LD Network

Learning Disability and Depression

Depression is a condition that affects the mood, such that a person constantly feels sad and loses interest in every activity. It is more prevalent in people with intellectual difficulties and autism than in the general population. However, it is not easily noticed in people with communication and social challenges even though people with autism and intellectual dysfunction are more prone to it than the general population. This is because of their lack of communication skills or unusual expressions of depression.

Table of Contents

Speaking of the general population, many people will go through depressive states at one point in their lives. Their depressive state may be caused by life’s circumstances like sickness, death, stress, or traumatic event. In some cases, there are no evident causes of depression. Some people do not get naturally relieved from their depressive states within an expected period. Such people would need the services of a medical expert.

Depression might not be recognised as sickness on its own in individuals with intellectual disabilities. Most times, it is seen as an effect of the intellectual disorder. This condition is known as diagnostic overshadowing. Some individuals with learning difficulties may not have their depressive symptoms recognised, while others might be wrongly diagnosed.

For instance, an individual with Down’s syndrome who has a light case of depression may be wrongly diagnosed with early-stage dementia because dementia is prevalent among people with Down’s syndrome. Depression traits can be linked with underground physical health illnesses like hypothyroidism. As a result, health professionals should explore physical health.

Difficulties In Depression Communication

People who have difficulty in communicating find it hard to explain the alterations in their moods. The problem also affects the people around them because of how hard it would be to discover their mood changes. Depression is not always correctly recognised in people that cannot communicate effectively. Especially people that cannot verbally relay their low moods or are incapable of relaying their feelings nonverbally.

There are means of assisting people who cannot recognise their depressive states. This assistance is also needed for people who are wholly or partially incapable of communicating how they feel through verbal communication. These support procedures help the individuals to understand their strengths and weaknesses in terms of communication. However, these procedures are often trial and error until the best method is discovered for the individual concerned.

Aids For Communication Difficulties

Diagnosis of communication difficulties is performed by speech and language specialists. They also give suggestions that would aid the person in communicating their depressive states. When the therapist discovers the kind of support the individual needs, they can provide the following tips:

  • Picture Exchange Communication, also known as PEC.
  • Sign language like British Sign Language and Makaton.
  • Personal pictures.
  • Social articles and other scenario recommended books. Books like “Sonia’s Feeling Sad” “Ron’s feeling Blue” helps with coming out of depression. Books like “I Can Get Through It” helps to understand an underlying condition and the treatment process. “Feeling Cross and Sorting It Out” are for people who are consumed by their feelings or unsure how to respond to annoyances.

Assistive technology is also valuable in aiding communication difficulties. With improvements in technology, individuals with intellectual dysfunctions can use iPads or other smart devices. These devices have software that helps them to communicate appropriately. Some of these softwares have pictures that enable them to disseminate information to people around them. They can also create sentences that would be spoken aloud on the device.

This method of communication is more convenient and practical. Besides, they can save all the pictures on one device. Some software on iPads has social stories in them. Some of these softwares allow people to create stories as well. Some software includes Visual Schedules and Fun Routines, BWStoryApp, and Social Stories.

These intelligent devices have multipurpose functions aside from reading and creating stories. They can use them for phone calls and video chats to help with interaction with family and friends that are far away and to avoid social solitude. The use of intelligent devices helps the individual with the intellectual condition and the caregivers. With time, they will adequately understand their situation and know how to help them better.

Signs and Symptoms of Depression In People With Intellectual Disability

There are several signs and symptoms linked with depression. Also, their manifestation differs between people. Some of the signs and symptoms are:

  • Anxiety
  • Suicidal thoughts/ actions/ imagination
  • Self-hurt
  • Insomnia
  • Weight loss or weight gain
  • Low moods
  • Loss of self-belief
  • Decision-making incapacity
  • Inability to concentrate
  • Loss of hygiene and self-care abilities
  • Petulance
  • Social isolation
  • Imaginations about death
  • Lack of enough sleep
  • Oversleeping
  • Lack of appetite
  • Blaming oneself
  • Loss of sexual desire
  • Retarded thinking
  • Aggressiveness
  • Lack of interest in regular activities
  • Fatigue and Loss of Energy

Usually, individuals with depression do not get involved in social activities, unlike their pre-depressive states. They turn down requests to social gatherings or events they enjoyed in the past. Unlike their pre-depressive periods, they also prefer to stay away from their family members, friends, and carers. Some prevalent depression symptoms are explained below.

Anxiety

People who are depressed often experience anxiety. When they are anxious, they experience fears and worries. They also suffer from bodily irritations like sweating, palpitations, nausea, frequent urination, chest pains, and dry mouth. Sometimes, they experience anxiety attacks that make them feel like they would die.

Low Moods

Some people who have suffered terrible depressive stages often say that their depressions come as oppressive low or dark moods. Some others say they experience it like severe physical pain. In essence, it is beyond feeling moderately low.

Lack of Interest

Depression comes with the loss of enthusiasm for life. People in depressive states lose their love for hobbies and attractions. Instead of love and happiness, what they feel is trouble and apathy. This state consumes more energy than average.

Fatigue and Loss of Energy

People with intellectual disabilities often experience depression with fatigue and loss of energy. These depressive symptoms happen to people with light cases of intellectual disabilities. But for people with severe levels, they are challenging to discover. However, there is no proof to claim that people with severe intellectual dysfunctional cases do not suffer from these symptoms.

Obsessive Thoughts

Depressed individuals that have intellectual disabilities are prone to thoughts that obsess them. They also exhibit compulsive behaviours. These symptoms can be discovered during the first periods of depression. Sometimes, these thoughts and behaviours are related to previous traumatic events. If proper treatments are not administered, such people might exhibit more repetitive and dangerous characteristics that cause self-inflicted injuries. There should be checks for any traumatic histories and PTSD in cases like these.

Features Of Depression In People With Learning Disabilities

Depression in people with learning disabilities often come with different features like cognitive and somatic features. They are explained below.

Cognitive Features

Cognitive features refer to individuals’ distinctive experiences when they suffer from depression. Some of them include:

  • Inadequate concentration
  • Decision-making incapacity
  • Self-criticism
  • Lack of motivation
  • Feeling of worthlessness
  • Suicidal thoughts
  • Lack of self-confidence
  • Loss of self-esteem

People who suffer from extreme cases of depression usually have sluggish thinking. The sluggishness also affects their speech and body movements. These conditions can cause psychomotor retardation and psychomotor agitation. Psychomotor agitation makes them incapable of sitting and relaxing. It also makes them fidget continuously.

Some people with severe cases of depression also suffer from depressive delusions. These delusions are extreme thoughts that occur with hallucinations. At this point, such individuals are suffering from psychotic depression.

Sometimes, depression comes as a loss of skills caused by a slow down of the brain and physical bodily movements. People in this condition need to relearn self-care skills like bladder and bowel control and wearing clothes after being treated.

It is complex to differentiate cognitive features associated with intellectual disability from depression. Therefore, one needs to be aware of the pre-depressive states of these people to decipher the depressive symptoms fully.

Somatic Features

Somatic features happen in depressed people as lack of appetite, lack of sexual desire, weight loss, a feeling of obstipation, etc. In extreme cases, there is a need for emotional and antidepressant therapy. People who suffer from somatic depressional features experience the worst moods in the mornings. But as the day goes on, their moods get better. This condition is called diurnal mood variation.

People in the worst states experience sleep disorders like waking early in the morning, sleeping excessively, difficulty dozing off, and short sleep periods. Sleep disorders are visible in those suffering from depression at cognitive stages. The people who notice them more are family, friends, or carers.

Aetiological Factors of Depression

Several factors cause depression. Some of them include:

  • Biological factors like physical sickness and genetics.
  • Psychological factors like death loss and abuse.
  • Social factors like boredom, relationship issues, poverty, solitude.
  • Autism

Unfortunate Circumstances

Several unfortunate circumstances happen to people with intellectual disabilities. Most of these functions worsen their dysfunctional states. Some of them include:

  • A person may not have the same carers throughout the treatment period, so the new carers may not know how well the person is improving.
  • Some people do not identify their symptoms, so they would not know that they need to see a doctor.
  • Some people do not receive timely treatment reviews because of repeat prescriptions by the supporters or insensitivity by the health expert.
  • People who eventually see the doctor may not know how to communicate their conditions, and the people around them may not understand what is going on.
  • The person suffering from intellectual disabilities may not be exposed to proper healthcare.
  • It may not be easy to live with people who suffer from depression, so people around them may not know how best to help them.
  • Some people may not know the reason for seeing a doctor, so they may not answer adequately or behave appropriately.
  • Some people suffer from diagnostic overshadowing. In this case, the healthcare expert might misdiagnose the depressed person and relate the symptoms to their intellectual dysfunction instead of depression. An example is social isolation.

Treatment

The treatments for depression administered to people with intellectual disabilities is the same for the general population. Every treatment must follow due medical process for effectiveness. The first step to treatments for depression is diagnosis.

Differential Diagnosis

Differential diagnosis is a situation where a medical expert distinguishes between two or more illnesses that might be the causes of an individual’s depressive symptoms. Some of these causes include:

  • Physical ailments like viral disease or hypothyroidism.
  •  
  • Mood swings caused by the patient’s menstrual cycle.

Depression can be easily mistaken for other types of illnesses. This mixup happens when the symptoms are associated with behaviour. Some health disorders can also cause depression. That is why it is essential to perform a complete and thorough examination if the diagnosis is unclear. Proper inspections are also needed if there are conditions like endocrine irregularities, body disabilities, epilepsy, dental illnesses, etc.

Medications

The most common types of medication are antidepressants. Some antidepressants include:

  • Monoamine oxidase inhibitors which are also known as MAOIs. An example is Phenelzine.
  • Noradrenergic and Specific Serotonergic Antidepressants, also known as NaSSAs. An example is Mirtazapine.
  • Serotonin/ Noradrenaline Reuptake Inhibitors, commonly known as SNRIs. An example is Venlafaxine.
  • Tricyclic Antidepressants, also known as TCAs. An example is Lofepramine.
  • Selective Serotonin Reuptake Inhibitors, commonly known as SSRIs. An example is Sertraline.
  • Selective Noradrenaline Reuptake Inhibitors, also known as NARIs. An example is Reboxetine.

Social support

Support from family members, friends, carers, and medical professionals are vital. The patients need a simple and unambiguous explanation about their condition. It helps them cooperate. Also, community nurses can be very instrumental in the support process.

There is a need for regular physical activity at home or anywhere. It helps to reduce fatigue and disinterest. They should maintain daily routines and always keep in touch with family and friends. When they are encouraged to partake in activities they previously enjoyed, they tend to have high self-esteem. Also, they should always be encouraged to eat and maintain their weight, which helps restore their appetite.

Their careers should endure to watch out for the following areas:

  • The age effects on the level of depression, duration, and response to treatment.
  • The possibility of healing.
  • The probability of relapse.
  • The amount of care

In essence, treatments for depression in people with intellectual disabilities should be carried out using a person-centred technique. Treatments must be done based on the needs of every patient. Before any treatment is administered, there should be checks for psychological, social, biological, and relational factors.

When a depressed patient does not respond to treatment, a different cause has not been discovered. Some reasons include adverse childhood experiences (ACE’s) or other tragic events.

While some people may need antidepressants, others may not respond positively. Therapies are also very instrumental. They could be one on one or in a group. The patient might be required to read helpful wordless, engaging articles together. This kind of procedure can aid the therapist to relate to the mental condition of the patient and help them out of their state.