It’s 3 pm on a warm, sunny Saturday. For the past 20 years your mother would dress in her finest clothes and walk to her neighbor’s house for her weekly bridge game. For the past month, however, she has not been interested in playing bridge. Although she sometimes required prompting (as well as reminders to brush her hair), she usually returned from these games cheerful. Her indifference this month is new.
Your mother received the diagnosis of mild Alzheimer’s disease last year. Although visibly frustrated at times, especially when she cannot think of the right word or find her pocketbook, she seemed to enjoy her routine until recently. You now see her crying in the morning. She is no longer sleeping or eating well, and she becomes scared when you leave her for a moment. You wonder whether she might benefit from medications.
Depression and anxiety in dementia
Depression and anxiety symptoms are extremely common in dementia and mild cognitive impairment (MCI). As a result of these symptoms, many people with dementia experience a decrease in their quality of life. Depression and anxiety may lead to disengagement from daily activities, which may further exacerbate memory difficulties. Social withdrawal and discontinuation of cognitively stimulating activities as a result of depression increase the likelihood of nursing home placement.
Do antidepressants work in dementia?
Among older adults living with depression, those with cognitive impairment differ from those without cognitive impairment. Although data on antidepressant use in dementia is ambiguous, much of the current research suggests that antidepressants don’t work well in people with dementia (unless they have a pre-existing mental health problem). This could be the result of changes to the brain that occur in dementia. Although many doctors prescribe antidepressants as a first-line treatment, guidelines do not suggest the routine treatment of depression and anxiety with antidepressants in people living with dementia. Even the best-tolerated antidepressants in older adults carry serious risks of falls, fractures, and drug interactions.
A better approach to treatment
Recently, researchers at Weill Cornell Institute of Geriatric Psychiatry in New York studied the effectiveness of a new home-delivered therapy called Problem Ad