Dementia & Suicidal Depression

Today I’m home from the hospital. I had a stay of five days in a psychiatric hospital for depression

with suicidal ideation. I’m no stranger to stays in psychiatric hospital because of my bipolar but I could tell there was something different about this depression. It was not the norm of my bipolar depression. And I hadn’t had depressive episode in almost a year. This felt different.

To give you a glimpse into my world of depression I call it the Nothing Feeling. I never see the episodes coming. They sneak up on me. But when they make their presence known it’s too late and I am at their mercy. You would think after 40 years by now I would be able to spot them a mile away. Maybe my brain just becomes too weak and unable to recognize them; depression. 

I would feel nothing. I call it the Nothing Feeling. There is no happiness. No joy. No sadness. Not even depression. Absolutely nothing. Calling it depression gives it no justice. I wouldn’t want to exist. I wouldn’t want to die either.

Thinking is all but non-existent. Imagine trying to think feeling nothing? It’s impossible. What minimal thinking I can muster up is reduced to thinking how you don’t want to do anything.
And that’s what I do. Nothing. Exhaustion sets in and even rolling over in the bed I have secluded myself to is a chore. It is where I would spend most of the day with low music in the background. I listen to Standards 90% of time and it seems to fit the occasion. It’s just to have something fill my mind. 

That is the trap my mind is in during my depressions.

What should you do if someone with any form of dementia talks about depression, especially suicide? How should you react? What questions should you ask? What action should you take? Is your loved one a danger to them self? Does your loved one require hospitalization?

Dementia or not talk of depression, let alone suicide must be taken seriously. Dementia can’t be down played and suicidal talk taken less seriously. According to a study published Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, data from the Department of Veteran Affairs was examine and it was determined that an increase suicide risk in people over the age of 60 was associated with the following:

• ·         A recent diagnosis of dementia
• ·         Caucasian race
• ·         A history of depression
• ·         History of psychiatric hospitalizations
• ·         Prescriptions of antidepressant or ant-anxiety medications

A second study identified two other risk factors for suicide in people who dementia: a higher cognitive functioning in dementia and previous suicide attempts.

An awareness of the possibility of depression in people with dementia is important in preventing and responding to suicidal feelings in dementia. Twenty-five to fifty percent of people with dementia develop depression. Evaluating for and recognizing the symptoms of depression in dementia are very important since depression increases the risk of suicide. Treating depression, through both non-drug approaches and antidepressant medications can make a dramatic difference in the person's quality of life and reduce their suicide risk.

What treatment is available?

The main treatment or depression includes psychological therapies, antidepressants, and social support or attention to the person environment.

Psychological Therapies

Counseling is increasingly offered through GP surgeries. Counselors are trained to listen, and can provide a supportive environment for their clients. There are many different types of counseling therapies, and their suitability will depend on the person and the stage of their dementia.

Cognitive behavioral therapy can help to overcome the negative feelings that can sometimes be the cause of depression, and is often available on the NHS.

Support groups may also be helpful. People usually find talking to others who are going through a similar experience immensely supportive. For information about groups near you, contact the Alzheimer’s Society National Dementia Helpline.

Antidepressants

Antidepressants work by prolonging the activity of neurotransmitters (chemical messengers) in the brain. It is thought that a dysfunction of neurotransmitters may be associated with depression.

Most antidepressants work well for a lot of people. They are usually taken for at least six months, and often longer. Some people find that they have great difficulty coming off them, so antidepressants should always be withdrawn slowly. People may have to try one or two different brands before they find one that is effective for them. There may be side-effects to begin with, but these should lessen as the body adjusts to the drugs. The doctor may decide to change the dose or provide an alternative antidepressant if the side-effects continue.

There may also be a delay of two or three weeks before the effects of the drugs are felt, and response to the drugs is progressive over two or three months. It is important that the medication is taken as prescribed, even if the drugs do not appear to be working. Missing doses or stopping the drugs can affect the efficacy of the medication.

There are many different types of antidepressants, including:

• Selective serotonin re-uptake inhibitors (SSRIs) − These are used most commonly, because their side effects are usually better tolerated than those of other drugs, and they have the best evidence supporting their use (Lyketsos 2003). These include Prozac (the trade name for fluoxetine), Seroxat (paroxetine), Faverin (fluvoxamine), Lustral (sertraline) and Cipramil (citalopram).
• Other safer classes of antidepressants − There are some other classes of antidepressants that are also safer than tricyclic antidepressants (see below). These include Zispin (mirtazapine) and Edronax (reboxetine).
• Tricyclic antidepressants − These drugs, which include Lentizol (amitriptyline), Tofranil (imipramine) or Dothiepin, Prothiaden (dothiepin), have several common side-effects that can cause significant problems for older people, including urinary retention, blurred vision and drops in blood pressure, sometimes leading to falls. In addition, they can cause confusion even in older people without dementia, and therefore make the problems of those suffering from dementia even worse. This type of drug should not therefore be taken by people with dementia.
• Monoamine oxidase inhibitors (MAOIs) − These are sometimes prescribed for depression. It is important that a strict dietary regime is followed when taking these drugs, which usually makes them unsuitable for people with dementia. However, there is one ‘reversible’ MAOI called Manerix (moclobemide) that does not require the same dietary restrictions. A positive study has been carried out on this drug in people with cognitive decline (Roth 1996).

Other approaches

Studies have shown that depression may respond to increased social support and attention to the person’s environment (Teri 1997 and 2003). This can be achieved by, for example:

• pleasant activities that the person can still enjoy, such as short walks or outings
• making sure there is a reassuring daily routine
• protecting the person from unwanted stimuli, such as bright lights, loud noises and too much rush and bustle, or from feeling isolated and bewildered in a large group
• more one-to-one interaction, such as talking, hand holding, or gentle massage, if appropriate.

Today I feel safe and depression free for now after a change and adjustment to my medication. But it was because of the quick action I was willing to take. When you’re depressed and suicidal you don’t feel like taking action. You have to force yourself to. And with the help of my wife she got me into the hospital where I felt I needed to stay.

Always take depression symptoms serious and especiously talk of suicide.