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.
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.
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.
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.
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.
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