Depression

Drugs for treating depression

Symptoms of depression are very common in dementia.  In the early stages they are usually a reaction to the person's awareness of the diagnosis.  In the later stages of the illness, depression may also be the result of reduced chemical transmitter function in the brain.  Both types of depression can be treated with antidepressants, but make sure that this is done with the minimum of side-effects.

Antidepressants may be helpful in improving persistently low mood and also in controlling the irritability and rapid mood swings that often occur in dementia and that are also seen after a stroke.

The doctor will usually prescribe antidepressants for a period of at least six months.  For them to be effective, it is important that they are taken regularly, without missing any doses.

Improvement in mood typically takes two to three weeks or more to occur, whereas side-effects may appear within a few days of starting treatment.

Side-effects

Tricyclic antidepressants such as amitriptyline, imipramine or dothiepin, which are commonly used to treat depression in younger people, are likely to increase confusion in someone with dementia.  They might also produce dry mouth, blurred vision, constipation, difficulty in urination (especially in men) and dizziness on standing, which may lead to falls and injuries.

Newer antidepressants are preferable as first line treatments of depression in dementia.

Drugs such as fluoxetine, paroxetine, fluvoxamine, sertraline and citalopram (known as the selective serotonin re-uptake inhibitors) do not have the side-effects of tricyclics and are well tolerated by elderly people.  They can produce headaches and nausea, especially in the first week or two of treatment.