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In people with dementia and symptoms of depression, some nondrug interventions were as good as, or better than, drug interventions for reducing symptoms

Watt JA, Goodarzi Z, Veroniki AA, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. BMJ. 2021 Mar 24;372:n532.

Review question

In people with dementia who also have symptoms of depression, what types of treatments reduce depression symptoms?

Background

Depression is a common symptom of dementia. It can reduce your quality of life and your ability to do everyday things. People with dementia and depression may have less interest in eating or have low energy. They may be sad or irritable, and they may feel isolated.

Interventions may reduce depression symptoms and improve quality of life. This review looks at how well drugs and nondrug interventions work for reducing depression symptoms in people with dementia.

How the review was done

The researchers did a systematic review of studies available up to October 2020. They found and analyzed 213 randomized controlled trials that included 25,177 people. The average age of people in most studies was 75 years or older.

The key features of the studies were as follows:

• all people had dementia and symptoms of depression but had not been diagnosed with major depressive disorder;
• 14 drug and 26 nondrug interventions were evaluated on their own or in combinations;
• most interventions were compared with usual care (access to routine health care and some supports in the home for activities of daily living such as bathing) or placebo; some were compared with another intervention); and
• most people were treated for 20 weeks or less.

What the researchers found

Seven mainly nondrug interventions reduced depression symptoms more than usual care. These interventions are briefly described in the Table and included

• cognitive stimulation alone;
• cognitive stimulation plus a cholinesterase inhibitor drug;
• cognitive stimulation plus exercise and social interaction;
• massage and touch therapy;
• occupational therapy;
• multidisciplinary care; and
• reminiscence therapy.

Cognitive stimulation plus a cholinesterase inhibitor drug, cognitive stimulation plus exercise and social interaction, and massage and touch therapy also reduced depression symptoms more than some drugs. Other nondrug and drug interventions didn’t differ from one another.

We cannot tell from these studies whether these interventions work as well for people with dementia and severe symptoms of depression.

Conclusion

In people with dementia and symptoms of depression, some nondrug interventions reduce depression symptoms more than usual care. Nondrug interventions were as good as, or better than, drugs.

Brief descriptions of nondrug interventions that reduce depression symptoms in people with dementia