Depression and dementia

Most people feel sad or low from time to time, but this is not the same as being depressed. Depression is when someone feels really low for a long time and struggles to do everyday tasks and activities. 

Depression is a common problem for people with dementia.  It is often diagnosed when a person is in the early stage of the condition, but it can develop at any time.

Some people may become depressed as a reaction to negative events or not having positive experiences to look forward to. Other people may become depressed because of damage to parts of the brain involved in mood.

Depression can be hard to treat with medicines when a person has dementia, but this doesn’t mean that there’s nothing that can be done about it.

What causes depression in a person with dementia?

It can be hard to know what is causing depression in dementia. For many people, the challenges of living with dementia can lead to feelings of deep sadness or hopelessness. In addition, the diseases that cause dementia may damage parts of the brain involved in emotions and behaviour.

Other factors that can contribute to depression include:

• a history of traumatic or upsetting events
• other health conditions or disabilities – particularly heart problems, breathing difficulties, chronic pain or hormonal problems
• side-effects of medications – including certain sleeping pills, steroids, beta-blockers and drugs used to treat Parkinson’s disease
• not having enough meaningful things to do, social isolation or a lack of social support
• not getting enough good-quality sleep
• bereavement – this can make a person more vulnerable to depression, although grief itself is not normally thought of as a type of depression
• feeling stressed about issues such as money, relationships or the future
• drinking too much alcohol.

A person with dementia is much more likely to become depressed if they have had depression in the past – particularly if they’ve had it several times during their life.

People who live in a care home seem to be at particular risk of developing depression. Staff who are well-trained in providing person-centred care, meaningful activities and regular visits from family members and friends can all make a positive difference. 

Symptoms of depression

Depression can affect people in more ways than just feeling sad or hopeless. Other common symptoms include:

• losing interest or pleasure in activities that used to be enjoyable 
• feeling worthless, guilty or having low self-confidence
• feeling tearful
• difficulty concentrating or thinking clearly, leading to forgetfulness
• giving up easily when something is difficult
• feeling irritable and prone to angry outbursts
• self-neglect, such as not eating or washing
• tiredness, aches and pains
• sleep problems, such as waking in the very early morning or sleeping during the day. 

Older people may have slightly different symptoms of depression than younger people. They are more likely to feel agitated and have health anxiety (worries about their own health). 

They are also more likely to have physical symptoms, such as aches and pains, which depression can make feel worse.
Depression can increase problems with thinking and memory caused by dementia. It may also contribute to changes in behaviour, such as becoming more agitated or not wanting to eat. 

For people in the later stage of dementia, symptoms of depression often include tearfulness and poor appetite. 

Suicide and depression

Some people with depression will have thoughts about ending their own life. Most people who have these kinds of thoughts don’t act on them, but some do. This is why depression should be taken very seriously. It should not be dismissed as a person just feeling ‘a bit down’.

Dementia increases the risk of suicide, particularly during the first few months after a dementia diagnosis. Younger people and those with a history of mental health problems are also at higher risk.

Treating depression in a person with dementia

Treatments for depression vary depending on how long a person has had it and how severe it is. If they have mild depression, they may be offered a support group or self-help (activities and strategies they can work through themselves).

If they have more severe or persistent depression, their GP or mental health professional may prescribe an antidepressant medicine as well as referring them for a talking therapy.

The symptoms of dementia, such as problems with memory and thinking, can make it harder to treat depression. To have the most benefit, talking therapies often need a person to have most of their mental abilities working well. Even so, they can still be effective and worth trying.

Many people find that talking with a professional counsellor or therapist can be helpful in making sense of their thoughts and feelings, particularly during the earlier stage of the condition.

Support groups can also sometimes help. They give people a chance to talk to others who are going through a similar experience and share their thoughts.

Antidepressant medication is widely used to treat depression. However, it doesn’t seem to be as effective in people with dementia. Instead, depression may be helped more by improving a person’s quality of life through:

• care and support that matches their needs, personality and preferences
• dealing with any underlying issues that may be contributing to depression, such as loneliness or treating pain
• ensuring they have opportunities to do things that provide pleasure or fulfilment.

Complementary and alternative treatments for depression

If the person wants to try complementary or alternative therapies to manage their depression, they should speak to their doctor first. These include herbal remedies, aromatherapy, massage and bright light therapy.

Most alternative therapies are unlikely to conflict with conventional treatments. However, some may interact with other drugs the person is taking, such as St John’s wort or cannabidiol (CBD) oil. That is why they should always check with their GP first. 

Tips for supporting a person with dementia who has depression

Always involve the person with any decisions and choices to make, whilst encouraging them to do the following:

Help them to talk about their thoughts and feelings

• be patient and understanding rather than trying to make them ‘cheer up’.
• they may need a listening ear more than practical suggestions.
• person doesn’t feel comfortable talking to someone they know, ask a professional counsellor or therapist for help first

Be sociable and spend time with other people 

• being around others can help them to feel less isolated, as can having one-to-one interaction with another person, such as talking and holding hands.

Stay physically active

• whether it’s gentle or vigorous, regular physical activity can reduce a person’s feelings of depression, as well as helping with sleeping problems and apathy.
• if they can, support and encourage them to regularly go outdoors and spend time in natural environments (such as a park or garden) and take part in gentle activities, such as walking, cycling, tai chi or pilates.

Do other activities they enjoy

• some people may benefit from doing life story work or reminiscence therapy, such as making a scrap book or photo album about their life. 
• creative or group activities can also help, such as dancing or singing. Some people may also get a lot of fulfilment from attending regular services with their local faith group.
• Singing for the Brain and other local support groups can be found using our dementia directory.

Eat a wide range of healthy foods

• having an unhealthy diet and drinking too much alcohol or caffeine may make depression worse.
• make sure the person has healthy, nutritious and enjoyable food to eat, ideally in the company of family and friends if they prefer it that way.

Continue with treatment

• keep taking any anti-depressant medications prescribed by the doctor. Some can cause unpleasant side effects or changes in behaviour if doses are missed, or stopped too quickly. If you think a medicine isn’t working, talk to the doctor first. 
• if the person starts a course of talking therapy, encourage them to keep doing it even if they feel the improvement is slow to start with.

Develop positive routines and a sense of purpose

• having a regular schedule of enjoyable activities and events to look forward to can be very helpful. This could include regular visits from friends and family or a weekly social activity group.
• involving a person with dementia in everyday tasks can help to keep their confidence levels up by reminding them of the things that they are still able to do, rather than those they can’t. This could include helping to look after a pet, working on a community project, or just helping with household chores. 

Create an environment that minimises stress 

• making changes to the home, such as reducing clutter and improving lighting, may also help to reduce everyday frustrations. 
• consider how a person’s living environment might be contributing to their low mood – for example, if they are not able to see outside.

Be mindful of limited energy levels

• living with dementia and depression can be mentally exhausting. It’s unlikely that someone feeling very low will have the energy to do lots of activities.
• trying to do too much at once may be overwhelming 
• for most people it’s best to start slow – just doing a bit more than they were doing before. 
• consider what you know about the person to find ways to help. If they found a particular activity meaningful or enjoyable in the past, there may be a gentle version that they can try.