Common Mental Disorders Depression - New Zealand Doctor

Chapter 8 Special issues: older adults/koroua/kuia
Specific interventions: evidence review
A review of the literature for randomised studies of pharmacological and psychosocial
interventions for depression with comorbid dementia was conducted. The evidence
was limited.
Pharmacological therapies
There is little evidence on the use of antidepressants for depression in older people
with dementia. A single small RCT from a Cochrane systematic review with a search
to 2005 536 found SSRIs effective. A further paper on this RCT 537 reported that response
to antidepressants was not associated with any baseline demographic, mood,
neuropsychiatric, neurophysical or caregiver variable. Other studies in the Cochrane
review were small, inconclusive and generally poorly designed. 536 A subsequent small
RCT of venlafaxine versus placebo was also inconclusive. 538
The Cochrane review also noted that the likelihood of side effects is significantly increased
by antidepressants compared to placebo in people with depression and dementia. 536
The Scottish Intercollegiate Guidelines Network (SIGN) guideline on dementia 522 notes
that evidence is weak to support the use of antidepressants to treat depression in older
people with dementia but suggests that they can be used providing their use is evaluated
carefully for each patient.
Psychosocial interventions
There is very limited evidence from a systematic review 539 which includes two relevant
RCTs 540,541 that psychosocial interventions are effective in treating depressive symptoms
in older adults with dementia. One of the studies 541 involved therapeutic biking,
whereby residents with dementia and depressive symptoms at a long-term care facility
were taken on one-to-one outings on a wheelchair bicycle. In the other study, 540
caregivers of older adults with dementia and depression in the community were taught
behavioural strategies such as environmental modification, distraction, communication
and increasing pleasant events. In both RCTs, depression scores decreased
significantly in the intervention group compared to controls, with evidence of continued
benefits at up to 6-month follow-up.
Depression with dementia: issues for evidence-based practice
The potential to improve depressive symptoms and functional ability in an older
person/koroua/kuia with dementia warrants active intervention if depression is
suspected. Either a psychosocial and/or pharmacological approach may be useful in
this population, though evidence is overall very scanty. Pharmacological treatment for
depression in an older adult with dementia should be managed in the same way as for
other older adults. 65
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