Often in dementia we can miss symptoms of depression and it is a complicated area to treat.
The reduction in antipsychotic use in patients with dementia may make symptoms of depression become easier to recognise in patients who are not sedated. We have become much more aware of depression and diagnosing it in complex groups.
This has been linked with a rise in antidepressant use, hopefully reflecting a higher index of suspicion on behalf of GPs and clinicians in picking up depression in this vulnerable group.
But this new study highlights that medication may not be the simple answer to this. It moves us away from a chemical reliance, to taking a more holistic view of the wider needs of the patient, their environment and their carers. If it reinforces GPs’ tendency to do this, then that would be very good.
I would hope that is already happening, so I don’t think the recommendation should be to abandon medication completely for these patients in terms of managing their depression.
There are very few validated alternative treatments available, so to move wholesale these patients to other as yet unvalidated treatments for depression in dementia would be too hasty. To change what is an established line of treatment, just on the results of one single trial in a secondary-care setting, would be too quick – it might be doing more damage and deprive these patients of supportive treatment regimes.
I am certain NICE will take cognisance of this, but it is one single study and in one setting, so I suspect GPs will not wholly abandon their standard approach.
These patients are often established on their treatment and their GP may feel there has been a positive response. To destabilise that, and shift to something that hasn’t been proven to be of benefit, would be a bit more concerning.
Dr Donal Hynes is a GP in Somerset and co-vice-chair at the NHS Alliance