Understanding and Diagnosing an Older Loved One’s Dementia- or IDD-Related Depression

By Julie HayesMarch 15, 2023

Dementia, intellectual and developmental disabilities (IDD) and depression can, unfortunately, be closely linked. An estimated 30 to 40 percent of individuals diagnosed with dementia may also suffer from depression. This number includes older adults in the IDD population who also have dementia—and who are already fifty percent more likely to struggle with mental health conditions, according to the Hogg Foundation for Mental Health. 

While dementia currently can’t be cured, symptoms of depression can often be treated with a combination of medications, support from friends and family, and other treatments such as therapy. Although your loved one may still experience memory loss, managing their depression will work to help them improve their day-to-day wellness and management of their condition.

Signs and symptoms of depression

Symptoms of depression in older adults with memory loss and IDD are similar to those of younger people. They may seem sad, hopeless and discouraged, and no longer take interest in activities they used to enjoy. Depressed people often have trouble sleeping at night, or nap frequently during the day. Older adults suffering from depression may have poor appetites and often skip meals. They may express feelings of guilt, worthlessness, or hopelessness, and may become more anxious than they are usually.

Some depressed older adults may even talk about suicide. Sadly, adults in the 75 and over age category are in one of the highest risk groups for suicide as per 2020 Centers for Disease Control data. People of any age who threaten suicide must be taken seriously. If your loved one mentions ending their life, seek help from their doctor or another health care professional immediately, or call the 9-8-8 Suicide & Crisis Lifeline.

Diagnosing depression and fighting diagnostic overshadowing

If you suspect that your loved one is depressed, schedule an appointment with their primary care doctor for a thorough physical and mental health evaluation. Before the appointment, write down your concerns about your loved one’s behavior changes and mental health situation and take notes during the exam. Also be sure to have a list of the medications your loved one takes on hand, as many medications can cause or worsen symptoms of depression.

One challenge you may face during the diagnostic process is “diagnostic overshadowing.” This happens when your loved one’s symptoms of depression are attributed to their dementia or IDD and not recognized distinctly as having to do with depression. Symptoms of depression can, in fact, mimic symptoms of dementia and IDD. People with depression can often experience memory loss, for example, while people with dementia and IDD may lack energy and interest in activities just as people with depression often do.

However, depression can also exist alongside dementia and IDD, and it can be very dangerous if it is ignored and dismissed as a normal part of your loved one’s condition. One way to avoid this is to keep track of your loved one’s baseline behavior or mental health state before any changes happened. For example, if your loved one with dementia and/or IDD was always engaged in their hobbies and interests even after their diagnosis, but suddenly disengages from the things they once changed about, this is a notable change in their baseline and may be a sign that something else is at play.

Mental health needs to be taken seriously. Be ready to advocate for your loved one if you need to and explain to your loved one’s doctor your reasons for thinking they may be suffering from depression.

Medications and depression

After diagnosis, your loved one’s doctor may suggest an antidepressant medication to treat their depression. Antidepressants affect chemicals in the brain that control brain function and can help improve your loved one’s mood. It is important for both you and your loved one to understand that it can take four to six months for antidepressants to be effective. If your loved one decides to try an antidepressant, encourage them to be patient and give the medication time to work. You should also keep an eye out for potential side effects and report them immediately to your loved one’s doctor.
Don’t hesitate to call the doctor if you or your loved one have more questions or need additional information about the medication the doctor prescribed. Together, you can decide if the potential benefits of these medicines to your loved one’s health outweigh potential side effects.

Offer your own support

Friends and family are also an important support system when a loved one is coping with depression. Here are just a few things you can do to help:

  • Work with your loved one to make their home a calm, cozy and safe place to live
  • Make sure they’re not alone too often or socially isolated from the people they care about
  • Check in regularly on their physical, mental and emotional health
  • Put in effort to communicate with them kindly and gently, and check yourself when you feel you’re becoming stressed, negative or frustrated around them

Resources:

  • In emergency situations, contact the 9-8-8 Suicide & Crisis Lifeline, 9-1-1 or the  National Suicide Prevention Lifeline at 1-800-273-8255.
  • Contact the SAMHSA Treatment Referral Helpline at 1-877-726-4727 for information services.
  • Your local Department of Aging, Office of Health and Human Resources, or local Alcohol Drug and Mental Health board can direct you to behavioral health resources in your area.
  • The Behavioral Health Services Department here at Benjamin Rose Institute on Aging can be reached through Intake, at 216-791-8000 or email [email protected].

This article was written as a part of the Expansion of Dementia-Capable Communities within Urban and Rural Settings in Ohio using Evidence-Based and Informed Programming project, funded by the Administration for Community Living, Alzheimer’s Disease Program’s Initiative (#90ADPI0052-01-00).