So what is the purpose of a psychiatric med in AD. Depending on the stage of Alzheimer's a person suffering with the disease may not be able to verbally communicate exactly how they feel. Their sadness, their fears, maybe even their joys our ability to feel content may not be expressed. It is quite true that dementia can co-exist Depression.
Depression is a well known phenomenon, and for that matter a bit more acceptable to be outspoken about and to even accept treatment for,in today's world. There is less stigma associated with depression. The same can not be said for other forms of mental illness. With that said there is now a little talked about phenomenon with our increased awareness of depression the tendency to pigeon-hole or clump all sorts of mental illnesses simply into "depression".
Nonetheless as a society we have come a long way in our awareness of major depression. We have more than ever before many pharmaceutical treatment modalities for major depression.
The problem is the AD victim might not be able to tell us they are sad or depressed. Yet we often use antidepressants to help them. Sometimes they show us they are depressed, for example by not eating, trouble sleeping, lethargy, low motivation etc. The problem is many of these issues overlap with dementia itself.
We gauge the behaviors and make the best clinical judgment.
Sometimes there is agitation and aggression. Sometimes this can be partly a manifestation of depression or the dementia itself or both.
The antidepressants can help calm agitation or conversely they can actually increase aggression and agitation.
There often is no perfect clinical marker on when to use an antidepressant and no guarantee it will help. Clear target symptoms have to be identified.
For example if loss of appetite in the context of lethargy and withdraweness is considered to be in part depression, then once an antidepressant is started you have those three possible outcomes, (better, worse or no change). It of course may take a few weeks for the antidepressant to reach full efficacy.
Another important issue is that in the dementia victim, especially with advancing age, lower doses of medicines, like antidepressants must be used. As we age the sensitivity to med effects can increase and the actual metabolism in a person can slow down considerably. A normal adult dose of a med may be much less in an elderly individual.
Meds like anything else ingested into the body are generally metabolized through the liver and sometimes kidneys or both depending on the med. Rarely the lungs will help metabolize some medicines and chemicals.
There is utility in using antidepressants, they are not sinister things the doctor throws at your loved one to make them stop lashing out. Make sure you understand what the med is supposed to do, and what that outcome will look like and how it will be gauged, and how long it generally will take to gauge efficacy. They can have side effects but don't just look and what for those understand the doctor is not trying to hurt your loved one, remember to look for the target effects in a realistic fashion and not just the side effects.
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