Tim’s story – “There is stigma around dementia”
Tim reflects on the stigma that is often attached to dementia and the importance of the Black, African and Caribbean Admiral Nurse clinics.
It is often assumed that people with dementia do not experience depression; however, this is not true. Due to the challenges associated with dementia and changes in abilities, it is common for a person living with dementia to develop depression. On this page, our dementia specialist Admiral Nurses explain what depression is, how it impacts those living with dementia, and the treatments available.
What is depression?
Depression is a state of low mood that lasts for weeks or months and interferes with a person’s everyday life.
Symptoms of depression
Symptoms of depression include:
- ongoing low mood or sadness
- feeling helpless or hopeless
- low self-esteem
- tearfulness
- feelings of guilt
- irritability
- withdrawing from family and friends
- loss of motivation and enjoyment in life
- difficulties with decision-making
- feeling anxious or worried
- thoughts of self harm or suicide
- psychosis in some people (hallucinations, delusions, unusual thoughts)
Depression can also cause physical symptoms, including:
- sleep problems
- slow speech and movement
- changes in appetite and weight
- aches and pains
- constipation
- tiredness and exhaustion
- low sex drive
- changes in menstrual cycle
How is depression different from dementia?
Depression and dementia are distinct conditions that can sometimes be confused due to having some similar symptoms. Depression is a mental health disorder, whereas dementia, although it can affect a person’s mental wellbeing, is a progressive neurological condition.
Causes of depression for people with dementia
There are many reasons why someone living with dementia may also have depression, some of them include changes to the brain, loss of independence, the impact of cognitive changes and feelings of social isolation.
Changes in the brain
It’s possible for dementia to cause damage to parts of the brain that control emotion and behaviour, meaning that a person is more likely to experience depression or anxiety.
The impact of cognitive changes on emotions
When someone develops dementia, the cognitive changes they face may cause them to feel upset and frustrated about how their life is impacted by the condition, leading to low mood and depression.
Social isolation
Some people living with dementia may feel different in social situations. They may feel that they are treated differently from before their diagnosis or feel less confident going out, even to familiar places, which could lead to social isolation and loneliness.
Loss of independence
As dementia develops, the person living with the condition will need greater support and become more reliant on others. They may need to stop driving soon after diagnosis or in the coming months or years. This loss of independence can be difficult to accept.
Does depression affect the progression of dementia?
There is evidence to suggest that depression increases the risk of developing dementia. Research suggests that almost half of dementia cases worldwide could be prevented or delayed if steps were taken to prevent or manage depression.
However, it is important to note that just because someone has experienced depression, it does not mean they will definitely develop dementia.
Diagnosing depression in people living with dementia
If it is suspected that someone living with dementia may also have depression, it’s important to seek medical advice so that they can get the appropriate support and treatment.
Challenges of diagnosing depression in those with dementia
Because depression and dementia can share similar symptoms, it can be challenging to diagnose depression in a person with dementia.
How to speak to a GP
Before going to see a GP, support the person in taking a self-assessment quiz if possible, and keep a symptom diary in the run-up to the appointment, which family or friends can contribute too.
In the appointment, the GP will usually ask about the person’s symptoms, including:
- how they are affecting them mentally and physically
- how long they have had them
- how often they are experiencing them
- if there are any triggers for these feelings
- whether there is a family history of anxiety or depression
Usually, a GP can diagnose depression based on what the person shares with them, however, they may want to take a blood test to rule out other conditions with similar symptoms.
Managing depression for people living with dementia
Depression is difficult for the person experiencing it, as well as for their family and carers to witness, but the condition is often manageable with the proper support and treatment.
Antidepressants
While antidepressants are often used to treat depression, research studies have found the benefits to be limited in people living with dementia. Further research trials are required into their use in different subtypes of dementia. Instead, the focus for management in a person with dementia is often on improving areas of their life and giving them the support they need.
Social engagement
While the person may not feel like socialising, it is important to encourage them where possible. Sometimes meeting up with other people who are in a similar situation can help, and taking part in activities that they enjoy can provide enjoyment and distraction and help manage their symptoms.
Exercise and diet
Taking regular exercise and eating a balanced diet can help a person with dementia, supporting their overall mental health and wellbeing.
The person’s ability to take part in physical activity will depend on things like their own preferences, their mobility and their stage of dementia, but even going for a walk around the block with them could be beneficial. Similarly, offering the person a variety of healthy snacks and meals will support their physical and mental health.
Therapy
Some people with dementia and depression may benefit from talking therapies like counselling or cognitive behavioural therapy (CBT), which aims to change negative patterns of thinking.
The person with dementia and depression can ask their GP to refer them for NHS talking therapies, or they can refer themselves. Bear in mind waiting lists can be long.
The NHS Every Mind Matters website provides some useful tips and videos to support people to develop strategies for managing depression. It includes information about CBT, short video guides, and online self-help techniques. These can help the person deal with worries and unhelpful thoughts, work through problems in new ways, build resilience, and boost their mental wellbeing.
Music therapy
For some people with dementia, music therapy has been shown to improve their thinking, feeling, perception, mood and behaviour. It can be used as part of a care plan. It can also give a social element if done in groups, helping with the social isolation that someone may be feeling.
Caring for someone with dementia who is experiencing depression
Caring for someone who is living with both dementia and depression can be difficult. The Carents Room has advice on supporting older adults with depression. Our Admiral Nurses are on hand to offer help and advice on our Helpline or in video or phone appointments.
Guidance on communication
The NHS Better Health: Every Mind Matters programme provides tips on how to help people with mental health problems, including how to start a conversation and advice for providing reassurance. However it is important to consider communication techniques depending upon the person’s language and cognitive skills and tailor accordingly. Our tips for communication might be helpful when talking to someone with dementia about depression.
Getting further support
When caring for someone with depression and dementia, it’s important to make an effort to stay well yourself, for example by setting realistic goals, seeking support from friends, family, or support groups, and taking time for yourself. Try to also make time for physical activity, ensure you eat a balanced diet, and get enough rest. This may involve asking a family member or friend to help out with the caring duties so you can take a break, hiring a paid home carer or considering a care home for the person with dementia.
Do not feel guilty for considering your own needs, as you can only support the person you care for if you are well yourself. If you need help with your own mental health, please speak to your GP.
Links between depression and developing dementia
While research suggests that there is a link between depression and dementia, it is not fully understood. Currently, evidence shows that depression may be linked to the changes in the brain caused by dementia, but more research is needed.
Depression is one of the 14 risk factors that have been identified as contributing to developing dementia. If a person is experiencing depression, treating it effectively may help to prevent or delay dementia developing. It is also important to address other risk factors that are linked to both dementia and depression, such as drinking alcohol excessively and social isolation.
Can severe depression cause dementia later in life?
It is not fully understood whether the length or severity of someone’s depression affects their risk of developing dementia, but ensuring depression is treated or managed as well as possible is important for the person’s wellbeing now and in the future.
