Mood and Anxiety Disorders
Depression Associated with Dementia
In severely afflicted seniors, depression may be mistaken for a dementia because it causes significant disturbances in concentration, memory, orientation, and behavior. We call this, pseudo-dementia because it is a false dementia and will disappear with treatment of depression.
As we age, the signs and symptoms of depression can change subtly, and seniors tend to express their mood disturbances with more physical complaints, such as being exhausted. Insomnia is very common and sometimes causes depression to be treated with tranquilizers or sleeping pills.
Depressed seniors often have such serious problems with memory and abstract reasoning that they appear demented during an interview or conversation. Or they may have increased body pain and other somatic complaints including GI problems with abnormal bowel movements or headaches. This misdirects health professionals from the real problem. Loss of appetite with weight loss is common in major depression affecting elderly patients. Anxiety is often more prominent than depression. Anxiety can be very intense and generate upsetting, negative thoughts. Treatment of depression reduces the anxiety, but treatment of anxiety alone will not reduce depression.
Depressed seniors may also express upset about their perceived cognitive declines, including problems with learning, memory, and attention. Severe, recurrent depressions may also be a harbinger of one of the dementia disorders. Nearly half of seniors with Alzheimer’s disease have symptoms of depression or true clinical depression two years before the diagnosis of AD is made. We now know that recurrent major depression is also associated with a significantly higher risk of stroke and early death.
Clinical Depression and Bipolar Disorder
Depression is associated with specific neuro-chemical changes in the brain regardless of what trigger initiates these changes. In some cases individuals may develop clinical depression in reaction to real world problems. But because something is upsetting or sad does not mean that clinical depression must follow. People are more or less prone biologically to clinical depression (major depressive disorder). A response to a traumatic life stress is a trigger, not the cause, of clinical depression. Others develop depression because they have dementia. Symptoms are somewhat different and may come and go rather than last the requisite 14 days straight.
The key symptoms of clinical depression include: disturbance in sleep, appetite, concentration, memory, functioning at home and at work, negative, often guilt-laden thoughts and self recrimination, inability to experience pleasure or joy, low or absent sexual desire, excessive fatigue, morbid or suicidal thoughts, and in some cases psychotic thinking, including delusions. At least 4 of these symptoms along with a depressed mood for 14 consecutive days confirm the diagnosis of clinical depression or major depressive disorder.
In either case early accurate diagnosis is key so appropriate interventions can be made that address depression and underlying dementia if it is present. Treating depression alone will not be sufficient to eliminate the symptoms depression causes in those people who have dementia and depression. Or if mood is improved, depression will often relapse in a short period of time.
We must also remember that Bipolar Disorder—depressive disorder that also includes mild or severe “high” periods characterized by enormous energy, decreased need for sleep, appetite and sex drive changes and inappropriate behavior—is a lifelong disorder. So, it must be treated preventively in seniors with no memory problems and in those with dementia. If the Bipolar Disorder is not managed properly with medications that protect from highs and lows, the emotional and behavioral disturbances will often be quite severe in demented patients.
Several forms of bipolar disorder exist. Accurate diagnosis is critical for treatment success. Bipolar II disorder has hypo-manic (mild highs) periods rather than true manias. Mania usually requires hospitalization since patients become highly agitated and psychotic. They cannot control their behavior which can be bizarre or self destructive. Hypomania can most often be treated as an outpatient. Other people develop mixed states which are very unpleasant and have combined features of agitation, depression, and mood instability. Drug and alcohol use is common during these periods as is promiscuity, shopping sprees, or binges.
Finally, a new category of bipolar disorder has been identified and is called Bipolar Spectrum Disorder. These patients are very often diagnosed as having anxiety disorders or depression and receive tranquilizers and anti-depressants. Unfortunately, anti-depressants often make their moods more unstable and their ability to function declines as the medicine worsens their condition. Once the disorder is properly diagnosed medications need to be changed to include mood stabilizers. There is usually a family history of depression or bipolar disorder.
Other Mood and Anxiety Disorders
CBBS is also a resource for difficult to treat cases of OCD, Post Traumatic Stress, and Borderline Personality Disorder. These disorders are frequently difficult to diagnose. Separating them from bipolar disorder, ADHD, and substance abuse can be quite difficult since they frequently co-exist. Complex pharmacologic treatment, including medical devices and alternative medical and nutritional therapies, combined with directed psychotherapies have been very successful in treating cases that were initially refractory to conventional approaches.
Our medical director is the author of Contagious Emotions: Staying Well When Your Loved One is Depressed. He was among the first of a small group of mental health professionals to recognize the tendency for emotions and moods to be infectious. He has designed an integrated biological and psychological therapy that involves the participation of loved ones. Dr. Podell’s approach to therapy has always been focused on finding effective combinations of medication, psychotherapy, alternative medical remedies, and medical devices—he focuses on clinical stability and mood normalization rather than keeping to rigid treatments or theory.
The key to treatment should be achieving full remission of depression. Theoretical rigidity has no place in seeking this most crucial goal. The openness to therapeutic flexibility and creativity has produced the highly publicized treatment results that Dr. Podell achieved including testimonials from celebrity patients in multiple media outlets who were unable to get help from other mental health experts. By involving family and loved ones in the treatment process, CBBS is able to achieve higher rates of success in treating the affected family member. This integrated treatment also helps protect the marriage and family relationships from the destructive, contagious forces that can leave permanent scars even after the depression has abated or passed.
CBBS prides itself in being a resource for patients who have not improved from traditional or alternative treatment methods.
