Ch.16. Depression and Lewy Body.
It’s February, 2019 in Wisconsin as I write this piece. There’s at least a foot of snow on the ground everywhere you look. It’s about 10 degrees above zero Fahrenheit, which is an improvement from -30 degrees last week. This is prime time for Seasonal Affective Disorder (S.A.D.), a depression that either only shows up in winter or, as in Pat’s case, adds to an already present depressive state. Pat’s been treated for depressive symptoms for many years, well before she was diagnosed with Lewy Body.
It’s natural to wonder how depression relates to Lewy Body. Does one predict the other? Does depression cause Lewy Body? Does depression increase Lewy Body symptoms? I did find one research study (published in the American Journal of Geriatric Psychiatry) that suggested a history of depression is a risk factor for the development of Lewy Body. The authors suggested two possibilities: either the depression is simply a noncausal early predictor of Lewy Body or depression itself might somehow be a causative agent in the development of Lewy Body. In other words, if you suffer from depression you may be at higher risk to develop Lewy Body later in life but the connection between the two is unclear.
Let me note that anti-depressant medications are not prescribed to treat Lewy Body. Nor are antidepressants prohibited for people with LB, as they apparently do not cause ill effects.
Some Lewy Body symptoms also occur in major depressive disorders, including hallucinations, memory problems, lack of energy, sleep problems, and inability to begin or complete tasks.
Let me return to our immediate situation. My observation is that Pat’s behaviors, emotions and thoughts have become more negative this winter. First, she is initiating and completing fewer activities than she did last autumn. Secondly, she expresses more negative emotions such as irritability, guilt, and fear, especially in the morning (perhaps partly because of her sleep difficulties). Thirdly, I believe her thinking includes more frequent episodes of doubt, suspiciousness, hopelessness, and despair. The diagnosis of Seasonal Affective Disorder explains these symptoms but so does Lewy Body. I would be surprised if even our neurologist could distinguish one from the other at this point.
I’m rooting for S.A.D. Why? Because spring is coming soon. Pat usually perks up with more sunshine and warmth. If these troublesome behaviors, emotions and thoughts are caused by S.A.D., then they will soon begin lifting and I’ll have a happier wife beside me. My fear is that these “winter” symptoms will last through the summer, either because they are indicators of worsening LB or because although they were caused by S.A.D. they won’t resolve as usual.
A care partner’s note: I do believe that depression is also a major risk factor for caregivers. We should be careful to eat well, exercise moderately, sleep as well as possible (I’ve talked with several caregivers who’ve had to move to separate beds from their partners to sleep better), and stay connected with positive friends and family members.
I’m by no means immune to depression myself. However, over the years I’ve learned that I don’t have to become depressed just because my wife is depressed. I try to stay positive without insisting that Pat cheer up. I’m certain it will not be helpful to Pat if I were to match her sad feelings with mine. Sometimes it’s better not to have too much empathy.
Pat’s comments on depression:
I don’t know whether depression and Lewy Body are the same yet. What I wonder is when I think about the years of my life I’m likely to lose if that isn’t a reason for depression? I don’t know how many years I’ll lose. I’m not convinced I’ll lose any. Still on the whole I don’t feel as depressed as I used to so perhaps these are different things. I know the prediction is that people with Lewy Body will lose years of their lives but I haven’t identified myself doing that yet.
When I’m going through a lot of hallucinations, that gives me more of a feeling of depression, but that doesn’t always happen every time I hallucinate. I actually don’t think I’ve hallucinated a whole lot recently.
One of my biggest frustrations is having all of my family stuff (pictures) around and not being able to put them in places that make sense. I get into an end of the road thing – I don’t know what to do or when and that is depressing. I’ve got a lot of pictures to sort and I’m not sure how to start them.
Added Note: January 2020. Pat.
I’m not feeling so depressed this winter. We have many friends and each has their way of looking at life but on the whole they’re doing better this year than last.