Agitation and Depression in Patients with Brain Disease

By: Madeline Roberts Vann, MPH

Depression and stress are normal among people who have illnesses that affect their brain. Understanding the possible causes of depression and stress can help ensure that the person gets the necessary medical or therapeutic care.

Depression and Brain Disease

Although everyone has times when they feel down or blue, negative feelings, thoughts and behaviors that continue for weeks and interfere with daily living are likely the result of depression. Many people respond to a difficult diagnosis with a period of sadness, grieving, anger or withdrawal before they start to cope with their new lives. Others cannot cope and become depressed. In people with dementia, depression can also spur "acting out" feelings of anger, putting additional strain on the caregiver.


Caregivers should know the signs of depression:

  1. Little or no interest in things that once brought pleasure
  2. Feeling down or hopeless
  3. Sleeping too much or not enough
  4. Feeling tired or without energy
  5. Overeating or loss of appetite
  6. Feeling bad about yourself
  7. Not being able to concentrate
  8. Thoughts of hurting or killing yourself
  9. Aggressive behavior or violent outbursts in a person who does not usually behave that way

The Brain Disease-Depression Link

Some brain diseases are more likely to lead to depression than others. A person with dementia often also experiences depression, in part because of the diagnosis and in part because depression and dementia tend to happen to the same person.

People who have left-brain strokes are more likely to experience depression than people who have right-brain strokes. Although no one fully understands why this happens, the relationship has been established.

A person who has received a terminal diagnosis of brain cancer is at risk for depression, but so is a person with a traumatic brain injury who is facing tough therapy. Whether people become depressed is a result of their vulnerabilities and coping skills as well as their environment and situation.


Triggers of Depression

When trying to understand what is affecting a person's mood and behaviors, consider recent events, their overall health, their environment and their ability to cope with their daily schedule.

Specific Triggers That Cause Depression:

  1. Requiring a person to do something they are not able to do. Examples include expecting stroke survivors to feed themselves if they have not yet relearned how to do so, and leaving people with dementia to navigate their daily schedule unassisted.
  2. Environmental stimuli — noises, colors, crowding, fast actions — can all agitate people who have an illness or condition that affects the brain. Continuous exposure to an agitating environment can cause depression and stress. However, each person's triggers will be different.
  3. Lighting is important and highly individualized. People with dementia are often frightened by shadows and mirrors, whereas overly bright or dim rooms can also be stressful for some people. Play with lighting options until you find a situation that is comfortable for the person and caregivers.
  4. Pain or an irritating infection, such as a urinary tract infection or tooth decay, can cause stress and depression if it is not treated. Many people who have a condition that affects the brain cannot speak well enough to explain what is bothering them so you may have to play detective.
  5. Poor nutrition or dehydration can contribute to stress and depression.
  6. A family history of depression or substance abuse, including alcohol abuse.
  7. Unresolved problems with family members or a history of difficult relationships with people.
  8. If a person is in a residential facility, stress is more likely if the facility has a poor patient mix, too few care providers for the size of the patient population or a lack of oversight at times when people come together in a group, such as for meals.
  9. Lack of control over choices, as appropriate to a person's physical, mental and emotional abilities.
  10. Lack of meaningful activities. Simple jobs such as folding laundry or gardening can be helpful.
  11. Exhaustion caused by lack of quality sleep
  12. Unexpected changes in schedule, surroundings or the person or people who provide care. For example, entering the hospital for a stay of any length of time can be very stressful because people are out of their familiar environment, are not doing the things they normally do and are being cared for by new people.
  13. Anger or grief over perceived or real losses.
  14. Cognitive ability: As a person's mental capacity decreases (for example, with the progression of dementia), the ability to cope with stress also decreases.
  15. Side effects or toxic reactions to medications.


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Related Articles


"Defusing Violent and Aggressive Behavior in the Long-Term Care Setting," October 1997, The Consultant Pharmacist; "Patients with Dementia in Acute Care," May/June 2004, Geriatric Nursing.


Written by Madeline Roberts Vann, MPH Reviewed by George T. Grossberg, MD

St. Louis University School of Medicine

Department of Psychiatry

Last updated August 2008