Dr. Keith: Treat All Dementia as Depression First
Right now, I believe a million or more Americans who have been diagnosed with dementia (including Alzheimer’s dementia), which is debilitating and incurable, are actually suffering with major depression - and that is completely curable in more than 90 percent of cases. This massive misdiagnosis of Americans has dire effects on families, well-being and productivity.
The symptoms of major depression can perfectly mimic those of dementia. Either condition can be marked by memory loss, profound changes in energy, difficulty concentrating and difficulty making decisions. What’s more, either condition can cause changes in motor function, leading to stumbling. Either condition can even lead to older adults wandering and getting lost. And either condition can lead to irritability, violent behavior or fixed and false beliefs (for example, being robbed or lied to).
Because major depression can so perfectly mimic dementia, I believe that every individual diagnosed with dementia should be treated for major depression, just in case that condition is actually to blame. That may seem like a very bold therapeutic strategy, but there simply is no way to know for sure what percentage of the millions of Americans diagnosed with dementia might have actually been misdiagnosed and might well be completely curable.
Only a brain biopsy after death can prove that dementia was to blame for a person’s cognitive decline.
I would certainly do this for my mother or father if either was diagnosed with dementia (which, thank God, is not the case), so I see no reason not to recommend it to others.
Treating major depression in those diagnosed with depression might include beginning with a low dose of an antidepressant medication with a favorable side-effect profile (such as sertraline or paroxetine), increasing the dose if no effect is obtained (while monitoring for side effects), then adding repetitive transcranial magnetic stimulation (rTMS).
rTMS is a relatively new technology, with no known serious side effects, that rivals or exceeds the antidepressant effects of medication in many patients. The treatment delivers magnetic waves to a particular area of the brain thought to be underactive in depressed individuals. rTMS, combined with an antidepressant, would be a robust treatment strategy for older Americans diagnosed (or misdiagnosed) with dementia.
The idea of “empirically” (without clear evidence) treating dementia as depression would be no different than empirically treating lung cancer with antibiotics were it impossible to know with absolute certainty whether pneumonia might be the real diagnosis. Wouldn’t it make sense to try to cure the patient?
To sum it all up, here’s this psychiatrist’s prescription: If your loved one is diagnosed with dementia, instruct the geriatrician or internist or family physician or neurologist to enlist the aid of a psychiatrist in treating your loved one for major depression. Insist on the use of an antidepressant (one with a side effect profile that is appropriate, given the other clinical facts) and insist on using rTMS at the same time. You might just save your loved one a decade or more of suffering.
Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at email@example.com. His team of Life Coaches can be reached at firstname.lastname@example.org.