Apathy, anxiety and depression

7. Treating anxiety

Treatment of anxiety, like treatment of depression, can involve a range of approaches depending on the person’s needs. You can help people with dementia with mild anxiety by making time to listen and provide reassurance. Other ways of helping include making adjustments so that their living environment is calmer and safer, and they have an improved structure to everyday life (including exercise and activities which have meaning for the person).

People with more severe and persistent anxiety can respond well to psychological therapies such as CBT (see ‘Treating depression’ above). There is also some evidence that music therapy with a qualified therapist reduces agitation, which can be a symptom of anxiety.

Medication can also be helpful. Common medications used to relieve anxiety include:

  • Antidepressants – These drugs can help relieve anxiety as well as depression, although the evidence for their benefit in anxiety is limited. An SSRI, such as sertraline, is recommended to be tried first. See above for information on the different types of antidepressants.
  • Benzodiazepines – These are very effective at treating anxiety but should only be used for a short period (up to two weeks). When used for longer periods they are addictive and may cause unpleasant withdrawal symptoms when a person stops taking them. They are not usually suitable for people with dementia as they can cause excessive sedation (drowsiness), unsteadiness and a tendency to fall, and they may worsen confusion and memory problems.
  • ‘Z’ drugs (non-benzodiazepines) – These drugs are used to treat sleep problems, which are common in both depression and anxiety. They have similar effects to benzodiazepines. Examples include zaleplon, zolpidem and zopiclone.
  • Buspirone – This is a specific anti-anxiety drug. It works in a similar way to benzodiazepines but does not cause drowsiness and is not addictive. It should, however, still only be used for a short period of time.
  • Antipsychotics – Antipsychotics are sometimes used for severe or persistent anxiety, but should generally be avoided for treating anxiety in people with dementia . For more information see factsheet 408, Drugs for behavioural and psychological symptoms in dementia.