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Treatments for Depression in Alzheimer's Disease

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Updated: August 9, 2006

Medication Options for Depression

Depression is common in people with Alzheimer's disease and doctors will often use antidepressant medication to treat it.

SSRI Antidepressant Medications
Depression with or without agitation can be treated with medications such as those in the SSRI group of medications. SSRI stands for Selective Serotonin Reuptake Inhibitors. This describes the way in which the drug works in the brain. SSRI medications have been found to be effective in the treatment of depression for people with Alzheimer's disease. These medications include: Prozac, Zoloft, Lexapro, Paxil, Celexa.

Side effects of SRRI medications include can sweating, tremors, nervousness, insomnia or somnolence, dizziness, and various gastrointestinal and sexual disturbances.

Depression with Agitation and Alzheimer's Disease
Trazodone (Desyrel) can be very good for depression with agitation because of its sedating qualities. Initial dosage 25 to 50 mg daily. Increased to 100 to 300 mg daily in two or three doses. Side effects include over sedation, Less commonly dizziness, orthostasis, headache, cardiac irritability. Very rarely priapism.

Tricyclic Antidepressants for Alzheimer's
Another group of antidepressants used in the treatment of depression in Alzheimer's disease are called tricyclic antidepressants. Examples of this drug group are desipramine (Norpramin) and nortriptyline (Pamelor).

Desipramine (Norpramin) is good for people with Alzheimer's disease and depression who have more apathetic features as the drug tends to be activating. Dosage initial is from 10 to 25 mg in the morning.to a maximum 150 mg in the morning.
Side effects of desipramine include tachycardia.

Nortriptyline (Pamelor) tends to have a more sedative effects so may be useful for people with Alzheimer's disease who are depressed but agitated and who may also suffer from sleep disturbances such as insomnia.
Dosage may initially be 10 mg at bedtime. If well tolerated dose can be increased to 10 to 40 mg per day given in two doses.

Electroconvulsive Therapy ECT
ECT may be recommended by a doctor if the person's depression is very severe. People suffering from depression and Alzheimer's disease may be exibiting life threatening behaviors such as staving themselves or refusing fluids, self injuring or they may be experiencing psychotic symptoms. Although a side effect of ECT can be memory problems this sometimes has to be weighed against the life threatening behaviors. Multidisciplinary team approach in evaluating the 'patients' needs are very helpful in making some of the more difficult decisions.

Medical Monitoring of Anti depressant Medication
It is important that some one who has Alzheimer's disease with depressive features is closely monitored. The therapeutic effects need to be properly assess if the medication is beneficial and to see if they are experiencing any side effects. Sometimes medication treatments can lead to agitation or increased agitation. Medication can even trigger a psychotic reaction.

The effectiveness of medications for depression do vary from person to person. Just because one medications shows little if any benefit does not mean that another anti depressant will not work. The doctor will rely on the feedback from caregivers as well as from the 'patient' when they assessing medication effectiveness.

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