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Depression in DementiaAka: Dementia with Comorbid Depression

Epidemiology
1. Incidence in Alzheimer's Disease: 20-30%
2. Often occurs in early Dementia
Symptoms
1. Dementia patients rarely report sadness
2. Patients often report vague somatic symptoms
3. Common presenting complaints
  1. Lack of energy
  2. Patient reports "feeling old"
  3. Pessimism
  4. Hopelessness
  5. Anhedonia (lacks pleasure)
  6. Negative attitude
4. Vegetative Symptoms
  1. Anorexia
  2. Weight loss
  3. Sleep disturbance
Differential Diagnosis
1. Depression as primary etiology for Delirium
2. Hypothyroidism
3. Occult malignancy
4. Chronic infection
5. Medications
Management: Medications
1. Course
  1. Consider stopping medications after 6-12 months
  2. As Dementia progresses, Depression regresses
2. Tricyclic Antidepressants (Avoid older tricyclics)
  1. Nortriptyline (Aventyl, Pamelor) 10-75 mg PO qhs
  2. Desipramine (Norpramin) 25-150mg PO qhs
3. Selective Serotonin Reuptake Inhibitors (SSRI)
  1. Fluoxetine (Prozac) 10-40mg qAM
  2. Sertraline (Zoloft) 25-100 mg PO qAM
  3. Paroxetine (Paxil) 10-20mg PO qd
4. Other
  1. Venlafaxine (Effexor) 18-50 mg PO bid
  2. Bupropion (Wellbutrin) 25-100 mg PO tid

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.