Alzheimer's or depression: Could it be both?

Early Alzheimer's disease and depression share many symptoms, so it can be hard — even for doctors — to distinguish between the disorders. Plus, many people with Alzheimer's disease also are depressed.

Just as treatment is important for people with depression alone, it's equally crucial for people with Alzheimer's disease and depression to get treatment for their depression.

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 tell the difference between the two disorders, especially since they often occur together. A thorough physical exam and psychological evaluation can be helpful in making a diagnosis.

But, many people with more advanced Alzheimer's disease may not be able 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 within a two-week period, 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

Depression in Alzheimer's disease can be different too

People with Alzheimer's may experience depression differently from that of 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 come back as frequently
• Seem less likely to talk of suicide and attempt suicide less often

Scientists aren't sure of the exact relationship between Alzheimer's disease and depression. The biological changes caused by Alzheimer's may intensify a predisposition to depression.

On the other hand, depression may increase the 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:

• Worsening cognitive decline
• Greater disability involving daily living skills
• Increased dependence on caregivers

Treatment options

Several options are available to treat people diagnosed with Alzheimer's disease and depression:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — for example, citalopram (Celexa) and sertraline (Zoloft) — are usually the first antidepressants chosen for people who have depression and Alzheimer's. These medications have a low risk of side effects and drug interactions.

  However, these medications may not be as effective at treating depression with Alzheimer's as they are at treating depression alone. Other antidepressants, such as venlafaxine (Effexor XR) or bupropion (Aplenzin, Wellbutrin, others), also may be used.

• Physical exercise. Regular physical exercise may help ease the symptoms of depression.
• Support groups and counseling. Support groups and professional counseling may help people with depression in the early stages of Alzheimer's disease, before their communication skills deteriorate.
• Decreasing social isolation. Continuing to participate in activities with other people may decrease depressive symptoms. It may also be helpful to find ways for your loved one with Alzheimer's disease to contribute to family activities, and let them know you appreciate their contribution.

Making the diagnosis of depression in people with Alzheimer's disease and getting appropriate treatment can help make life easier and more enjoyable for both the person with Alzheimer's and his or her caregivers.