Agitation and Depression in Patients with Brain Disease

By: Madeline Roberts Vann, MPH

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.


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