Dr Kellyn Lee is a BPS Chartered Psychologist with a special interest in dementia care. She has carried out dementia related research in hospitals, care homes and in the community for more than a decade. She is the Founder and CEO of the charity The Dementia Care Hub, who provide support services grounded in research evidence to people living with dementia and their families. She also runs therapeutic programmes for family carers and training for paid care workers.
In this blog Dr Kellyn Lee discusses the potential usefulness of antidepressants in dementia care.
It is widely accepted that depression and anxiety are common in dementia. The symptoms can be disabling and cause significant distress to the person living with dementia and their care partner. Recently, I recorded an interview with Fiona Chaabane, a Clinical Nurse Specialist in Younger Onset Dementia and Huntingtons Disease and Consultant Admiral Nurse at Southampton General Hospital to explore the usefulness of precribing antidepressants for people living with dementia.
A major concern for me is that I see many families and people living with dementia who do not understand the medications they are on, what they are intended for, whether or not they are useful and have no reviews in place. In essence they are discharged. I have also been shocked to see so many people who have a diagnosis of dementia and their families who are unsure of which type of dementia it is or understand that dementia is a terminal condition. This suggests more discussions need to be had both pre and post diagnosis.
Many of the people who engage in our services are experiencing symptoms such as misidentification, hallucinations and high levels of anxiety. This in turn causes high levels of distress for them and their carers and family members. I believe we need to do better and that we can do better. One medication type that I have become increasingly interested in for dementia care is antidepressants. Reading around the topic is it clear that the reviews on their usefulness in dementia is mixed. However, from the research in favour of their use and from talking to Fiona who has over 30 years experience in the field, I think they should be considered more widely by primary care.
So what can antidepressants do and how might they be useful?
As I previously mentioned the research relating to the usefulness of antidepressants and dementia is mixed. Some researchers have found antidepressants to be useful whilst others suggest they make no significant difference at all. From talking to Fiona and by her sharing her insight into the field of mental health and dementia care, what she has often seen in people diagnosed with dementia is a drop in mood. The low mood can then lead to behavioural and psychological signs such as lack of motivation, not wanting to go out, irritability, bad temper, a reduction in appetite and a lack of personal hygiene and care. Whilst some might say 'well that is the dementia', we can look at this in a slightly different way. If these symptoms are viewed as a depressive disorder that hasn't been spotted or has been overlooked because the person has dementia and may not be able to articulate their experience we can take a different approach.
The usefulness of antidepressants in managing low mood is their ability to work on the anxiety component. The anxiety mechanism for a person living with dementia is very reactive and doesn't take much to activate because of the cognitive impairment. If you or I were to become upset, we are able to think it through and make some decisions, attempting to take action to rectify it perhaps by thinking differently. This is much more difficult for a person living with dementia. The aim of the antidepressant would be to get the anxiety under control, bringing down the agitation or distress a person is experiencing, which can result in a person living better.
When we talk about anxiety we are talking about observable behaviours which demonstrate a person feeling unsettled.
What might I see in a person who is experiencing anxiety?
constantly organising things
wanting to leave the house - sometimes at odd times
needing to know what is happening next
a person's face might change, they may appear preoccupied or look confused
What will an antidepressant do?
An antidepressant will not change the dementia or how it progresses. It will not stop, reverse or slow down the progression of dementia but what it might do is bring the anxiety experienced under control. This may help life gets a little easier for the person with dementia and their care partner and family. It is also important to note that antidepressants can take up to 6 - 8 weeks to start making a difference. It is also important to note that the difference may not be transformation. The difference may be more subtle such as pacing for 30 minutes rather than 2 hours, they might be calmer and more cooperative with the day to day stuff that they perhaps resisted before. You might notice that the person sleeps just a little bit longer or has eaten a little but more.
Antidepressants are NOT a happy pill, the best they can do is reduce the frequency and/or severity of negative experiences.
So if I am a carer what should I do?
Look at the environment, is there anything that is impacting on them?
Is the person in pain?
Are their other illnesses under control?
Are usual routines being maintained?
Contact the GP or mental health service, write a list of the symptoms of anxiety you are seeing and the low mood. Ask your GP if they would consider an antidepressant to reduce these negative experiences.
If would like any more information or support, do get in contact: firstname.lastname@example.org
To watch the full conversation, you'll find the video on my YouTube channel: https://www.youtube.com/channel/UCtrBSh0rND-_TqU9HG3IhlA
Why not join our facebook group for tips, support and a friendly dementia community: https://www.facebook.com/groups/907919000144748