title: Management of Depression in Patients with Dementia: Is Pharmacological Treatment Justified?
abstract: Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia. Antidepressants are the mainstay of pharmacological treatment for clinically significant depression in the general population but evidence to support their use in dementia is mixed. Trials of antidepressants should generally be reserved for individuals with depression where the symptoms are distressing and surpass the threshold for major depression. Acetylcholinesterase inhibitors and memantine are effective in the symptomatic treatment of Alzheimer's disease but current evidence does not support their use to treat depressive symptoms in dementia. Similarly, antipsychotics and mood stabilizers have no proven efficacy for depression and the risk of adverse effects seems to outweigh any potential benefit. Pain can be a frequent problem in dementia and may have significant effects on behavior and mood. Preliminary evidence supports a role of adequate analgesia in improving mood in people with dementia.
authors.affiliation: School of Psychiatry and Clinical Neurosciences (M573), Western Australian Centre for Health and Ageing (M573), Harry Perkins Institute of Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. andrew.ford@uwa.edu.au.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ford
authors.affiliation: School of Psychiatry and Clinical Neurosciences (M573), Western Australian Centre for Health and Ageing (M573), Harry Perkins Institute of Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy / Q000523:psychology; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008559:Memantine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D008559:Memantine