The drugs don’t work… as well as social prescribing

Felicity Allman dives into a recent study on alternatives to antidepressants.

Felicity Allman
30th May 2021
Dementia and depression often have overlapping symptoms, such as poor concentration, low mood and social withdrawal. There is even a form of depression where the cognitive (thought-related) symptoms are so severe, it’s known as pseudodementia. It’s important for doctors to work out what might be causing a person’s symptoms, so that the most appropriate treatments can be offered. There are drugs for dementia and drugs for depression, and writing a prescription can take moments. But what if a person is living with both depression and dementia? A recent publication in the British Medical Journal suggests that antidepressants are rarely the answer.

In the UK, dementia costs health and social care services more than cancer and heart disease combined, and 1 in 3 people with develop dementia in their lifetime.

The article, which looked at over 250 studies of nearly 30,000 people with dementia, found that interventions like art therapy, counselling, massage and touch therapy, exercise, social interaction, and reminiscence therapy were as good as antidepressants or even more effective at reducing symptoms of depression. And there’s a lot that we can learn from this in terms of prevention:

Creative pursuits like art therapy keep the mind active and learning. Reminiscence family involves spending time with family and friends, remembering the good times and sharing stories. Counselling is helpful for validating how a person feels and coming up with ways to cope with those feelings and adapt. Massage and touch therapy are soothing, and can be a useful grounding technique in times of stress or anxiety. Exercise – aerobic, resistance or balance – promotes brain health. And social interaction is something we’ve all recognised the benefit of, having been deprived of it over lockdown. Most importantly, these activities counter the symptoms that people may be experiencing: social interaction is the opposite of social withdrawal, so can promote recovery. 

Depression is the second greatest cause of disability globally, and almost half of people in the UK report having experienced it.

It’s understandable how these activities can be useful for people living with dementia and depression, and they fit well with a model of healthcare that’s growing across the UK: social prescribing. Social prescribing means engaging in enjoyable and meaningful activities, rather than just using medication. A healthcare professional, commonly a GP or practice nurse, will refer the person to a ‘link worker’, who then meets with the person to discuss their needs and interests, and then identify activities that could be helpful. It is commonly used for people with mental health issues and chronic health conditions, but it seems obvious that it could be helpful for people living with dementia as well, with adaptations where necessary. This is especially important in older people who are often taking lots of medication and living with all the side effects of those drugs.

The BMJ study found that antidepressants were still beneficial for people with dementia and ‘major depressive disorder’ (severe depression), but this does not exclude them from social prescribing activities and non-pharmaceutical interventions. Equally, for those of us without dementia who live with mental health issues, the benefits of exercise, social interaction, creative pursuits and reminiscence cannot be understated. Furthermore, many social prescribing activities are run by volunteers, and have really suffered during the pandemic, so please explore volunteering opportunities in your area to see how you can make a difference to people’s lives.

Image Credit: Wikimedia Commons

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