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September 03, 2006

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Paula

Mona - A very interesting post. In the past year, I've thought a lot about my mom's depression, which she suffered from her entire life. I'm not sure when my dad's started, but it certainly became noticeable after years of retirement in which they were pretty much shut away from everyone. But the fact is, in addition to depression, they both had physical problems that may have brought on the dementia. So it's a "chicken or the egg" kind of thing.

Gail Rae Hudson

This review (which is excellent, by the way) made me wonder if there are differences between people who "enjoy" their depressive episodes and those who don't. I'm not talking, here, about people who use their depression to garner attention they fear they would not otherwise receive, but those who find personal pleasure in a depressive outlook and/or use this outlook creatively and/or as a tool to sharpen their minds and expand their peculiar understanding of life. My father did this. I do this. Both of us had/have tendencies to become annoyed with people who tried/try to talk us out of (or sympathize with) our "blues", even the indigo and navy shades, thus tending to isolate ourselves when we want to muck about in our mud. My inept understanding is that creative people in many fields (not just the arts) embrace their depression, unless and until it interferes with their relationships...sometimes beyond this, though, allowing relationships to be sacrificed to their preference for the darkly askew. I've often wondered what might "happen" if mainstream U.S. culture were not so addicted to the idea of "the pursuit of [relentless] happiness". Believe me, I recognize that there is another side to this...highly creative people who are immobilzed by their depression. But, you know, this isn't a "31 flavors" culture, thus, it's hard for us to recognize that some people actually like the taste of sour over sweet. Anyway, I wonder if people with a taste for sour and who prefer to lap it up alone are more or less inclined to senile dementia and how their preference affects their experience of dementia.
My dad only lived to 68. Although he longed for dementia (I know, bizarre, but he would have liked to have blamed it for his advanced alcoholism), he never experienced it. Perhaps he would have if he'd lived longer. Then again, he also might have developed into a very crochety, unpleasantly sharp old man.
Provocative post, Mona! Thanks!

Deb Peterson

Mona--Once again, a very interesting and well-presented essay. I was also wondering if treating depression might reduce the risk of AD in later life--if possibly the "newer" anti-depressants (SSRIs) might cause some permanent realignment of brain chemicals? I'm not surprised it's as complex as you describe it. My mother has a history of depression, and was fairly open to trying "talk" therapy as well as medication. I think Gail's point is interesting and adds yet another layer to it all: how an individual's beliefs about depression affect the ramifications of the disease. If it weren't still considered (surreptitiously) a character flaw and if people felt freer to talk about it--if there was a place for it--would all that lessen its momentum? You've got us thinking...

Gevera Bert Piedmont

Very interesting. I know my dad is depressed as well as having AD--it's his depression/anti-anxiety medicine he ran out of when he flipped this weekend. Have you found any stats on suicide? I've been looking but haven't found any.
Thanks for the link, I'll give you one in return.
Bert

Mona Johnson

Bert,

I'm sorry to hear about your dad. I've not looked carefully for statistics on suicide. I have noticed one study at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed. You'll notice two things about that study:

1. It's relatively small, analzying the case histories of 28 people over age 60 who committed suicide versus 56 people who died naturally.

2. The conclusion is that Alzheimer's patients were "over-represented" in the suicide cases. At least in the abstract I can access, I don't see anything that would estimate suicide rates in Alzheimer's patients. I would think that might be a very difficult number to come by.

I've almost completed a post about depression in Alzheimer's patients, and will post it as soon as I can. I hope this information is at all helpful for you.

Here's the usual disclaimer - please remember that anything I write is my opinion only, and not a substitute for qualified medical advice! I'm really sorry you're having to deal with these difficult issues, and hope that you find the best possible care for your dad and the rest of your family!

Mona

Ellana Livermore

Thanks. I needed the information and just followed a link from Grand Rounds. Printed off part the second and the abstract about Mociobemide to take along to my mom's next appointment.

Question - should we be seeing a neurologist for AD?
We've just been going to an Internist who has a large geriatric practice.

Thanks

Mona Johnson

Ellana,

I'm glad this information was helpful for you! I can't really tell you whether you need to see a neurologist. Maybe your internist would have an opinion or a recommendation. If you decide a specialist is right for you and your mom, you might want to spend some extra time making sure the specialist has your mom's records from the internist, and vice versa. We had a very difficult time coordinating care for my father among various doctors. It would be very useful for you to have a copy of all the records yourself (you'll need your mom's written permission). It might also be helpful for you to summarize issues and medications for each doctor - in our case, they didn't always have the time to read a lot of records before each visit. For more about this part of caregiving, you may want to take a look at Gail Rae Hudson's site (http://themomandmejournals.net/index.html. She has several posts about record-keeping and acting as an advocate for her mother during doctor's appointments.

Good luck, Ellana.

Marty

Gail, that is a most interesting perspective! Here's a thought: perhaps those who "suffer" from depression (as opposed to enjoying it) also experience stress from thinking their depression wrong and from struggling to pull themselves out of it rather than riding the waves as you do. And perhaps it's the chemical result of this stress--not depression--that influences AD tendencies.

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