Dementia and Bereavement: Adverse Life Experiences Complicating Depression in Later Life

Adverse life experiences late in life, notably cognitive decline and bereavement, can precipitate depression as well as greatly complicate the recognition, course, and treatment of the depressive disorder. Cognitive decline is commonly experienced late in life, and although many adults learn to cope with this change, it may become overwhelming to an individual with depression. In patients with dementia, recognition of depression is hampered by problems patients may have reporting symptoms, and there is significant overlap of symptoms between depression and dementia. Depression is also underrecognized in individuals who have suffered a bereavement. Over time, most bereaved individuals adapt to life without their spouse, but a significant minority will experience exacerbation, onset, or persistence of depression. Clinicians can, however, be reluctant to diagnose depression in the face of such a highly disruptive life event, substituting understanding for treatment. Effective treatment of depression can also improve cognitive decline in patients with dementia and facilitate the natural grieving process in bereaved subjects. In both conditions, selective serotonin reuptake inhibitors are efficacious and well tolerated, and patients show good compliance to treatment regimens.