The Cochrane Review paper suggests that talk therapy is an effective treatment for alleviating depression in people with dementia.
For patients with dementia and mild cognitive impairment, symptoms of anxiety and depression are prevalent, with there currently being no optimal treatment to reduce their burden due to conventional medications either not being effective or causing side effects to dementia patients.
This novel review is the first evaluation of the efficacy of psychological interventions, such as talk therapy, in remedying depression in people, finding that they are beneficial and enhance other aspects of a patient’s quality of life and everyday function.
The research team, which includes experts from UCL, University of Nottingham, Universidad de Jaén, and Salford Royal NHS Foundation Trust, are calling for dementia clinical guidelines to be updated to recommend talk therapy and, specifically, Cognitive Behavioural Therapy (CBT).
Dr Vasiliki Orgeta, the lead author of the paper and an Associate Professor at UCL Psychiatry, commented: “We currently have no standard treatments for depression for people with dementia, as antidepressants do not work for them. Yet, despite the lack of supporting evidence, they are still prescribed for many people living with dementia, which is an important problem given that more and more evidence is accumulating suggesting that not only they do not improve symptoms, but they may increase the risk of mortality.”
“Previous evidence into the clinical effectiveness of psychological treatments has been limited. Reporting on the most up to date evidence, we found that these treatments, and specifically those focusing around supporting people with dementia to use strategies to reduce distress and improve well-being, are effective in reducing symptoms of depression.”
The link between dementia and depression
Research suggests that dementia patients are twice as likely to be diagnosed with a major depressive disorder as other people their age, with estimates that 16% of people with dementia experience depression, although this could be as high as 40%. Effective treatments are essential, as depression and anxiety can exacerbate the neurological impairment, which decreases the patient’s independence and increases their chances of requiring long-term care.
Dr Orgeta said: “Our findings break the stigma that psychological treatments are not worthwhile for people living with cognitive impairment and dementia, and show that we need to invest in more research in this area and work towards increasing access to psychological services for people with dementia across the globe. We want people who experience cognitive impairment and dementia to have the same access to mental health treatments as everyone else.”
How does talk therapy treat dementia?
The team’s paper employed evidence from 29 talk therapy trials involving people with dementia or mild cognitive impairment, including nearly 2,600 study participants. Various types of talk therapy were included, including CBT and supportive and counselling interventions, but were predominantly aimed at supporting well-being, reducing distress, and improving coping.
The results signified that talk therapy improved depressive symptoms and enhanced quality of life and daily activities. More research is required, but the findings infer that these treatments can also improve depression remission. The researchers explained that the evidence used in the paper had moderate quality overall, meaning it is high enough to warrant clinical recommendations for implementing talk therapy, although more studies are required as they may establish a more significant effect.
Dr Phuong Leung, a co-author of the paper from UCL Psychiatry, said: “There is now good enough quality evidence to support the use of psychological treatments for people with dementia, rather than prescribing medications, and without the risk of drug side effects. What we need now is more clinicians opting for talk therapies for their patients and commitment to funding further high-quality research in this area.”
Dr Orgeta concluded: “Pharmacological treatments in dementia have been prioritised in trials for many years; as a result, they benefit from more investment, so it will be important to invest more in studying psychological treatments. There is a need for novel treatments, specifically developed alongside people with dementia, their families, and those contributing to their care.”