Jennifer Watt, MD, PhD, on Non-Drug Interventions Effective for Depression Symptom Reduction in Dementia
Non-drug interventions may be more effective than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder, according to a study published online in The BMJ.
Ten interventions were found to be more effective in reducing symptoms of depression: animal therapy, cognitive stimulation, exercise, massage and touch therapy, reminiscence therapy, multidisciplinary care, occupational therapy, cognitive stimulation and a cholinesterase inhibitor, exercise combined with social interaction and cognitive stimulation, and psychotherapy combined with reminiscence therapy and environmental modification.
In this video, researcher Jennifer Watt, MD, PhD, from St. Michael’s Hospital, Toronto, Canada, discusses the study methods, practical implications for clinicians, and future directions for research and policy.
Hello, my name is Dr. Jennifer Watt. I'm a geriatrician at St. Michael's Hospital in Toronto, Canada and a scientist at the Li Ka Shing Knowledge Institute.
Q: What led you and your colleagues to look into drug and non-drug therapies in patients with dementia? (00:15)
A: We were interested in studying the effects of drug and non-drug therapies in people with dementia because when I was in medical training, we were always taught that non-drug therapies were preferable, that they should be something we look to first.
However in practice, whenever I finished my medical training, I saw that we were often using medications instead and that there was this general belief among people, including clinicians, that medications worked better.
We didn't really know this for sure because studies directly comparing medications to non-medication-based strategies for treating certain neuropsychiatric symptoms in dementia, such as aggression or depression, were very rare.
We undertook this study and other research before this to look at that question and to try and figure out which was better, medications or non-medication-based strategies so that we could properly inform shared decision making with patients, caregivers, and other clinicians.
Q: Please briefly describe the study methods and most significant findings. (1:34)
A: We completed what's called a systematic review and network meta-analysis. For the systematic review portion, we basically combed the entire body of published literature in medicine and related fields to identify all the randomized control trials looking at studies where one or more treatments was compared to one another where the outcome of interest was to treat depressive symptoms in people with dementia.
We then used network meta-analysis, which is an advanced statistical method, to directly and indirectly compare the efficacy of these different treatments. By that, let me give you an example.
Say, in a study, they have compared the effects of music therapy to usual medical care, and in another study, they've compared the effects of an antidepressant to usual medical care, but no study has compared the effects of music therapy to an antidepressant.
Using network meta-analysis, we can infer the relationship between those two treatments to understand which is better, which can help us with decision making for patients.
Q: Were any findings particularly surprising or unexpected? (3:01)
A: Was I surprised by any of our findings? I would say no because we published an earlier study where we showed that non-medication-based strategies, such as massage and touch therapy or music therapy, were as or more efficacious than medications for reducing symptoms of agitation and aggression in people with dementia.
When we undertook this study, I was wanting to build on that previous work in the hope that we would show there are further non-medication-based strategies that can help people living with dementia to live better lives and to have fewer depressive symptoms than they might otherwise have had.
Q: What are the practical applications for clinicians treating dementia? (3:54)
A: I believe that there are a number of practical implications to our findings. First of all, it really can inform decision making at the bedside between patients, caregivers, and clinicians. Even beyond that, this opens up a large area of future study.
We identified a number of gaps in terms of comparisons between medication and non- medication-based strategies that have not been done before. People might be interested to look at that. There's also a lot of work in terms of implementation.
It's one thing to show that something works in studies, but it can sometimes be quite different to get it out there into the real world and then helping patients. That's also something we need to work on.
Then, of course, for policy makers, because one of the concerns that a number of people have is that, okay, great. We have identified that all of these treatments work, but it's not feasible for us to actually recommend them to our patients and to use in our communities because we might not have the resources.
That's where there's another layer of stakeholders or knowledge user who do need to be involved in putting our findings into practice.
Q: Is there any further research in this area that you feel is needed? (5:25)
A: In terms of related research, I would like to build on what we found. As I said, one of the things that I worry about the most is that there's lots of really great research out there that gets published. Everyone's excited about it. Then, that's it. It doesn't go any further than that.
I don't want that to be the case.
I'm young. I'm a junior scientist at the beginning of my career. I'd like to think that putting my findings into practice is an important goal for my career. I hope there's many other scientists, and community organizations, and policy makers who feel the same.
Q: Any final thoughts pertaining to this research? (6:13)
A: If I was to add any last thoughts about the study and our findings is that I really do recognize that this is a first step in that for many patients and caregivers out there, they may be very interested in the findings. It may be something that they would like to try, but it's not always feasible for them.
I think it is that we use this research to support ongoing advocacy efforts toward improving resources for social care for people with dementia and their caregivers.
Watt J, Goodarzi Z, Angeliki A, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. The BMJ. 2021;372:n532
Dr. Jennifer Watt is a geriatrician at St. Michael's Hospital, Toronto, Canada, assistant professor in the Department of Medicine at the University of Toronto, Canada, and scientist in the Li Ka Shing Knowledge Institute, Toronto, Canada. Her research focuses on the comparative efficacy and safety of pharmacologic and nonpharmacologic interventions in older adults.