Tuesday 7 October 2008

Low mood

I've a lady with Alzheimer's disease, let's call her Gladys.

She's living on her own but has frequent support from family who live nearby (very near, it's about 2 to 3 minutes walk from their house to hers) so has folk around her much of the time.

Still, they have their own lives so are busy and aren't with Gladys all the time.

Much of the time Gladys is low in mood. She's down, feeling miserable and glum. She doesn't cry, but feels as if she could. She doesn't see much of a future for herself, with nothing to look forward to. She eats what family cook or bring, but doesn't enjoy food, has no interest in it and no appetite. She has no guilt, no initial insomnia, no early morning wakening, no broken sleep, no significant weight loss, no diurnal variation in mood. She's never self harmed and has never had suicidal thoughts or feelings or impulses.

Gladys has tried different antidepressants. She's tried them at the maximum doses, so she's tried them at a therapeutic dose. She's tried them for a minimum of 6 weeks, so she's tried them for a therapeutic duration. She's no better on them. She has no evidence of a chemical mood disorder (endogenous depression) so it's no surprise that fiddling with the chemistry (i.e. taking tablets) has made no difference.

Still, it's hardly a cheery scenario. Alzheimer's disease damages your mood before it damages memory (with changes in the limbic system being the first changes in Alzheimer's disease) so she's structural changes in her brain that mean her mood's likely to be different. Changing or low mood is likely, then.

She sees herself becoming a burden to her family (they already invest huge amounts of time caring for her rather than just being with her), they won't entertain social services home care since they believe they can do it better and are happy to do so.
Gladys is miserable because she has a terminal condition that's getting worse by the month, robbing her of her memory and speech and personality then will kill her.
Unlike cancer, there's no hope of surgery, no hope of chemotherapy, it's destined to march on and take its toll.

She's low in mood because she should be.

Not an easy scenario to manage.


David said...

Moving post. I utterly hear where you're coming from. D

Milk and Two Sugars said...

Oh, such a sad situation; though I wonder how much better it might be if family could focus on enjoying their time with mum, rather than on caring for her? And with no magic pill to make things better it's hard sometimes for doctors to watch their patients deteriorate so.

Pem said...

My husband, in the very early stages of Lewy Body Dementia, is committed to the idea of ending his life some years from now when it gets worse, so as not to have to live through the later stages. He can't imagine having any quality of life if he is not longer himself.

As I read more about dementias, I am slowing coming to understand that letting go of control is the spiritual lesson for us to learn as we approach death. Perhaps even more important is that we still have value and still can enjoy the small blessings of this life when we are no longer contributing members of society and even when we are no longer ourselves.

The Girl said...

Thank-you for your post.
Dementia is such a sad illness. What kind of proportion of your work is made up of patients with dementia and related conditions? What can you do for them if (as in this case) medications won't help?