How can I tell if my loved one with dementia is depressed and what can I do to help them?

By: Dr. Nicole Ruggiano, PhD, MSW

May is mental health awareness month! One common mental health challenge that people living with dementia face is depression. Depression is a common condition for adults and can range in severity and duration. While depression is common among all adults, older adults with dementia are at greater risk of developing depression. According to the Alzheimer's Association, up to 40% of people with Alzheimer's disease will experience significant depression. This can cause stress for caregivers, who may not understand why their loved one has become depressed, not know what to do, and may even feel guilty that their loved one is suffering. Many often ask how to assess whether their loved one is depressed and what they can do to help them. 

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What causes depression?

Depression can be caused by a number of things, which is why talking to a healthcare provider is important so that the best treatment can be identified. Many causes of depression for people with dementia are similar to adults who do not have dementia, such as:

• A history of trauma or upsetting events in one's life. 
• Other medical conditions.
• Side effects of medications. 
• Poor sleep. 
• Social isolation. 
• Stress, worry, and/or anxiety about other issues. 
• Substance abuse. 

For people living with dementia, there may also be issues that contribute to dementia that are related to their dementia diagnosis. For instance, it's not uncommon for a person to become depressed after they first receive their diagnosis of dementia. In these cases, fear and sadness about potential challenges they will face in the future cause depression. Also, as a person's dementia progressively gets worse, they may become depressed as they cope with new challenges that arise as their condition progresses. In cases of moderate to advanced dementia a person may confuse present day with past events. This could result in developing grief about trauma and loss they experienced in their younger years and are now revisiting. 

How do I know if my loved one is depressed?

Symptoms of depression in people with dementia are similar to depression among those without dementia. Isolating oneself, reduced appetite, frequent crying, and feelings of worthlessness are all signs of depression. In some cases, depression may cause agitation or irritability that may not initially seem like depression. This is particularly true for people with dementia who have difficulty communicating and cannot express their feelings, so their behavior becomes increasingly agitated. This YouTube video shows an example of what depression may look like for someone with dementia when they show agitation or apathy.

It's important to remember that depression is a long-term problem, and many assessment tools for depression consider thoughts and behaviors that have been present over the past two-week period. First, think about your loved one's mood over the past two weeks. If they have frequently appeared sad, tearful, hopeless or disinterested in things they usually enjoy doing, them may be depressed if they also show the following behavioral issues:

• Isolating themselves from others.
• Changes in their appetite. 
• Agitation.
• Slower behavior than normal.
• Poor sleep quality.
• Fatigue.
• Expressing feelings of guilt or worthlessness.

People with dementia who are depressed may also express thoughts of death or suicide. If this is the case for your loved one, contact their medical provider (or a crisis hotline if the person discusses suicide plans or a suicide attempt) right away. ​

My loved one is depressed. What can I do to them them?

Caregivers may feel helpless when they are dealing with their loved one's depression. However, there are many things that you can do to help support your loved one if they appear depressed. First, resist telling the person to "get over it" or "cheer up." People with depression usually cannot make themselves feel better through will power. 

Talk to a Healthcare Provider

There are many reasons to talk with a healthcare provider if the person you care for with dementia shows signs of depression. First, you should rule out other causes of depression that aren't related to dementia. For example, if the depression is caused by chronic pain from an undiagnosed condition or a side effect of medications the person is taking. 

A second reason to talk with a healthcare provider is that they may be able to provide treatment for their depression. For example, talk therapy has shown to be beneficial for people with dementia who are depressed. For example, talk therapy could help the person cope with their stress and sadness related to their dementia diagnosis. are many medications available that help reduce depression. There are also medications to treat depression, though there is mixed evidence on how effective (or potentially harmful) some types of antidepressants are for people with dementia. If your healthcare provider suggests medication as part of your loved one's treatment, ask them about the risks and benefits from the medication being prescribed as well as potential alternatives. 

Approaches without Drugs

There are a number of steps that caregivers can take to help reduce depression in someone with dementia. 

• Continue doing things the person enjoys until they are no longer able to do them. Sometimes, people in early stages of dementia feel like their life as they knew it is now over. In such cases, they may withdraw from activities they enjoy. In other cases, family members may stop doing certain activities with the person with dementia because they think they can no longer do them. Dementia is rarely a condition that happens overnight. Oftentimes, people can do activities they enjoy as their dementia progresses. In some cases you may find that alternating the time of day you do the activity or providing additional support may help. Previously Caregiver 101 posted an article related to this titled, "My loved one was recently diagnosed with dementia. How can I help them in the early stages?"
• If there are activities the person used to enjoy, but are difficult for them to participate in now, consider an alternative. For example, if the person enjoyed going to baseball games before they had dementia, they may enjoy having a friend or family member watch their favorite teams play on television together. 
• Acknowledge that your loved one is frustrated and sad. People with depression often feel like others do not understand what they are going through. Sometimes recognizing their struggle can help them feel supported and potentially more likely to talk about their feelings. 
• Help your loved one stay physically healthy. Making sure that they maintain a good diet and regular exercise can help alleviate some symptoms of depression. 
• Try to maintain a daily routine with your loved one. That can minimize agitation throughout the day. 
• Suggest a support group, especially for those in the early stages of dementia. They may find that talking to others who are going through the same thing that they are may be beneficial. 
• Try to have them interact with other people. Invite family or friends to visit to avoid social isolation. 

The Takeaway

Being a caregiver for someone with dementia is very challenging. When their loved one's behavior changes, they may feel at a loss for what to do for them. This can also cause caregivers to be stressed, anxious, or depressed. While these tips are for caregivers to help their loved one with depression, if you are a caregiver make sure that you are taking care of your own mental health by talking with a provider if you are feeling depressed. In my work with caregivers, I often find that caregivers tend to prioritize their loved one's health over their own, which leads to them suffering from mental and physical problems. If this sounds like you, remember the instructions that they give on airplanes before takeoff in case of an emergency: "Place your own oxygen mask on first before helping others." In other words, taking care of yourself will help you be your best for caring for your loved one.