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For people with Down syndrome, family members, caregivers and professionals.

Depression in People with Down Syndrome

June 2021 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Depression is a mental health condition that is characterized by persistent feelings of sadness and/or a decreased interest in things that an individual previously enjoyed. Depression is more common in people with Down syndrome (DS) than in people without DS. In fact, depression is the mental health condition diagnosed most often at the Adult Down Syndrome Center.

Symptoms

Depression can impact our physical, mental, and social health and well-being. Symptoms of depression include:

  • Depressed or irritable mood
  • Loss of interest or pleasure in activities
  • Weight loss or gain
  • Change in sleep patterns
  • Slowing down of physical movement or restlessness
  • Fatigue
  • Feelings of worthlessness
  • Decreased concentration
  • Recurrent thoughts of death
  • Psychotic features (extreme withdrawal, hallucinatory self-talk, etc.)
  • Inappropriate fears or avoidances of people/things
  • Strong refusal to leave the home

People with Down syndrome will typically provide less self-report of guilt or low self-esteem. Instead, observable behavioral changes are more commonly reported. These may include lack of interest in activities that were previously found pleasurable, social withdrawal, and psychologically and physically slowing down. Some people with Down syndrome who talk to themselves may have a change in their self-talk.

Causes

For people with and without DS, there are three main causes of depression:

  1. Social and environmental stress
  2. Biochemistry of the brain (i.e., neurotransmitters, receptors, etc.)
  3. Physical health problems (such as hypothyroidism, sleep apnea, celiac disease, and vitamin B12 deficiency)

Assessment and Diagnosis

A diagnosis of depression is made after speaking with an individual, obtaining their medical history, and reviewing their symptoms. Mental health conditions such as depression can be challenging to diagnose in some individuals with DS who may have difficulty communicating their symptoms and the frequency and severity of their symptoms. Information shared by family members or care providers who observe and spend time with the individual with DS may be used to make a diagnosis of depression. Every thorough mental health assessment should include an assessment of physical health to ensure that physical health problems are not affecting mental well-being.

Treatment

Treatment for depression may include one or more of the following:

  • Counseling
  • Identifying and reducing stress
  • Medications
  • Establishing healthy eating, sleeping, and exercising routines
  • Encouraging participation in affirming social activities

Notes about Medications

When prescribing an antidepressant, we consider both the effects and possible side effects. There are five types of antidepressants that are prescribed to treat depression: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin modulators, and other antidepressants. Individuals with DS we see tend to have fewer side effects from SSRIs and SNRIs than from TCAs. However, while we see some similarities in responses to medications among people with DS, each individual is unique and what is effective for one person may not be effective for another. It is also important to note that it often takes several weeks to see the effect of starting an antidepressant or making a change in dose. 

Where to Find Additional Information

Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.

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