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Therapy for anxiety and depression in people with dementia

Dr Joshua Stott, Alzheimer’s Society Research Fellow at UCL describes cognitive behavioural therapy for anxiety and depression in people with dementia
© UCL 2016 - CC BY 4.0
This week we’ve heard about some of the ways in which dementia can affect relatives and relationships, and how people with dementia with Lewy bodies are more likely to experience symptoms which fall under the umbrella of mental health such as hallucinations. It’s important to recognise that dementia can affect aspects of mental health more generally. In this article, Dr Joshua Stott introduces the topic of depression and anxiety in people with dementia, and some of the therapies that aim to reduce these symptoms.
This article is written by Dr Joshua Stott, Alzheimer’s Society Research Fellow (Department of Clinical, Educational and Health Psychology, UCL Psychology and Language Sciences).

Depression and anxiety in people with dementia

People with dementia are more likely than those without dementia to experience anxiety and depression. For people with dementia, anxiety and depression are distressing and associated with earlier mortality, increased institutionalisation and greater carer burden. It also seems that antidepressant medication may not be very effective in relieving depression in people with dementia (Banerjee et al., 2011). Partly because of this, there has been increased interest in developing psychological therapies to help reduce depression and anxiety and improve quality of life in those with dementia.

Psychological therapies for depression and anxiety

In adults without dementia, psychological therapies are effective in reducing anxiety and depression and initiatives aimed at improving access to such therapies have been rolled out nationally. Cognitive behavioural therapy or CBT is one of the most widely used of such therapies. CBT involves working together with a therapist to change thinking patterns and behaviours that lead to depressed mood or anxiety. It has recently been adapted to take into account the thinking and memory problems of people with dementia with the therapy somewhat simplified and strategies used to help people remember what is said. In general, a friend or relative also joins the person with dementia and the therapist in the therapy.

How useful is CBT for people with dementia?

There have been two recent randomised controlled trials to evaluate how effective adapted CBT is for people with dementia who also have anxiety (Spector et al., 2015; Stanley et al., 2013). These provided some evidence that CBT may be helpful although they were both quite small and the results, although positive, were different across trials. In one trial anxiety was reduced through use of CBT, but in the other, the therapy actually had a bigger effect on depression (even though the trial aimed to reduce anxiety).
These promising but mixed results suggest that we should be offering CBT to those with dementia and anxiety. However, the inconsistency of the results also suggest that we need to do further work to establish exactly how well CBT works and also how we need to refine CBT so that it is the most effective it can be for those with dementia. This latter is something that my fellowship research aims to do.

Other psychological therapies

Additionally, while an emphasis on CBT is important given that it has the most evidence of any psychological therapy, it is not the only type of psychological therapy that is potentially useful for those with dementia, and anxiety or depression (Orgeta, Qazi, Spector, & Orrell, 2014). The ultimate aim is to be able to offer a ‘smorgasbord’ of therapies to those with dementia, just as we do for those without.
In general, this research into psychological therapies is encouraging, but it will be to little end until we start providing evidence based therapies identified in research within the NHS. Work on translating research findings into clinical settings is only just beginning and has some challenges with limited resources and the need for staff training. However, dementia awareness is being introduced into training of therapists and I hope that in years to come, those with anxiety and depression as well as dementia will be increasingly well served by evidence based psychological interventions.

Further reading

For further information on psychological therapies and anxiety and depression in dementia please see information provided by the Alzheimer’s society.
References
Banerjee, S., Hellier, J., Dewey, M., Romeo, R., Ballard, C., Baldwin, R., . . . Katona, C. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. The Lancet, 378(9789), 403-411.
Orgeta, V., Qazi, A., Spector, A. E., & Orrell, M. (2014). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev, 1.
Spector, A., Charlesworth, G., King, M., Lattimer, M., Sadek, S., Marston, L., . . . Orrell, M. (2015). Cognitive-behavioural therapy for anxiety in dementia: Pilot randomised controlled trial. British Journal of Psychiatry, 206(6), 509-516. doi:10.1192/bjp.bp.113.140087
Stanley, M. A., Calleo, J., Bush, A. L., Wilson, N., Snow, A. L., Kraus-Schuman, C., . . . Schulz, P. E. (2013). The Peaceful Mind program: A pilot test of a cognitive–behavioral therapy–based intervention for anxious patients with Dementia. The American Journal of Geriatric Psychiatry, 21(7), 696-708.
© UCL 2016 - CC BY 4.0
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