Are Anxiety and Depression Related?

One of the most challenging symptoms of Alzheimer's disease to witness and alleviate is anxiety.
Anxiety is so common in Alzheimer's disease and dementia and is often an indicator that the person is "suffering" at some level. Dealing with anxiety is very complex as there are countless things that could be contributing to the anxiety. One thing is for certain, and that is we need to stand up and pay attention when anxiety is present because there is a reason for it.

One of my "pet peeves" in the dementia world is when medications that commonly have significant side effects are used to "dull" or attempt to alleviate the anxiety. While the goal to alleviate the anxiety, is a noble one, the way we go about it is so important in order that we enhance  quality of life and minimize adverse effects.

Whenever anxiety is present, it is vital that all psychosocial, environmental and underlying physical causes of anxiousness are ruled out.  This means that the environment needs to be calm, the person who is anxious is physically comfortable, the expectations being placed on the person are realistic, frustrations are minimized, and that the person has had a chance to burn off excess energy.

It is important to note that a very high percentage of people with dementia and anxiety also meet the criteria for a diagnosis of depression. Why is this important? This is important because we have a lot more success managing the anxiety when it's recognized as part of an underlying issue such as depression. Secondly, when we treat the depression the chances of improving quality of life and alleviating suffering is possible. When we just treat the anxiety with traditional medications, like benzodiazepines, such as Ativan, we often end up with significant side effects and a whole spectrum of other issues. James Clyde Sellman Ph.D,  provides a helpful overview about this in the article, Alzheimer's Disease and Anxiety.

In summary,  if the person is anxious and there is a chance that they are also depressed, I would focus on the depression and manage it with one of the newer antidepressants that have minimal side effects and a good chance of improving quality of life. I would love to hear your stories and experiences with anxiety and depression....