Alzheimer’s and Depression: A Cautionary Tale

We’ve been looking at the “What-If’s” of caring for someone with Alzheimer’s: the questions that pop up in our minds without warning or provocation, daring us to answer them immediately lest we move into the future unprepared.  But we’re taking a slight detour in the last post and this one to consider at length a big “what-if” in the world of Alzheimer’s: what if the person I’m caring for has depression in addition to Alzheimer’s?

As we discussed in the last post, according to the Alzheimer’s Association, it’s not uncommon for people with Alzheimer’s to be depressed, especially in the early and middle stages of the disease. In fact, the Association says, “Experts estimate that up to 40 percent of people with Alzheimer’s disease suffer from significant depression.” Speaking for myself, the fact that 40 percent of people diagnosed with Alzheimer’s become depressed doesn’t surprise me. But at a presentation given by well-known geriatric psychiatrist Dr. David Crumpacker, I heard something that did surprise me.

“Depression is never normal,” Dr. Crumpacker stated. Not even for someone with Alzheimer’s? No, not even for someone with Alzheimer’s.

The importance of this fact is underlined by two other facts:

  • Depression, unlike Alzheimer’s, can be treated effectively.
  • And available treatments, the Alzheimer’s Association says, can lead to “significant difference in quality of life.”

As I noted in the last post, that’s information caregivers can act on. I suspected my mom had depression, but I didn’t push hard enough for diagnosis and treatment. As a new caregiver, I wrongly assumed the doctor would take the lead. I made the mistake of thinking, “The doctor knows this disease. He knows all the important topics to be discussed, all the important problems we’re encountering in caring for Mom.  If he doesn’t bring it up while we’re here in his office, it’s not really important.”

I was wrong. But I was fortunate. The results of my mistake could have been far more serious than they were. As promised, here’s the story of how I learned about the effects of depression on someone with Alzheimer’s. 

angry bluebird

After I heard Dr. Crumpacker speak about the impact of depression on someone with Alzheimer’s, my father and I made an appointment for Mom to see him. On the day of the appointment, Mom refused to go.

“No doctor but mine!” she shouted at me, punctuating the declaration by throwing a chair my way.

The doctor Mom was referring to was the primary care physician at the Senior Medical Center in the small suburb of Dallas where they lived. Dad and I had been totally unable to get this man to listen to us regarding Mom’s increasing anger, lack of cooperation, and even aggression. Instead of considering the information Dad and I provided, the doctor watched Mom. She smiled in his office. Chatted with him. Answered questions politely. Even promised to stop smoking.

Later, at home, Dad and I looked at each other through the smoke of Mom’s ever-lit cigarette. The situation seemed impossible: Mom refused to see the doctor who could help her, while the doctor she would see would not even acknowledge the problem.

This impasse lasted a few weeks. With no help for the symptoms of depression, Mom grew angrier. And Dad…Dad was like a soldier forced to march in place while the enemy closed in on Mom. He was desperate to help her but growing weary of fighting with love his only weapon.

As for me, I was useless. I should have done whatever was necessary to make the doctor see the truth of Mom’s symptoms. Maybe she’d yell, even throw another chair—but so what? Isn’t that what I wanted him to see? Isn’t that what he needed to see?

But no. I was accommodating, as usual. To Mom, who was, after all, unfailingly cooperative in the doctor’s office.  To Dad, who was, after all, relieved to hear a doctor who spoke as though Mom was fine, except for maybe a little “fatigue.” And to the doctor, who was, after all, the expert in Mom’s care. Right?

What I failed to accommodate, of course, was the truth. The truth is that Mom was depressed, severely so, and while Dad, the doctor, and I ignored it, she could not.

Mom never wore hats. So the morning I walked into their house and saw her sitting at the table wearing a perky red ball cap, my mind shifted immediately to high alert mode. Dad’s almost shouted question, “How do you like your mother’s hat?” did nothing to allay my anxiety.

Mom didn’t like to wear hats, but she did like her hair short. A “pixie” style, I think it’s called. But lately she’d refused to go to her hair stylist. The longer her hair grew, the more loudly she complained…and the more determined she was not to go anywhere to have it cut. Yes, I offered to cut it, and was lucky not to have to dodge a chair. But now I wondered if maybe Dad had taken her to the barber shop. And bought her a hat to cover up a bad job.

Now I said, “Well, I like your hat.” Still accommodating. “Where did you get it?”

“Your father gave it to me,” Mom said. Then, with a grand flourish she waved her arm over her head, knocking off the cap.

I gasped. Mom’s head looked a dog’s chew toy with most of the fur chewed off. Her hair was gone. Well, most of it was gone. Grey-brown tufts stuck out here and there, their edges uneven, hacked. The jagged lines of surviving hair ran like old rick-rack trim across her poor, mottled scalp.

When I had recovered enough to take in information, Dad told me that, the day before, he’d gotten tired of Mom’s complaining about her hair. So he left the room. He went out to his garage, his refuge, for some quiet time. Twenty minutes later, when he came back inside, Mom wasn’t at the table. She wasn’t in the living room. The bathroom door was closed, but he rushed in anyway.

Mom was standing at the mirror, scissors in her hand. Long-bladed utility shears, Dad called them. “Hair was everywhere. Everywhere,” he said.

Though Dad assured me he’d already checked, I had to look again. How could Mom have done such damage without slicing her scalp? But no cuts, large or small. No blood. It was a miracle.

Two weeks later, the three of us walked in to Mom’s doctor’s appointment as usual. She had long since thrown the ball cap away, refusing to wear anything on her head.

This time when the doctor came in, there was no cheery “Well how are you, Mrs. Bailey?” Instead his chin dropped and his mouth hung open. He never said a word to Mom, turning, instead,  to the other side of the room, where Dad and I sat. “Did she do this?” he asked.

I looked at Dad. Dad looked at the doctor. “Yes, sir. She did.”

That day we left the office with an appointment for Mom to see the geriatric psychiatrist who visited the senior clinic once a month. Another miracle: his next visit was only days away. Because of what was labelled her “self-destructive tendencies,” Mom was moved into the first slot on his list of patients.

accommodating

Mom wasn’t a candidate for talk therapy, but the medication the psychiatrist prescribed began to improve her mood much faster than expected. The little white pills had no effect on the Alzheimer’s, but they released Mom from much of the anxiety and anger that had taken over her life. They helped her say “yes” more often, cooperate more often, smile more often. At last the good days began to outnumber the difficult ones, and Mom and Dad had more long, relaxed evenings, a mainstay of their 50+ year marriage. Of course Alzheimer’s continued to make its presence felt, but with Mom more relaxed—just plain happier—Dad and I found renewed strength and hope to fight it for her.

Alzheimer’s is never easy. But maybe it doesn’t have to be as difficult as it is now for you and the person you care for. If you suspect your loved one may be depressed. I urge you to check it out. Remember: caregiving is mostly about keeping our loved ones safe and comfortable. I saw for myself that my mother’s depression was treatable. I saw how different she was after treatment: more relaxed, more upbeat, more comfortable. And safer.

“Depression is never normal.” Check it out. Please.

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As a shepherd looks after his scattered flock when he is with them, so will I look after my sheep. I will rescue them from all the places where they were scattered on a day of clouds and darkness.  (Ezekiel 34:12 NIV)

Father, help us as we try to shepherd our loved ones. You are the one Good Shepherd. Teach us, please, to see as You see, care as You care, love as You love.