Depression

Depression is a relatively common problem in HD, although by no means all patients are affected. Its recognition is important because its effects can be profound, yet it can be effectively treated resulting in dramatic improvements in patients’ well-being and ability to function efficiently. The loss of drive and initiative, which is an integral part of the mental changes that occur in HD, does not necessarily indicate a depressed mood. Nevertheless, the possibility that it represents a symptom of depression should always be considered, particularly if the change in patients’ level of motivation and interest has occurred relatively rapidly. Do not hesitate to seek medical advice if depression is suspected.

Irritability and Aggression

Although some HD sufferers may be even-tempered through the disease course, it is not uncommon for sufferers to become emotionally volatile. They may ‘flare up’ for no apparent reason, or over trivial issues. Patients may experience a feeling of internal agitation and be aware that they are easily ‘worked up’ yet the sudden surge of anger often comes without warning and is outside the patients’ control. In these circumstances it is best to avoid confrontation, which will tend only to add fuel to the fire. If necessary leave the room, particularly if there is a threat of physical aggression. There is no fool-proof solution to prevent emotional outbursts. However, it is worthwhile considering whether there are specific precipitating factors which can be avoided. Experience may suggest a range of everyday situations which ‘work up’ the patient. These might appear quite trivial - for example, someone switching over television channels while the patient is watching a programme. Some patients may become irritable whenever they do not get their own way or their own views are opposed.

Remember that patients, by virtue of the changes that take place in their thinking, may have difficulty seeing another’s point of view. Continually arguing a point is unlikely to convince the patient - it is more likely to increase his/her emotional agitation.

Another point is worth reiterating: HD patients find it more difficult than other people to do two things at once. Overloading what the patient can cope with at any one time may provoke in the patient feelings of agitation and potential loss of temper. Avoid whenever possible placing multiple simultaneous demands on the patient. One thing at a time is best. Symptoms of irritability and aggression, like depression, can be treated medically. If you are concerned do consult your doctor for advice.