- Obsessive Compulsive Behavior
Depression Symptoms: Depression is one of the most common symptoms of Huntington's, often preceding motor symptoms. At the time of a single interview, more than 50% of Huntington's patients surveyed in a large study reported ongoing depression [Paulsen JS 2005]. Lifetime incidence of depression in HD approaches 100%. More on depression in HD
There are two reasons for depression in Huntington's. The first is reactional, or related to the sadness of this diagnosis; the second is organic, or related to disordered brain chemicals directly caused by the disease.
There are many different symptoms of depression that vary greatly from person to person. Depression is a persistently sad mood that interferes with the activities of daily life. It decreases the ability to concentrate or work. It can cause either insomnia or over-sleeping. Appetite can be excessive or lost. There are persistent feelings of helplessness, hopelessness and guilt. Anxiety is often a part of depression. With severe depression there are often thoughts of suicide.
Depression Treatments: Antidepressant drugs can be split into classes: serotonin reuptake inhibitors (SSRIs) with Prozac® as an example, serotonin-norepinephrine uptake inhibitors (NSRIs) with Effexor® as an example, atypicals with BuSpar® and Remeron® as examples, and tricyclics with Elavil® as an example. Remember that no matter what antidepressant drug is used, it takes at least two weeks for first hints of benefit, and at least four weeks before full benefit is felt. Increasing dosage of any antidepressant can often give increased benefit but may also increase side effects. Note that many of these drugs also treat anxiety. When depression is not controlled at the highest dose of SSRI drug, adding another type of antidepressant like mirtazapine (Remeron®) may be helpful. [Blier P 2010] (See Antidepressant Fact Page for more information on these drugs).
Starting and Stopping: It is often best to start with a lower dosage and increase as needed over several weeks. Anxiety can occassionaly occur during first days of SSRI use, but decreases after the drug has been used a week or so. Remember that beneficial effects take weeks of time. Never stop an antidepressant abruptly. Though it is more important for certain of these drugs, it is always best to taper off an antidepressant over several weeks. This is often necessary even if you are starting a new one at the same time.
Paulsen JS, Nehl C, Hoth KF, Kanz JE, Benjamin M, Conybeare R, McDowell B, Turner B. Depression and stages of Huntington's disease. J Neuropsychiatry Clin Neurosci. 2005 Fall;17(4):496-502. PubMed abstract
Blier P, Ward HE, Tremblay P, Laberge L, Hébert C, Bergeron R. Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010 Mar;167(3):281-8. doi: 10.1176/appi.ajp.2009.09020186. Epub 2009 Dec 15. PubMed abstract