Intervention Series: Mom seems to be depressed - what you can do

Depression Interventions

In a recent study researchers found that depressive symptoms were more than twice as common among assisted living residents with mild or moderate dementia than among those without dementia.  Depressed residents often do not have positive outcomes and are greater risk of discharge to nursing homes and death. Chronic depression can lead to loss of appetite and weight loss, lethargy, and a host of other premature health complications. Findings of the study document the high prevalence of depressive symptomatology among those with dementia.  About 54% of the depressed and 33% of the non-depressed participants were taking antidepressant medication.[i] Sixty-two of the participants of the study were depressed had no formal mental health treatment.  Depression was more common among participants with severe dementia, behavioral symptoms and those with pain.  The study also found that over half of the depressed participants were undetected by staff.

These results indicate a strong need to properly assess residents for depression. Seeking interventions for those suffering who are undiagnosed and corrective actions for those currently treated for depression who may not be depressed can derail potential problems.  Identifying these at-risk residents and advising attending physicians and family members may help operators to avert unnecessary mental health triggered discharges, while improving the quality of life for each individual.

The Cornell Scale for Depression in Dementia (CSDD) was developed in response to a need in the industry for a diagnostic tool to quantify incidence of depression in elderly populations with dementia[ii].  This simple 19 question tool enables operators to identify at-risk residents who are suffering from depression and are undiagnosed so that they might be treated, and also identify those who may be already prescribed antidepressants who may not in fact be depressed.  This way attending physicians may be offered a nationally recognized diagnostic tool to use to evaluate and prescribe for their patients, rather than relying upon sporadic observations from caregivers and family members.

Alternatives for Depression Intervention:

Treatment for depression depends upon the cause and severity of the depression and, to some extent, on personal preference. In mild or moderate depression, psychotherapy is often the most appropriate treatment. But incapacitating depression may require medication for a limited time along with psychotherapy. In combined treatments, medication can relieve physical symptoms quickly, while psychotherapy enables the patient to learn more effective ways of handling his/her problems.

Personal Measures: mild exercise, music therapy, pet therapy, gardening or other hobbies, social engagement, volunteerism, intergenerational activities, reminiscing with family members or other residents, social interventions to help with isolation and loneliness (group outings, regular visits from volunteers, participation in a support group), humor, maintaining a healthy diet, religious or spiritual groups, continuous engagement in stimulating activities and craft programs.

Medical measures: treatment of underlying medical conditions, counseling, psychotherapy, anti-depressants, hormone replacement therapy, changes in prescription dosages. Antidepressant medication can help some people feel better by controlling certain symptoms. The can be helpful in mobilizing people who suvive the repair of a broken hip, but lose the will to get out of bed. It should be noted that antidepressants can potentially lead to falls as they are sedating and can cause a sudden drop in blood pressure when a person stands up. Also selective serotonin reuptake inhibitors (SSRI) drugs can create dependency and may lead to self-destructive thoughts.

Psychotherapy and Counseling and Measures: Supportive counseling includes religious and peer counseling. It can help ease the pain of loneliness and address the hopelessness of depression. Both peer counseling and pastoral counseling usually are provided without cost. Cognitive Bahavioral Therapy (CBT) helps people distinguish between problems that can and cannot be resolved, and develop better coping skills. Interpersonal psychotherapy can assist in resolving personal or relationship conflicts. Somatic or trauma psychotherapy with a professional can help bring about resolution of traumatic experiences.

 Why it is important to treat: The body often follows the mind and depression substantially increases the likelihood of death from physical illnesses. Depression can increase impairment from a mental disorder and impede its improvement, while psychological treatment frequently improves the treatment success rate for a variety of medical conditions. Untreated depression can interfere with a patient’s ability to follow the necessary treatment regimen or participate in a rehabilitation program. According to a study conducted by the Rand institute, depressed elerly patients use 6 time more prescription medications and spend four times more in total healthcare dollars than their nondepressed counterparts. Seniors who are vulnerable for depression experience more comorbidities and run a higher risk of catastrophic health failure.

The Cornell Scale for Depression in Dementia (CSDD) is a way to screen for symptoms of depression in someone who has dementia. Unlike other scales and screens for depression, the CSDD takes into account additional signs of depression that might not be clearly verbalized by a person. For example, if your loved one or patient has Alzheimer's disease, vascular dementia or other kind of cognitive impairment, he might not consistently be able to accurately express his feelings. The Cornell Scale measures observations and physical signs that could indicate depression. 

Conduct your own assessment: http://primaris.org/sites/default/files/resources/Depression/depression_cornell%20scale%20for%20depression%20final.pdf

[i] Baldini-Gruber, Ann, Zimmerman, Sheryl, Boustani, Malaz, Watson, Lea, Williams, Christianna, Reed, Peter. Characteristics Associated with Depression in Long-Term Care Residents with Dementia. The Gerontologist. Vol. 45, October 2005, Page 50-55.

[ii] Alexopoulos, G.S., Abrams, R.C., Young, R.C., & Shamoian, C.A. Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 1988, Page 271-284.