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Finding success with non-drug treatments: 4 common conditions that can benefit

The Bottom Line

  • Medication is not always the best or most appropriate treatment option due to factors such as lacking effectiveness, potential harms, and financial barriers.
  • In people with dementia, high blood pressure, or urinary incontinence, certain non-drug treatments may help to reduce agitation and depressive symptoms, lower blood pressure, and cure or improve urinary incontinence, respectively.
  • Before starting a non-drug treatment, speak with your health care team about the comprehensive list of treatments available for your condition, and weigh the risks and benefits. Together, you can decide on the best treatment for you.    

Specific diseases and conditions can have various management and treatment plans, generally consisting of one or more strategies. The most readily prescribed therapeutic strategy is medication (1). However, medication may not always be an effective option, can come with undesirable or potentially serious side effects, and may be a financial burden for some (2-6). Fortunately, many non-drug treatments are available either as an alternative to medication or a complementary strategy to work alongside it. But what does the research have to say about leaning on non-drug treatment strategies? Let’s explore the possible benefits and pitfalls through a few common conditions. Click on the links below to learn more.


1. Agitation within dementia

The vast majority of people with dementia—almost 90%—experience agitation (6;7). This behavioural issue negatively impacts multiple areas of a person’s life, including their relationships and ability to carry out everyday activities (2;8). A number of medications are used to treat agitation. However, their effectiveness is often limited, and they come with the potential for serious risks, such as cognitive decline and heart-related complications (2;9-15). Research shows that in adults with dementia, non-drug treatments including massage therapy, personally tailored interventions, animal-assisted interventions, and pet robot interventions may help decrease agitation by small to moderate amounts (6).


2. Depression within dementia  

Similarly, using medication to treat depression in people with dementia has also been questioned due to potential harms—such as falls, broken bones, and sleep disturbances—and in some cases (e.g., antidepressants) limited short-term effectiveness (16;17). There are alternative options for those with dementia who are experiencing depressive symptoms but do not have an official depression diagnosis. Research illustrates that non-drug treatments including cognitive stimulation alone, cognitive stimulation plus exercise and social interaction, massage and touch therapies, occupational therapy, multidisciplinary care, and reminiscence therapy may be effective in reducing depressive symptoms in this population. Certain non-drug treatments also show the potential to be more effective than some medications (16).


3. High blood pressure

High blood pressure, also known as hypertension, increases the risk of developing various health issues and dying prematurely (18). A diverse set of medications that aim to lower blood pressure are available and have been shown to be effective in many people (3;19). With that said, there are still some folks that are unable to get their blood pressure under control with medication. Other factors that may have people looking for non-drug alternatives include the cost of medications and associated side effects, such as kidney problems, fainting, and low blood pressure (3-5). Research demonstrates that certain dietary approaches, physical exercises, stress reducing practices, weight loss interventions, and comprehensive lifestyle modifications can help reduce blood pressure in people with prehypertension to established hypertension (3). In particular, DASH—a dietary pattern that promotes the consumption of whole grains, low-fat dairy, fruits, and vegetables and recommends decreasing sodium, saturated fat, and total fat content—appears to be effective (3;20-21).


4. Urinary incontinence

Urinary incontinence, more commonly understood as involuntary loss of bladder control, is a stressful condition that can impact everything from mental to social health (22-25). This condition is especially prevalent in older women (26). Both medication and non-drug treatments exist to help women battle their bladder woes. However, it is generally recommended that women first try achieving success with non-drug treatments before moving to medications that are known to produce side effects, such as constipation, headaches, and blurry vision (27). One non-drug treatment is pelvic floor muscle training, which has been shown to help cure or improve urinary incontinence in women with different subtypes of the condition (22).


For those living with the conditions described above, you may be wondering where to go from here. If you are interested in trying a non-drug treatment, consult your health care team to inquire about all available treatment options for your condition, as well as their advantages and disadvantages. Remember, do not stop taking prescribed medications without first consulting your health care team. With the help of health professionals, you can come to an evidence-informed decision about the best strategy or combination of strategies for you, while also voicing and incorporating your needs, preferences, and concerns. 


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References

  1. Health Quality Ontario. Medication safety: Care in all settings. [Internet] 2021. [cited August 2021]. Available from https://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-all-Quality-Standards
  2. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry. 2014; 205(6):436-442. doi: 10.1192/bjp.bp.113.141119.
  3. Fu J, Liu Y, Zhang L, et al. Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. J Am Heart Assoc. 2020; 9(19):e016804. doi: 10.1161/JAHA.120.016804. 
  4. Albasri A, Hattle M, Koshiaris C. Association between antihypertensive treatment and adverse events: Systematic review and meta-analysis. BMJ. 2021; 10;372:n189. doi: 10.1136/bmj.n189. 
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  9. Bierman EJ, Comijs HC, Gundy CM, et al. The effect of chronic benzodiazepine use on cognitive functioning in older persons: Good, bad or indifferent? Int J Geriatr Psychiatry. 2007; 22(12):1194-200. doi: 10.1002/gps.1811.
  10. Maher AR, Maglione M, Bagley S, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: A systematic review and meta-analysis. JAMA. 2011; 306(12):1359-1369. doi: 10.1001/jama.2011.1360.
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  13. Fox C, Crugel M, Maidment I, et al. Efficacy of memantine for agitation in Alzheimer’s dementia: A randomised double-blind placebo controlled trial. PLoS One. 2012; 7(5):e35185. doi: 10.1371/journal.pone.0035185.
  14. Banerjee S, Hellier J, Dewey M, et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): A randomised, multicentre, double-blind, placebo-controlled trial. Lancet. 2011; 378(9789):403-411. doi: 10.1016/S0140-6736(11)60830-1.
  15. Husebo BS, Ballard C, Sandvik R, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: Cluster randomised clinical trial. BMJ. 2011; 343:d4065. doi: 10.1136/bmj.d4065.
  16. Watt JA, Goodarzi Z, Veroniki AA, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: Systematic review and network meta-analysis . BMJ. 2021; 372:n532. 
  17. Dudas R, Malouf R, McCleery J, et al. Antidepressants for treating depression in dementia. Cochrane Database Syst Rev. 2018; 8:CD003944. doi: 10.1002/14651858.CD003944.pub2.
  18. World Health Organization. Hypertension. [Internet] 2021. [cited August 2021]. Available from https://www.who.int/news-room/fact-sheets/detail/hypertension 
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  21. Zou P, Dennis CL, Lee R, et al. Dietary approach to stop hypertension with sodium reduction for Chinese Canadians (DASHNa-CC): A pilot randomized controlled trial. J Nutr Health Aging. 2017; 21(10):1225-1232. doi: 10.1007/s12603-016-0861-4.
  22. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women . Cochrane Database Syst Rev. 2018; 10:CD005654. doi: 10.1002/14651858.CD005654.pub4.
  23. Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989; 320(1):1-7.  doi: 10.1056/NEJM198901053200101.
  24. Papanicolaou S, Hunskaar S, Lose G, et al. Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU International. 2005; 96(6):831-838. doi: 10.1111/j.1464-410X.2005.05722.x.
  25. Fantl J, Newman DK, Colling J. Urinary incontinence in adults: Acute and chronic management: 1996 update. AHCPR clinical practice guidelines No. 2. Rockville (MD): Agency for Health Care Policy and Research (AHCPR), Public Health Service, US Department of Health and Human Services; 1996 Mar. AHCPR Report No.: 96-0682.
  26. World Health Organization. Evidence profile: Urinary incontinence. [Internet] 2017. [cited August 2021]. Available from https://www.who.int/ageing/health-systems/icope/evidence-centre/ICOPE-evidence-profile-urinary-incont.pdf
  27. Shamliyan T, Wyman J, Kane RL. Nonsurgical treatments for urinary incontinence in adult women: Diagnosis and comparative effectiveness. AHRQ Comparative Effectiveness Reviews. 2012.  

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