depression and anxiety. Adult coloring, is an easy way to incorporate artwork into day-to-day activities and provides tactile and visual stimulation. Therefore, it can improve mood but also increase attention and concentration and lower anxiety. Artwork also creates opportunities for shared experiences with nonverbal communication; the person can express themselves when they can no longer find the words.
  4. Going back to Kathleen’s story at the start of this chapter, something as simple as verbal praise (auditory stimulation), such as saying, "You look beautiful in your necklaces," can go a long way in improving someone's mood.
  5. Other uplifting approaches are inviting pets to come around or having someone to care for, as in doll therapy, both of which were discussed in chapter 3 can also boost mood.
  6. Aromatherapy, specifically citrus scents, are uplifting, provide olfactory stimulation, and may be useful in treating symptoms of depression. These scents can be diffused in the air (lasting up to four hours after the diffusing stops), or you can apply drops to diffuser jewelry (lasting up to eight hours). Additionally, you can apply them to pulse points around the neck (this will last for four hours), or even apply a couple drops to all-natural furniture movers (“their personal diffuser dots”) and stick it under your loved one’s lapel on their clothes or the inside of their sweater by the neckline (this can last up to eight hours).
  7. If your loved one is in the earlier stages of their disease, they may benefit from talking to a counselor or psychologist about how they are feeling. This can give them an outlet to vent and process what they are going through but also provide cognitive stimulation through the therapeutic process. Occupational therapy may be another option. Enhancing their motor skills may help your loved one feel more confident in their abilities, boosting their self-esteem and decreasing feelings of depression.
  8. If the cared-for person is spiritual, leaning on their faith may be what they need to help them through what they are feeling. Seeking out a chaplain or priest can also be therapeutic.
  9. Getting your loved one back to doing their favorite activities can be beneficial. Gardening, cooking, or baking, as discussed earlier, can help improve their mood through the positive sensory stimulation they are obtaining from engaging in those activities."

Try what you think may work. If they are successful - then add these to your caregiving toolbox! And if there are some that aren't successful, then you know those aren't for that individual.

Keep building that toolbox!

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