A diagnosis of DLB or PDD might make anyone depressed. It may also depress the spouse and family, although that is a topic for a later chapter. There are several reasons for depression in those with DLB or PDD. First, it may be a reaction to the diagnosis. Second, depression may also be a response to the limitations placed on life and activities. Third, it may reflect Lewy neurodegenerative damage within brain regions that mediate affect. Further complicating this issue is the fact that signs of parkinsonism give the appearance of depression (e.g., masked face). Moreover, symptoms that psychiatrists consider to be vegetative signs of depression, such as apathy, are also common primary symptoms of parkinsonian disorders. Depression is a quality-of-life issue that needs attention and appropriate treatment. Recognizing true depression is a crucial starting point and may be difficult in the context of DLB or PDD. Parkinsonian features often make someone appear depressed when clinically they are not. The following are primary symptoms and signs of parkinsonism that may be misinterpreted as evidence of depression: • Loss of facial animation (masking) • Slow to respond (bradykinesia) • Slowed thinking (bradyphrenia) • Apathy and loss of motivation • Poor appetite (sometimes) • Sleep disorder Moreover, declining engagement in sports, gardening, yard work, and other activities, may simply be due to the challenges of parkinsonism rather than to depression. Occasionally, people with DLB or PDD develop pseudobulbar affect, which is characterized by a markedly reduced threshold for crying (or laughing) in response to emotional stimuli. For example, mildly emotional stimuli easily provoke tears, such as a religious hymn or ritual. Similarly, scenes in a movie that might bring a tear to the eye of most people provoke uncontrollable crying. People with this condition report incongruity between what they are feeling and the emotional display. Pseudobulbar affect is important to recognize, as this is a component of the neurologic disorder and is not true depression. Although pseudobulbar affect is not true depression, it may respond to a low dose of certain antidepressants: tricyclics (e.g., nortriptyline, amitriptyline) or an SSRI (e.g., fluoxetine, sertraline); see the discussion below of antidepressant drugs.
Keywords: Elavil (amitriptyline), Norpramin (desipramine), Prozac class of medications (SSRIs), Sinequan (doxepin), desipramine (Norpramine), doxepin (Sinequan), norepinephrine (neurotransmitter), nortriptyline (Pamelor), prolonged QT syndrome, tricyclic antidepressants
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