A quantitative and qualitative analysis of the pharmacological management of depression and anxiety in people with dementia

Abstract

Introduction
Depression and anxiety are common in people with dementia. However, little is known about the pharmacological management of these symptoms. The overarching aim of this PhD thesis was to investigate how the management of depression and anxiety may be optimised in people with dementia in the primary care setting.

Methods
A nested case-control study described prescribing trends of antidepressant and anxiolytic medications among a retrospective cohort of people with dementia (n=31,525) in Northern Ireland. The association between exposure to these medications and mortality was also evaluated. A qualitative approach was used to understand carers’ experiences and perspectives regarding the pharmacological management of depression and anxiety through the analysis of posts (n=953) from an online discussion forum. Semi-structured interviews were also conducted with carers of people with dementia (n=12) to further explore their experiences and identify facilitators and barriers to the successful management of these symptoms. All data were analysed using appropriate techniques.

Results
The nested case-control study highlighted the high prevalence of prescribing of antidepressant (59.2%, n=8,542 of 14,420 cases) and anxiolytic (44.8%, n=6,484 of 14,420 cases) medications. A strong association between exposure to anxiolytic medications and mortality [adjusted odds ratio (OR)=1.26; 95% confidence interval (CI): 1.19–1.33] was observed, with a weaker increased risk associated with antidepressant exposure (adjusted OR=1.08; 95% CI: 1.02–1.14). Analysis of discussion forum posts emphasised that these medications are commonly prescribed and that symptoms are challenging to recognise and manage, impacting negatively on carers’ burden. Interviews provided a richer understanding of symptom presentation, identification, and responses to treatment.

Discussion and conclusion
This thesis provides a greater understanding of pharmacological management of depression and anxiety in people with dementia, highlighting challenges with symptom recognition and high prescribing despite evidence of associated risks. Further research is needed to understand prescribers’ motivations for using these medications.

Thesis is embargoed until 31 July 2029.

Date of Award	Jul 2026
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Carmel Hughes (Supervisor) & Heather Barry (Supervisor)