How to find counseling

MBP

Hi,
I am new to this forum. My husband has EO Alzheimers, is currently on sertraline, but is struggling more with depression as his disease is progressing. I would like to get him started with counseling and was hoping to find someone who has experience with patients with dementia. I am thinking that I would go with him and sit in the background so I could remember any tools or practices that the counselor suggests. We live in Greensboro, NC. How would you suggest I find a good counselor?

loveskitties

Not sure if "counseling" for depression will be of value to a PWD.

Does he have a neurologist? If so, bring the depression to his/her attention and request medication. If no doc, then you should get a referral from his PCP for one.

While many caregivers shy away from medications early on in the journey, you will find that the right ones at the right dosages can be given without making the patient a "zombie".

Marta

You don’t say what stage of dementia, so I’ll generalize and say that it is unlikely that a PWD will benefit from counseling, as most lack the insight to be successful with it.

Could you call PCP and increase the sertraline?

How is his depression manifested?

Behaviors you are seeing may be typical of dementia, with or without depression.

Ed1937

MBP, welcome to the forum. Sorry you have a need for it, but it's a good one. We have a lot of people who will help with support and suggestions. You just need to be active to get the most out of it.

I agree that counseling may not bring success. But you could call the alz helpline at 1-800.272.3900. Ask to speak with a caregiver counselor for suggestions with this. They may have ideas for you. There is no charge for this service, and they can often help.

Iris L.

Welcome MBP. How is his disease progressing? Was he diagnosed by a neurologist who specializes in diagnosing the dementias? Depression can overlap dementia, but major depression can also mimic dementia. Had he been in counseling in the past? Does he have a history of depression? Please post back.

Iris

harshedbuzz

Hi and welcome.

Given his EO diagnosis, he's probably no longer an appropriate candidate for talk therapy. Even without anosognosia, the skills needed to participate in therapy-- ability to learn, short term memory, ability to recognize his own mood, ability to initiate a plan and executive function-- are lost fairly early on in the disease process.

In your shoes, with a history of treatment for depression, I would add a geriatric psychiatrist to his care team. They are the experts in psychoactive medications and should be able to put together a plan to help him feel better.

HB

MBP

Thank you for all of the comments. His PCP prescribed Sertraline for anxiety/panic attacks and general depression that he has experienced for a long time. He increased the dose about a year ago as my husband was struggling more with depression. He has some history of depression and has used counseling successfully in the past. A neurologist diagnosed him a couple years ago, but we haven’t been back. He has participated in two clinical studies and we get regular cognitive test results, MRI and lumbar puncture CSF results and have tracked the disease that way. I have done a lot of research on the study drugs and approved drugs. He has two copies of APOE4 genotype and is not a good candidate for recently approved IV drugs because of a higher risk of brain bleeds. He is in a clinical drug study now, but unfortunately I think he is getting the placebo judging by the large decline in cog test scores and behavior.

What can a geriatric neurologist offer us? Would they be better able to prescribe meds?

He is somewhere between mild and middle stages. He recently failed (rather convincingly) a driving assessment and his license will be revoked. He hasn’t been driving for the last year and a half anyway due to detached retinas, but this was a big psychological blow. I am comfortable leaving him home alone for a few hours. Socially, people often don’t notice anything is wrong.

So even if I went with him to the counseling and helped him remember the things discussed, you don’t think counseling would be of any benefit?

MBP

Also, someone asked how is depression is manifested. He ruminates on a depressing future an inordinate amount of the time. I try to schedule his day every morning to try to keep him busy and engaged. I try to include some exercise, some socializing with friends, some time for his music hobby and something to do around the house that helps him feel, productive (this is getting harder). I want him to enjoy his days and feel like there is something to look forward to. It’s only going to get harder so looking for as many tools as possible to help.

Iris L.

MBP, the last things you mention, scheduling activities and socializing and getting your DH to enjoys his days, these are part of what we call Best Practices. These involve appropriate medications, a brain-healthy diet, exercise, docislization snd keeping the brain stimulated. You already knew to do these things. Keep them up!

As for medication, a geriatric psychiatrist is usually the specialist who prescribes for the complications of dementia.

As you know, Alzheimer's Disease is a progressive, terminal illness. The majority of PWDs (persons with dementia) have anosognosia, meaning they are unaware of having dementia and certainly unaware that they have a progressive terminal illness. There is no point of going to a therapist or counselor for a person with anosognosia. If they are confronted with the raw truth, they will resist and become upset. You don't want that.

For those who do not have anosognosia, they may know that they have dementia, but they may or may not be aware that it is terminal. Is the counselor going to force the PWD to accept having a terminal disease? This is not a good idea! What you can do is read a lot of threads to see what the other members are doing. If a Memory Club Support Group is available in your area, it may be useful for your DH and you. This is what I can suggest.

If your DH is depressed, use this time to make memories. For you, not for him, because he won't remember. Do your Bucket List, if you have one. Visit with the family. Go on trips while you still can. Stay in contact with the members. They are your best "counselors" because they have been where you are and they can know what they are talking about!

Iris

Ed1937

"So even if I went with him to the counseling and helped him remember the things discussed, you don’t think counseling would be of any benefit?" Even if everything was handled as it should be by the counselor, if you have to help him remember what was discussed, would he remember that? Not likely. This is one of the cases where I think the cons outweigh the pros.

upstateAnn

My husband really has benefitted from weekly therapy sessions.

Ed1937

That's great! I'm glad he can still get something out of it.