While some medications, including antidepressant drugs, are widely used to treat depression, these drugs don’t work as well or as effectively in people with dementia. However, new research suggests psychological/psychotherapy treatments and interventions also known as “talking therapies” can be used to reduce depression and anxiety in people with dementia and mild cognitive impairment (MCI).
Talking therapies usually involve a therapist who works with an individual or a small group of people. It’s also a method used to help individuals address mental health issues such as coping with severe mental disorders as well as daily life stressors, Bisma Anwar, LHMC, a licensed mental health counselor for Talkspace, told Seasons.
Psychotherapy uses many different approaches to treat depression and anxiety in adults, including cognitive-behavioral therapy (CBT), behavioral activation (BA), problem-solving therapy (PST), interpersonal therapy (IPT) and integrative approaches such as counseling. These types of therapies may be used in combination with other therapies and/or medication.
Approaches to psychotherapy:
The study is the first review showing how psychological interventions are effective and valuable, especially because there are no standard treatments for depression in dementia patients.
“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 toward increasing access to psychological services for people with dementia and their families across the globe,” said Vasiliki Orgeta, PhD, lead author of the study at University College London. “We want people who experience cognitive impairment and dementia and their carers to have the same access to mental health treatments as everyone else.”
What else you need to know about the study
Orgeta and her colleagues looked at psychological interventions including CBT and support and counseling interventions based on evidence from 29 trials that included nearly 2,600 people in total with dementia or MCI. The treatments were all generally aimed at supporting a patient’s overall well-being, reducing distress and improving coping.
The researchers found cognitive-behavioral therapies – a type of treatment that helps people learn how to identify and change disturbing thought patterns that have a negative influence on behavior and emotions – were slightly better than “treatment as usual or active control conditions” for reducing depressive symptoms in people with dementia and MCI.
Orgeta said cognitive behavioral therapies may also increase rates of depression remission, along with improving patient quality of life and activities of daily living at the end of treatment compared to the usual care.
“Supportive and counseling interventions may not improve symptoms of depression in people with dementia but may improve by a small amount of quality of life,” Orgeta added. “It is encouraging that CBT treatments were favored compared to control conditions for several outcomes other than depressive symptoms, such as quality of life and activities of daily living.”
The researchers noted they could only be moderately certain about the small positive effects of CBT-based treatments on depression and quality of life and daily activities, which means they can be relatively confident in their findings. However, they were less certain about other results, including the effect of CBT on anxiety at the end of treatment.
“For all types of psychological treatment, the evidence related to anxiety symptoms was of very low certainty and hence, inconclusive, so further research on the effectiveness of psychological interventions for reducing anxiety symptoms is necessary,” Orgeta said. “It is not clear whether these changes are clinically meaningful, and most of the evidence is for people living with mild dementia in community settings. Most people with dementia probably do not access these types of treatments.”
While there are limitations to the current study, she said the results show some benefits and are encouraging, especially in light of the lack of evidence of benefits and potential harms compared to pharmacological treatments.
How does talk therapy improve symptoms of depression?
While not enough is currently known about the power of talk therapy, Orgeta said it’s likely that when people engage in these types of treatments, many changes are taking place—including changes in the brain.
People with dementia and their carers likely become psycho-educated on depressive symptoms, she said, and can identify what triggers them, along with relaxation techniques that may help.
In general, therapy can help individuals in the early stages of dementia understand and process their thoughts and behaviors along with what triggers their depressive symptoms, Anwar said. It can also help them navigate their feelings of anxiety, sadness and depression.
Therapy can help individuals in the early stages of dementia understand and process their thoughts and behaviors along with what triggers their depressive symptoms.
Talk therapy additionally provides healthy coping strategies and problem-solving skills to manage these kinds of emotions. However, a patient in the later stages of dementia might find it hard to engage in talk therapy as focusing and articulating thoughts and feelings might become more challenging.
“Talk therapy can provide a safe and confidential space for patients to process their thoughts and feelings around their situation,” said Anwar. “It can provide alternative ways to cope with ineffective treatments, outcomes and symptoms of depression. Therapy is a source of support for patients of dementia.”
What does this mean for caregivers and seniors?
According to Orgeta, CBT treatments may not necessarily improve outcomes for caregivers, but the findings suggest CBT treatments have a small positive effect on depressive symptoms for people with dementia and MCI immediately after treatment and may improve quality of life. This can be important and meaningful for caregivers and families providing care to a loved one with dementia or MCI.
Because therapy is not looked at as an effective treatment option for these patients, this study makes it clear there are certain benefits, Anwar said. The study helps caregivers understand the benefits of therapy for their loved ones diagnosed with dementia or MCI and allow them to have the space to process feelings and thoughts around their diagnosis.
“This gives patients another source of emotional support and gives caregivers a sense of relief,” Anwar added.
This gives patients another source of emotional support and gives caregivers a sense of relief.
Families, caregivers and loved ones with dementia or MCI should talk with their doctor to see if talk therapy or other forms of psychotherapy is available or is right for them.
Orgeta said the review has shown that older people living with cognitive impairment and dementia may potentially receive the same benefits from psychological treatments as older people who do not live with dementia or cognitive impairment—including a slight reduction in depressive symptoms and an improvement in daily living or quality of life.
The authors said even though their research is encouraging, more research on non-medication treatments is desperately needed. They added more clinicians need to choose talk therapies for their patients and more funding needs to be applied to this area to better understand psychological treatments and the effects on people with dementia.