The drugs don’t work – lessons from the management of neuropsychiatric symptoms in dementia

Depression, agitation, and other neuropsychiatric symptoms (NPS) are a common challenge for people with dementia with profound negative impacts for them and their family carers. Non-drug care is first-line treatment, but evidence on medication use evidence is sparse, other than for antipsychotics in agitation which have significant harms. Antidepressants have increasingly been used as treatments for depression in dementia and as alternatives to antipsychotics in agitation, but with little evidence to support their use. Here we will review the status of NPS as a treatment target and the effectiveness of drug treatments using data from the SYMBAD and SADD RCTs. The concept of NPS in dementia being a complex problem requiring the skills of secondary mental health care and a multifaceted personalised approach will be explored. The limitations of seeking simple answers (such as medication) for a complex problem (NPS in dementia) will be discussed.