Living with Mild Cognitive Impairment (MCI)

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Welcome to the HABIT page for people living with Mild Cognitive Impairment (MCI) and program participants.  The HABIT Program is for individuals with MCI and their loved ones to learn the best strategies for adapting, coping, and living their best lives with MCI.

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Tue, Mar 27, 2018 10:16am

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

By Dr. Dona Locke, HABIT AZ Director, @DrDonaLocke

shutterstock_440476696Most 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 the National Suicide Prevention Lifeline at 1-800-273-8255.

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.

 

What if you are already taking an antidepressant and feel several of the above symptoms. Should I change or add to?

@janelb

What if you are already taking an antidepressant and feel several of the above symptoms. Should I change or add to?

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Thanks for your question, its a good one! Sometimes a treatment helps but doesn't fully treat depression. I would encourage you to talk to the doctor who prescribed the medication for you. A number of factors would go into the decision about what to do next including how long you've been on the medication, what dose you are taking, what medications you've tried in the past and which symptoms you are still having. Depending on the answers to these questions your doctor could decide to have you increase your dose, switch to a different medication, add an additional medication, consider adding psychotherapy to your treatment, or perhaps even evaluate you for some other problem (for example–if the main ongoing problem is fatigue, your doctor may want to look at the possibility of a sleep problem). So please speak up about how you are feeling so you and your doctor can discuss the right next step for you.

Will be interesting to see treatment options post. Thank you. BonnieP

@bonniep

Will be interesting to see treatment options post. Thank you. BonnieP

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Thanks @bonniep That is definitely coming this week and I hope you find it helpful.

After my stroke, I lost "myself"-everything. That was the day my life[me]-ended. I thought there might be a chance that I might regain some of my past functions, skills, & physical abilities. I now realize that this may not be possible & I am imprisoned in a body that is will permanently & increasingly disabled.
So yes, I am very, very depressed, angry, & sad. I do not feel anything close to how I felt before my stroke & existence for me is just survival, but nothing close to "Living" as I have known it. Medication? In the past, I've been proscribed "Anti-depressants" & I remember having very negative reactions to each of them.. As physical pain is a message that something is wrong in the body that should be addressed, perhaps the same is true for emotional pain? If my current state of existence is too painful to bear & it cannot be "changed" or improved then isn't "depression", a very logical & legitimate emotional response to a very real physical experience so why try to block it by various medications?

I do not feel safe in my own home. My husband presents one face to the world outside our home, but a different face with in our home. I lock myself in my bedroom at night. I rarely take take naps, but when I do, I lock myself in my bedroom.

@lucyl

I do not feel safe in my own home. My husband presents one face to the world outside our home, but a different face with in our home. I lock myself in my bedroom at night. I rarely take take naps, but when I do, I lock myself in my bedroom.

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Hi @lucyl
You have taken the first important step on the path to safety – telling someone. Please visit the National Domestic Violence Hotline website http://www.thehotline.org/ On this website you will find a phone number to call 1-800-799-7233 or you can use the online chat and get help without saying a word.

It is good that you have a room that you can lock for your safety. I hope you will call the Hotline and work with professionals there to find a permanent safe place for you.

@lucyl

I do not feel safe in my own home. My husband presents one face to the world outside our home, but a different face with in our home. I lock myself in my bedroom at night. I rarely take take naps, but when I do, I lock myself in my bedroom.

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I wish they had a sad button. I could not bring myself to press the like button. My heart is just breaking for you. I'm not having that same problem but it sounds like a nightmare. Please be safe and know that there are people who care about you. Could you keep us posted on how you are doing? I hope you see some light at the end of that dark tunnel.

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