Depression and MCI: Part 1, How do we identify depression?

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Mar 27, 2018 | Dona Locke | @DrDonaLocke | Comments (9)

Most of our blog topics are designed to offer tips and support for maximizing functioning, quality of life, and happiness for those who are already living fairly well with MCI.

However, it is important that we acknowledge that a sizable percentage of patients living with MCI will experience significant clinical depression that requires medical intervention. This recent large study confirming the effectiveness of antidepressant medications is an opportunity to review the common symptoms of depression and to encourage any of you who feel you may be struggling with depression to ask for help. Certainly, if you are having any thoughts of self-harm or suicide, this is an emergency situation requiring immediate care.  If you are having such thoughts of self-harm or suicide, stop reading now and seek help. You can contact your primary care physician, go to a local Emergency Room, or call or text 988 the 988 Suicide & Crisis Lifeline.

What are other symptoms of depression? This is an important first question as many of us have “bad days” and “stress.” It is normal human functioning to have emotions, both positive and negative, in response to situations around us. Emotional responses are normal. However, sometimes, emotional symptoms are prolonged (feeling bad for a couple of weeks instead of just a bad day), and we experience additional physical or emotional changes that mean we may have a problem that is not just “stress” or a “bad day”. If this is the case, it is time to ask for help.

Review the symptoms below to determine if you might need to seek help.

Primary Signs of Depression:

Depression is often characterized by feeling sad, but for others, especially older individuals, depression is not a feeling of sadness, but a loss of positive emotion. Do you have either

• Feelings of sadness, emptiness, or tearfulness more often than not, more days than not for a period of two weeks.

AND/OR

• A loss of positive emotion: Lost of interest in joyful activities or loss of pleasure in things you usually enjoy. This is a sign medical personnel call “anhedonia” or patients may call feeling "blah" or "detached." For example, do you find that your grandchildren don’t cheer you up as they once did? That you do not enjoy your favorite hobby?

Additional Signs of Depression:

1. Feelings of worthlessness or inappropriate guilt most days. Consider if you are telling yourself these kinds of things: "I can never do anything right." "I’m ruining my family’s life."
2. Reduced concentration or difficulty making decisions. MCI involves cognitive changes by definition. Therefore, to determine if there are additional thinking changes related to depression, you would be looking for cognitive difficulties that are new, and in the context of some other depression symptoms. For example, maybe you know you have short term memory changes, but now you have trouble deciding just what to wear each day or what to have for breakfast.
3. Physical changes most days such as:
   1. Changes in sleep patterns (sleeping too much or too little)
   2. Changes in appetite (eating too much or too little)
   3. Changes in activity level (being so restless you can’t sit still or being so slowed down you can’t get anything done)
   4. Fatigue or low energy
4. Suicidal ideation or recurrent thoughts of death or dying.

If you are either feeling sad or loss of positive emotion in your life most days for at least a couple of weeks, and you have more than one or two of the above additional symptoms , I strongly encourage you to see your doctor. I also encourage you to discuss how you are feeling with your loved ones. Sometimes it is hard for the person who is depressed to recognize all of the above changes. Perhaps review the above list with your spouse, partner, or other significant family member (adult children for example) and see if they notice the above symptoms. In our next post, we'll review treatment options for depression. In the mean time, depression can range from mild to severe, so even if you just have a few symptoms that you think might be mild or “stress” your doctor can help evaluate this further and determine if treatment is warranted.