A multicountry clinical trial found that structured group music sessions provided no sustained improvement in depressive symptoms among dementia care home residents compared to standard care protocols. The study revealed significant geographical variation in outcomes, with cultural and healthcare system differences emerging as the primary determinants of intervention effectiveness rather than the music therapy itself. This finding challenges the widespread adoption of music therapy as a depression intervention in institutional dementia care. The null result aligns with a growing body of evidence suggesting that non-pharmacological interventions for dementia-related depression may be more context-dependent than previously assumed. While short-term mood benefits from music engagement are well-documented, translating these into clinically meaningful long-term depression reduction appears more complex than early enthusiasm suggested. The research highlights a critical gap between promising pilot studies and real-world implementation across diverse care settings. For families considering care facilities, this suggests that while music programs may enhance quality of life, they should not be viewed as therapeutic substitutes for evidence-based depression treatments. The study's emphasis on cultural tailoring points toward more personalized approaches rather than standardized international protocols.