Apathy Apathy Apathy is one of the most frustrating symptoms for families because from the outside it can look like the person with HD has simply stopped trying, says Bang. In Huntington’s, though, it is part of how the disease advances, and it tends to worsen as the disease progresses. There is no medication to treat apathy, though it may help to treat coexisting mood issues such as depression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bfb81c8d-4922-4b82-aff1-3c13fb32d5d4 These strategies may help:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f27ed73-2129-4b77-a8f2-92262ca55d2b Don’t accuse the person with HD of being lazy, unhelpful, or uncaring, and recognize that apathy is a symptom of a brain change. Encourage the person with HD to join you in doing activities (but don’t continue to ask if they decline). Encourage regular social contact and regular physical activity. Visual reminders (a whiteboard, a calendar, to-do lists) can help. Create a consistent routine and predictable schedule. Use cues, prompts, and alerts such as phone alerts, reminders, and watches with alarm or text messages that remind the person when to complete activities or tasks.
Irritability Irritability “Irritability is quite frequent in Huntington’s disease,” says Margolius, and it is often marked by severe frustration or abrupt outbursts. In HD, irritability can look like a short fuse, angry reactions that seem to come out of nowhere, aggression, or hostility that strains relationships at home and may even threaten work or other support systems. It can also show up early, sometimes before motor symptoms. Experts recommend trying to address any possible triggers that could be causing the irritability, especially pain and akathisia, which is restlessness and an uncontrollable need to move.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a00e8b4-357d-427b-88d8-9de608103795 Families and caregivers can sometimes make a real difference by learning the pattern around these episodes, says Bang. Pain, overstimulation, poor sleep, upsetting surprises, and other triggers can all make things worse, she says. Treatment options may include the following: SSRIs (when irritability overlaps with depression, anxiety, or obsessive symptoms) Antipsychotics (when irritability comes with aggression or psychosis) Mood stabilizers like valproate (Depakote) or carbamazepine (Tegretol)e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a00e8b4-357d-427b-88d8-9de608103795 Medication choice is often shaped by the whole symptom cluster, Bang says. Caregiver strategies may also help: Keep routines predictable. Minimize upsetting surprises. Whenever possible, de-escalate situations when the person with HD is getting angry and avoid confrontation. Redirect their attention or offer a distraction.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294c80a25b-4afe-44fd-b15e-8b1ab544c430
Huntington’s disease (HD) is an inherited brain condition that causes nerve cells in the brain to gradually break down and die, causing involuntary movements called chorea, dementia, and mood changes. For many people with Huntington’s disease , mood and personality changes — including depression, anxiety, irritability, apathy, impulsivity, and obsessionality — are among the first signs of the condition.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297f85c89c-7c8b-40c1-bdab-125d208786a0 These personality changes aren’t simply a reaction to having a progressive disease. Rather, they are believed to be caused by changes in the brain — the same degenerative process that causes chorea . Mood symptoms can take a serious toll on one’s marital, social, and economic well-being. “It can be very difficult for the individual with Huntington’s disease but also on their family members. It may be hard to understand why their loved one isn’t motivated to do the things they used to enjoy,” says Jee Bang, MD, MPH , a neurologist and the clinical director of the Johns Hopkins Huntington Disease Center of Excellence in Baltimore. While there is no easy path forward, there is still a great deal that clinicians and families can do to improve the quality of life for people with Huntington’s disease, says Dr. Bang. That includes managing mood and personality changes with medications, psychotherapy, and lifestyle strategies.
Anxiety Anxiety Anxiety is more common in people with HD than in the general population, and it tends to be more noticeable earlier in the disease course, says Dr. Margolius. It can show up as constant worry, tension, racing thoughts, poor sleep, muscle tightness, social anxiety, or repetitive fear-based thoughts, and it often overlaps with depression, irritability, or obsessive-compulsive traits.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f7f4527f-af73-4e9f-9051-6314e92bcbb0 Bang says that sleep is one of the first things she tries to optimize, because poor sleep can worsen mood symptoms, including anxiety. The same goes for exercise, says Margolius. Treatment for anxiety may include the following: SSRIs These medications can be especially helpful when anxiety overlaps with depression, which is common, says Margolius. Benzodiazepines Benzodiazepines should be used carefully because of sedation, falls, and dependence concerns.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ebcebba1-449c-4ca9-9f38-74d659b2f473e60dc2a1-f33c-4a05-9b50-8e3e8e597629388ef4fc-df72-417f-a268-23d9c6130ae5 Benzodiazepines include: Short-acting drugs like alprazolam (Xanax) Intermediate-acting drugs like lorazepam (Ativan) Long-acting drugs like clonazepam (Klonopin), diazepam (Valium) Psychotherapy Counseling or cognitive behavioral therapy , especially earlier in the disease course, when cognitive symptoms are still mild enough for a person to use those tools in the moment, can help. Other Strategies These strategies can help with anxiety:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f7f4527f-af73-4e9f-9051-6314e92bcbb0 Minimize clutter around the house. Establish regular routines and try to stick with them. Keep requests and questions short and straightforward. Plan ahead for changes in routine.
Executive Dysfunction Executive Dysfunction Executive dysfunction is a thinking problem, but it can intensify many mood and behavior symptoms. A person with executive dysfunction may have difficulty with planning, multitasking, and decision-making, says Margolius. Sometimes it looks like forgetfulness or dementia, but it’s not the same, says Bang. “With executive dysfunction, it’s not always true memory loss. Often the information is there, but it takes longer to retrieve, organize, or act on it,” she says. There’s no medicine to help people with HD retrieve things quickly or problem solve, says Bang. Margolius agrees that no medication has been conclusively shown to improve executive dysfunction in Huntington’s. Bang recommends dealing with this by keeping things simple. If you tell the person five things they need to do before going out, they may still be processing the first one before you get through the list. “Slow down, give one step at a time, and wait for the person to catch up,” she says. Other strategies include the following: Cognitive rehabilitation may sound intimidating, but it is basically doing brain exercises with rehab specialists, says Bang. Tools like notepads, whiteboards, routines, calendars, and other cues can reduce mental load.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291b329a2b-c241-4960-9b21-37cda55fd347
The Takeaway Mood and personality changes such as depression, anxiety, irritability, and apathy are common parts of Huntington’s disease and may show up before movement symptoms. These changes are believed to be caused by the same brain disease process that affects movement and thinking, not simply by reacting emotionally to the diagnosis. Treatment often depends on the symptom pattern and may include medication, therapy, exercise, and better sleep. Avoiding triggers and following routines may help with some aspects of mood changes.
Depression Depression While uncontrolled movement and mood issues may seem unrelated, experts believe that the same processes that affect movement damage the brain circuits that help regulate motivation, reward, emotion, and drive. e60dc2a1-f33c-4a05-9b50-8e3e8e597629f32066e8-b939-40c7-86a2-677abfe63519 But there is another piece to depression in Huntington’s disease; it’s also a response to the reality of living with a neurological condition that will continue to get worse and has no cure, says Bang. That could look different for different people, she says. “It’s important to understand that depression doesn’t always come with crying or obvious sadness. Decreasing motivation, low energy, appetite changes, and sleep problems can all be part of depression. This can be hard to tease apart from other parts of the disease, especially apathy,” says Bang. One positive is that treating depression in Huntington’s doesn’t have the workarounds that many people expect, and many of the medications that are used for depression in the general population can be used for people with Huntington’s as well, says Bang. Treatment options may include the following medications.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d7d7383c-f114-42c8-bcd4-b335de1af634 Selective Serotonin Reuptake Inhibitors (SSRIs) fluoxetine (Prozac) sertraline (Zoloft) escitalopram (Lexapro) citalopram (Celexa) paroxetine (Paxil) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) venlafaxine (Effexor) duloxetine (Cymbalta) desvenlafaxine (Pristiq) Other Antidepressants bupropion (Wellbutrin XL, Aplenzin, Forfivo XL) mirtazapine (Remeron) Antipsychotics olanzapine (Zyprexa) aripiprazole (Abilify) cariprazine (Vraylar) clozapine (Clozaril) Medication choice is often guided by the full symptom picture, not depression alone. “It’s common for someone to have multiple mood conditions,” Bang says, such as depression plus irritability, insomnia, or obsessive thoughts. Sometimes a drug might be chosen to “harness the side effects” and help manage one of those issues — for example, if someone is depressed and has insomnia , an antidepressant that causes drowsiness might be prescribed, Bang says. Counseling or psychotherapy, especially earlier in the disease, when a person can still use those skills day-to-day, may be helpful.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d7d7383c-f114-42c8-bcd4-b335de1af634 People with Huntington’s disease are at a significantly elevated risk of suicide attempts or death by suicide versus the general population, says Adam Margolius, MD , a movement disorder neurologist at Cleveland Clinic in Ohio. Depression and impulsivity are risk factors for thoughts of suicide and suicide attempts, which is another important reason to address and treat depression, he says. e60dc2a1-f33c-4a05-9b50-8e3e8e59762978e180e3-579c-47c2-8ccd-3ec0319e45a5 It’s recommended that people with Huntington’s disease be asked about depression at every doctor’s visit and have a screening for suicidal thoughts or behavior.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dae0372d-3cec-49d8-8873-68fe6cb2aad5