Alzheimer's or depression

Early Alzheimer's and depression share many symptoms, so it can be difficult even for doctors to distinguish between the two disorders. And many people with Alzheimer's up to 40 percent, in fact also are depressed.

One important difference between Alzheimer's and depression is in the effectiveness of treatment. While Alzheimer's drugs can only slow the progression of cognitive decline, medications to treat depression can improve a person's quality of life dramatically.

People who have both Alzheimer's and depression may find it easier to cope with the changes caused by Alzheimer's when they feel less depressed.

Similar symptoms

Some of the symptoms common to both Alzheimer's and depression include:

• Loss of interest in once-enjoyable activities and hobbies


• Social withdrawal


• Memory problems


• Sleeping too much or too little


• Impaired concentration

With so much overlap in symptoms, it can be hard to distinguish between the two disorders, especially since they so often occur together. A thorough physical exam and psychological evaluation can be helpful in determining a diagnosis. However, many people with moderate to severe Alzheimer's disease lack both the insight and the vocabulary to express how they feel.

Signposts for depression

To detect depression in people who have Alzheimer's disease, doctors must rely more heavily on nonverbal cues and caregiver reports than on self-reported symptoms. If a person with Alzheimer's displays one of the first two symptoms in this list, along with at least two of the others, he or she may be depressed.

• Significantly depressed mood sad, hopeless, discouraged, tearful


• Reduced pleasure in or response to social contacts and usual activities


• Social isolation or withdrawal


• Eating too much or too little


• Sleeping too much or too little


• Agitation or lethargy


• Irritability


• Fatigue or loss of energy


• Feelings of worthlessness, hopelessness or inappropriate guilt


• Recurrent thoughts of death or suicide

Alzheimer's disease with depression is different

Men and women who have Alzheimer's disease become depressed with equal frequency. This differs from the general population, in which women are more likely to experience depression than are men. People with Alzheimer's may also experience depression differently from people without Alzheimer's. For example, individuals diagnosed with Alzheimer's disease:

• May have symptoms of depression that are less severe


• May experience episodes of depression that don't last as long or recur as often


• Talk of suicide and attempt suicide less often

Treatment options

Support groups and professional counseling may help persons with depression in the early stages of Alzheimer's disease, before their communication skills deteriorate. Regular physical exercise, particularly in the morning, also seems to ease the symptoms of depression. But the most common treatment is prescription antidepressants.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the first line antidepressants used for people who have depression and Alzheimer's because of the low risk of side effects and drug interactions. SSRIs include citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs are often tried next if the SSRIs don't work. However, SNRIs which include venlafaxine (Effexor), mirtazapine (Remeron) and bupropion (Wellbutrin) have more side effects, such as sedation, dry mouth and constipation.

Tricyclic antidepressants

These older antidepressants, such as nortriptyline (Pamelor) and desipramine (Norpramin), are no longer used as first-choice treatments because they can cause significant side effects, including increased confusion. However, they may be prescribed if other medications aren't effective.

When medications don't help

Some people with depression and dementia may not respond to medication. In many of these cases, electroconvulsive therapy can help relieve symptoms of severe depression. The procedure delivers electricity to the brain for a few seconds, to trigger a seizure. It's performed under general anesthesia in a hospital.

Electroconvulsive therapy is used more frequently for older people than for younger people perhaps because older people may have more side effects from antidepressants or have more severe complications from severe depression.

What's the link?

Scientists aren't sure of the exact relationship between Alzheimer's disease and depression. Some research has found that the biological changes caused by Alzheimer's may intensify genetic predisposition to depression. Other studies suggest that the presence of depression may increase your chances of developing Alzheimer's disease.

It's clear that depression has a strong effect on quality of life for people with Alzheimer's disease. Depression can lead to:

• Weight loss


• Physical fragility


• Earlier placement in nursing homes


• Greater disability involving daily living skills


• Physical aggression toward caregivers

Finding the proper diagnosis and getting appropriate treatment can help make life easier and more enjoyable for both the person with Alzheimer's and his or her caregivers.

Factors of a psychotic disorder

It may be possible to predict who will develop psychotic illnesses, such as schizophrenia and bipolar disorder, very early in the disease process.
The study found five factors that were often present prior to the diagnosis of a psychotic disorder in children who were already at high risk of such disorders.

These included a family history of schizophrenia with recent deterioration in functioning; higher levels of unusual thoughts; higher levels of suspicion or paranoia; greater social impairment; and a history of substance abuse.

When two or three of these factors were present, the odds of psychotic illness jumped. Two factors increased the likelihood of psychotic illness to 68 percent, and three factors combined raised the risk to 80 percent.

Not everybody who has early symptoms goes on to develop psychosis. But if we identify the group in which 80 percent will develop psychosis, the efforts of intervention would be best applied to those at highest risk.

Symptoms of psychosis are seen in numerous mental health disorders, such as bipolar disorder, schizophrenia, depression, and with some forms of alcohol or drug abuse.

The two most common psychotic symptoms are delusions and hallucinations, according to AACAP. Delusions are false but firmly held beliefs. Hallucinations are false sensory perceptions, such as hearing voices when no one is talking.

And Major depressive disorder

Major depressive disorder or MDD is the most common major mental illness, afflicting almost one in five individuals. More than 75% of people who recover from an episode of MDD will have at least one recurrence, with the majority having multiple recurrences. Major depressive disorder is the leading cause of disability of all medical illnesses, with substantial functional impairment, morbidity, and mortality. Few studies have assessed the efficacy of antidepressant medications beyond 1 year of maintenance treatment for the prevention of recurrent depression.

The investigators randomly assigned patients with recurrent depression to receive treatment with either venlafaxine extended-release (ER) or fluoxetine, an antidepressant already established as efficacious as a comparative medication. Although the PREVENT study followed patients for over two years, this article reports only on the acute and continuation phases, which were 10 weeks and 6 months long respectively.

The authors found that nearly 80% of the patients achieved at least an adequate therapeutic response to acute phase treatment with venlafaxine ER or fluoxetine, and almost none of the responders who continued on treatment for 6 months relapsed.

In addition to the high response rates by the patients in this study, the rates of adverse events (side effects) were similar among the two treatment groups