Non-drug therapies as, or more, effective than drugs for dementia patients with depression, research suggests

Around 16% of the estimated 50 million people worldwide suffering from dementia also have a diagnosis of major depressive disorder, with a further 32% experiencing symptoms of depression without a formal diagnosis. While previous research has shown non-drug approaches such as exercise to be effective in alleviating depressive symptoms in dementia patients, studies directly comparing the efficacy of such approaches with that of drug treatments are scarce.

Study design

The researchers conducted a systematic review and meta-analysis of 256 randomised controlled studies (n=28,483) comparing drug and non-drug interventions to treat symptoms of depression in people with dementia experiencing depression as a neuropsychiatric symptom of dementia or with a diagnosis of major depressive disorder.

Review findings

Findings from the primary network meta-analysis (213 studies, n=25,177) showed that the following non-drug interventions were more efficiacious than usual care (defined as appropriate access to healthcare and social care based on patient needs and preferences) for reducing symptoms of depression in patients without a diagnosis of major depressive disorder:

• cognitive stimulation
• cognitive stimulation combined with a cholinesterase inhibitor
• exercise combined with social interaction and cognitive stimulation
• massage and touch therapy
• multidisciplinary care
• occupational therapy
• reminiscence therapy

In pair-wise meta-analysis, animal therapy, exercise, and psychotherapy combined with reminiscence therapy and environmental modification were also found to be more effective than usual care for reducing symptoms of depression.

The researchers report that no drug intervention alone was more effective than usual care.

Network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder was not possible due to the clinical and methodological heterogeneity of these studies.

Evidence-based treatment

The researchers conclude that they have identified effective non-drug treatment options that clinicians can prescribe as part of an evidence-based treatment plan to reduce symptoms of depression in people with dementia, adding that their findings suggest a high probability that people with dementia will derive a clinically meaningful benefit from such interventions.