Alzheimer's: Medications for Treating Depression

Information on antidepressant medication to treat Alzheimer's patients with depression.

Researchers have discovered that treating depression in patients with Alzheimer's disease can have a significant impact on the well-being of these patients. They also found that treatment of depression can reduce caregiver stress.

In Alzheimer's and dementia patients, symptoms of depression are very common. In the beginning stages they are usually a reaction to the person's awareness of their diagnosis. In the later stages of Alzheimer's Disease, depression may also be the result of reduced chemical transmitter function in the brain. Simple non-drug interventions, such as an activity or exercise program, can be very helpful. In addition, both types of depression can be effectively treated with antidepressants, but care must be taken to ensure that this is done with the minimum of side-effects.

Antidepressants may be helpful not only in improving persistently low mood but also in controlling the irritability and rapid mood swings that often occur in dementia and following a stroke.

Once started, the doctor will usually recommend prescribing antidepressant drugs for a period of at least six months. In order 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.

Antidepressant side-effects

• Tricyclic antidepressants, such as amitriptyline, imipramine or doxepin, which are commonly used to treat depression in younger people, are likely to increase confusion in someone with Alzheimer's. They might also cause a 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 for depression in Alzheimer's.
• Drugs such as fluoxetine, paroxetine, fluvoxamine, and citalopram (known as the selective serotonin re-uptake inhibitors) do not have the side-effects of tricyclics and are well-tolerated by older people. They can produce headaches and nausea, especially in the first week or two of treatment. There is very limited information about the use of other newer antidepressants in people with Alzheimer's, although one large treatment study (M Roth, CQ Mountjoy and R Amrein, 1996) suggests that moclobemide (an MAOI not sold in the U.S.) is an effective treatment. Venlafaxine (Effexor) has many of the side-effects of tricyclic antidepressants, but can be very helpful in people who have not responded to other treatments.

Sources:

• Lyketsos CG, et al. Treating depression in Alzheimer disease. Efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry July 2003;60:737-46.
• Schneider LS: Pharmacologic considerations in the treatment of late-life depression. Am J Geriatr Psychiatry 4:S1, S51-S65, 1996.
• Roth, M, Mountjoy, CQ and Amrein, R (1996) 'Moclobemide in elderly patients with cognitive decline and depression'. British journal of psychiatry 168: 149-157.
• Alzheimer's Association: Depression and Alzheimer's

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