Psychological treatments for depression and anxiety in demen | Figure 1

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Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

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Key points

‐ Psychological treatments based on cognitive behavioural therapy (which focuses on changing thoughts and behaviours) probably have small positive effects on depression, quality of life and daily activities in people with dementia or mild cognitive impairment (MCI).

‐ There is not enough evidence to know whether any psychological treatments are helpful for anxiety in people with dementia or MCI.

‐ More evidence is needed about different types of psychological treatments and which treatments may be best for which people.

We found 29 studies that included 2599 people with dementia or MCI. Most of the evidence was about treatments based on cognitive behavioural therapy (CBT, which aims to alter thoughts and behaviours) and treatments aimed at supporting well‐being, which we called counselling and supportive therapies. We also found a very small number of studies about mindfulness‐based cognitive therapy and interpersonal therapy. The majority of studies looked at the effect on depression, but very few studies had anxiety as an outcome.

The evidence suggests:

‐ CBT‐based treatments probably improve symptoms of depression, quality of life and ability to manage daily activities at the end of the treatment period in people with dementia or MCI, although the effects were small. We could not be sure about any effect on anxiety. There was some evidence that the effect on depression might depend on how severe the symptoms of depression were before the start of treatment, whether people had a diagnosis of dementia or MCI and what type of treatment was used, but more research would be needed to be sure about this.

‐ Supportive and counselling treatments may have no effect on symptoms of depression at the end of treatment and there was not enough evidence for us to know if there was any effect on anxiety.

‐ We cannot be sure about the effect of mindfulness‐based therapies or interpersonal therapy because there were very few studies of these treatments.

There was limited information about unwanted effects associated with any of the treatments.

We could be moderately certain about the small positive effects of CBT‐based treatments on depression, quality of life and daily activities, but were less certain about other results.

Read the Cochrane Review:

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\ \ Review question\ Do pharmacological treatments, non‐invasive brain stimulation, psychological treatments, or combination treatments reduce the proportion of people with depression or the extent of depressive symptoms after stroke?\ Background\ Depression is common after stroke yet often is not detected or inadequately treated.\ Search date\ We identified studies by searches conducted on 13 August 2018.\ Study characteristics\ We included trials that reported on the use of pharmacological, non‐invasive brain stimulation, psychological, and combination therapy interventions to treat depression after stroke. Mean age of participants ranged from 54 to 78 years. Studies were from Asia (30), Europe (11), North America (6), and Australia (2).\ Key results\ We included 49 trials (56 treatments) involving 3342 participants. Pharmacological treatments resulted in fewer people meeting the study criteria for depression and less than 50% reduction in depression scale scores at end of treatment. Psychological therapy reduced the number of people meeting the study criteria for depression at end of treatment. More people in the pharmacological treatment group reported central nervous system (in five trials) and gastrointestinal side effects (in four trials) than in the placebo groups. Information on side effects of other treatments was not provided.\ Certainty of the evidence\ Estimates of treatment effects were imprecise due to small numbers in most studies and recruitment of people with very different baseline characteristics. We rated the certainty of evidence as very low due to these and other limitations in study design.\ Conclusion\ Antidepressant drugs may benefit people with persistent depressive symptoms after stroke, but care is required in their use, as little is known about their side effects. Psychological therapy may offer a treatment option. Future research should include a broader group of people with stroke.](https://app.figure1.com/case-detail/2a29da2f-e571-44d2-9893-1ae2aceaef02)

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