Nondrug therapies outperformed drugs for depression symptoms in dementia, review finds
Massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction were more efficacious for symptoms of depression in people with dementia and without a diagnosis of a major depressive disorder.
Nondrug therapies such as exercise are as effective as and may be more effective than drugs for reducing symptoms of depression in people with dementia, according to a systematic review and meta-analysis.
Researchers analyzed the results of existing trials to compare the effectiveness of drug and nondrug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia. Results were published by The BMJ on March 24.
Two hundred fifty-six studies involving 28,483 people with dementia, with or without a diagnosed major depressive disorder, were included. Drug approaches alone were no more effective than usual care, but several interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference, −2.93; 95% credible interval [CrI], −4.35 to −1.52), cognitive stimulation combined with a cholinesterase inhibitor (mean different, −11.39; 95% CrI, −18.38 to −3.93), massage and touch therapy (mean difference, −9.03; 95% CrI, −12.28 to −5.88), multidisciplinary care (mean difference, −1.98; 95% CrI, −3.80 to −0.16), occupational therapy (mean difference, −2.59; 95% CrI, −4.70 to −0.40), exercise combined with social interaction and cognitive stimulation (mean difference, −12.37; 95% CrI, −19.01 to −5.36), and reminiscence therapy (mean difference, −2.30; 95% CrI, −3.68 to −0.93).
When compared to some drug interventions, massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction were more efficacious. The other nondrug interventions did not show a statistically significant difference for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder.
The authors noted that they could not consider severity of depression symptoms or effects on different types of dementia, as well as potential costs or harms of implementing drug and nondrug interventions. Still, physicians should consider more “social” prescribing of nondrug approaches by linking patients with nondrug interventions in their community to treat symptoms of depression and loneliness, the authors noted.
“Our finding that non-drug and multidisciplinary care approaches alleviate symptoms of depression in people with dementia builds on our recent finding that these approaches also reduce symptoms of aggression and agitation in people with dementia,” they wrote. “However, cost effectiveness, scalability, and sustainability of efficacious non-drug and multidisciplinary interventions for reducing neuropsychiatric symptoms in people with dementia remain unclear and might vary by intervention.”