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Depression in Parkinson's disease

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Abstract

Depression is one of the most common non-motor symptoms in Parkinson's disease (PD) affecting 30–40% of patients and it has a major impact on quality of life. Depressive features in PD, however, overlap with core features of PD such as apathy, anhedonia, sleep–wake dysregulation, and lack of energy. Depressive symptoms in PD have been correlated with multiple neurotransmitter abnormalities in the parkinsonian brain including dopaminergic and noradrenergic denervation of parts of the limbic system and ventral striatum as well as loss of serotonergic brainstem neurons. Overall there are limited data from controlled clinical trials assessing interventions that target depression in PD. Recent studies have provided further evidence for antidepressive efficacy of dopaminergic therapies, in particular dopamine agonists. However, to date no placebo-controlled study has unequivocally established the efficacy of any dopaminergic agent or antidepressive drug specifically against depression in PD. From a pragmatic point of view tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) continue to be the most frequently used antidepressant treatments in routine clinical practice, while, so far, few data are available for the new mixed serotonergic and noradrenergic antidepressants reboxetine, mirtazapine, venlafaxine, and nefazodone.

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References

  1. American Psychiatric Foundation (2000) Diagnostic and statistical manual of mental disorders DSM-IV-TR 4th edition. First MB, Wipliger TA (eds)

  2. Andersen J, Aabro E, Gulmann N, Hjelmsted A, Pedersen J (1980) Antidepressive treatment in Parkinson's disease. A controlled trial of the effect of nortriptyline in patients with Parkinson's disease treated with L-dopa. Acta Neurol Scand 64:210–219

    Google Scholar 

  3. Avila A, Cardona X, Martin-Baranera M, Maho P, Sastre F, Bello J (2003) Does nefazodone improve both depression and Parkinson disease? A pilot randomized trial. J Clin Psychopharmacol 23:509–513

    Article  PubMed  CAS  Google Scholar 

  4. Barone P, Goetz C, Houben J, Koester J, Leentjens A, Poewe W, Rascol O, Reichmann H, Schapira A, Tolosa E (2006) PRODEST – Depression symptoms in Parkinson's disease (Abstract). MDS Congress, Kyoto

  5. Barone P, Scarzella L, Marconi R, Antonini A, Morgante L, Bracco F, Zappia M, Musch B; Depression/Parkinson Italian Study Group (2006) Pramipexole versus sertraline in the treatment of depression in Parkinson's disease: a national multicenter parallel-group randomized study. J Neurol 253:601–607

    Article  PubMed  CAS  Google Scholar 

  6. Bayulkem K, Torun F (2002) Therapeutic efficiency of venlafaxin in depressive patients with Parkinson's disease. Mov Disord 17(Suppl 5):204

    Article  Google Scholar 

  7. Bejjani B, Damier P, Arnulf I, Thivard L, Bonnet A, Dormont D, Cornu P, Pidoux B, Samson Y, Agid Y (1999) Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 340:1476–1480

    Article  PubMed  CAS  Google Scholar 

  8. Braak H, del Tredici K, Rub U, De Vos RAI, Jansen Steur ENH, Braak E (2003) Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 24:197–211

    Article  PubMed  Google Scholar 

  9. Ceravolo R, Nuti A, Piccinni A, Dell'Agnello G, Bellini G, Gambaccini G, Dell'Osso L, Murri L, Bonuccelli U (2000) Paroxetine in Parkinson's disease: effects on motor and depressive symptoms. Neurology 55:1216–1218

    PubMed  CAS  Google Scholar 

  10. Corrigan M, Denahan A, Wright C, Ragual R, Evans D (2000) Comparison of pramipexole, fluoxentine and placebo in patients with major depression. Depress Anxiety 11:58–65

    Article  PubMed  CAS  Google Scholar 

  11. Cummings JL (1992) Depression and Parkinson's disease: a review. Am J Psychiatry 149:443–454

    PubMed  CAS  Google Scholar 

  12. Damier P, Hirsch EC, Agid Y, Graybiel AM (1999) The substantia nigra of the human brain. II. Patterns of loss of dopamine-containing neurons in Parkinson's disease. Brain 122:1437–1448

    Article  PubMed  Google Scholar 

  13. Doder M, Rabiner EA, Turjanski N (2000) Brain serotonin 1A receptors in Parkinson'’s disease with and without depression measured by positron emission tomography with 11C-WAY 100635 (Abstract). Mov Disord 15:213

    Google Scholar 

  14. Forno LS (1982) Pathology of Parkinson's disease. In: Marsden CD, Fahn S (eds) Movement Disorders, Neurology 2. Butterworths International Medical Reviews pp 25–40

  15. Fregni F, Santos CM, Myczkowski ML, Rigolino R, Gallucci-Neto J, Barbosa ER, Valente KD, Pascual-Leone A, Marcolin MA (2004) Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 75:1171–1174

    Article  PubMed  CAS  Google Scholar 

  16. Gibb W, Lees A (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 51:745–752

    PubMed  CAS  Google Scholar 

  17. Goetz CG, Koller WC, Poewe W, Rascol O, Sampaio C; on behalf of the MDS Task Force (2002) Management of Parkinson's disease: an evidence based review. Mov Disord 17:Suppl 4

    Article  Google Scholar 

  18. Gonera E, van't Hof M, Berger H, van Weel C, Horstink M (1997) Symptoms and duration of the prodromal phase in Parkinson's disease. Mov Disord 12:871–876

    Article  PubMed  CAS  Google Scholar 

  19. Hely MA, Morris JG, Reid WG, Trafficante R (2005) Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord 20:190–199

    Article  PubMed  Google Scholar 

  20. Jouvent R, Abensour P, Bonnet AM (1983) Antiparkinsonian and antidepressant effects of high doses of bromocriptine: an independent comparison. J Affect Disord 5:141–145

    Article  PubMed  CAS  Google Scholar 

  21. Krack P, Kumar R, Ardouin C, Dowsey P, McVicker J, Benabid A, Pollak P (2001) Mirthful laughter induced by subthalamic nucleus stimulation. Mov Disord 16:867–875

    Article  PubMed  CAS  Google Scholar 

  22. Leentjens A, Van den Akker M, Metsemakers J, Lousberg R, Verhey F (2003) Higher incidence of depression preceding the onset of Parkinson's disease: a register study. Mov Disord 18:414–418

    Article  PubMed  Google Scholar 

  23. Leentjens AF, Vreeling FW, Luijeckx GJ, Verhey FR (2003) SSRIs in the treatment of depression in Parkinson's disease. Int J Geriatr Psychiatry 18:552–524

    Article  PubMed  CAS  Google Scholar 

  24. Lees AJ, Shaw KM, Kohout LJ, Stern GM (1977) Deprenyl in Parkinson's disease. Lancet 15:791–795

    Article  Google Scholar 

  25. Lemke MR (2002) Effect of reboxetine on depression in Parkinson's disease patients. J Clin Psychiatry 63:300–304

    PubMed  CAS  Google Scholar 

  26. Maricle RA, Nutt JG, Carter JH (1995) Mood and anxiety fluctuation in Parkinson's disease associated with levodopa infusion: preliminary findings. Mov Disord 10:329–332

    Article  PubMed  CAS  Google Scholar 

  27. Mayeux R, Stern Y, Sano M, Williams JB, Cote LJ (1988) The relationship of serotonin to depression in Parkinson's disease. Mov Disord 3:237–244

    Article  PubMed  CAS  Google Scholar 

  28. Meara J, Bhowmick BK, Hobson P (1999) Accuracy of diagnosis in patients with presumed Parkinson's disease. Age Ageing 28:99–102

    Article  PubMed  CAS  Google Scholar 

  29. Okabe S, Ugawa Y, Kanazawa I; Effectiveness of rTMS on Parkinson's Disease Study Group (2003) 0.2-Hz repetitive transcranial magnetic stimulation has no add-on effects as compared to a realistic sham stimulation in Parkinson's disease. Mov Disord 18:382–388

    Article  PubMed  Google Scholar 

  30. Okun M, Watts R (2002) Depression associated with Parkinson's disease: clinical features and treatment. Neurology 26(Suppl 1):S63–S70

    Google Scholar 

  31. Poewe W, Granata R, Geser F (2004) Pharmacological treatment of Parkinson's disease. In: RL Watts, WC Koller (eds) Movement Disorders, Neurologic Principles and Practice. McGraw-Hill, New York, pp 247–271

  32. Rektorová I, Rektor I, Bares M, Dostál V, Ehler E, Fanfrdlová Z, Fiedler J, Klajblová H, Kulit'ák P, Ressner P, Svátová J, Urbánek K, Velísková J (2003) Pramipexole and pergolide in the treatment of depression in Parkinson's disease: a national multicentre prospective randomized study. Eur J Neurol 10:399–406

    Article  PubMed  Google Scholar 

  33. Remy P, Doder M, Lees A, Turjanski N, Brooks D (2005) Depression in Parkinson's disease: loss of dopamine and noradrenaline innervation in the limbic system. Brain 128:1314–1322

    Article  PubMed  Google Scholar 

  34. Richard I, Kurlan R (1997) A survey of antidepressant drug use in Parkinson’s disease. Parkinson Study Group. Neurology 49:1168–1170

    PubMed  CAS  Google Scholar 

  35. Richard IH (2006) Apathy does not equal depression in Parkinson disease: why we should care. Neurology 67:33–38

    Article  Google Scholar 

  36. Sano M, Stern Y, Williams J, Cote L, Rosenstein R, Mayeux R (1989) Coexisting dementia and depression in Parkinson's disease. Arch Neurol 46:1284–1286

    PubMed  CAS  Google Scholar 

  37. Santamaria J, Tolosa E, Valles A (1986) Parkinson's disease with depression: a possible subgroup of idiopathic parkinsonism. Neurology 36:1130–1133

    PubMed  CAS  Google Scholar 

  38. Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry 69:308–312

    Article  PubMed  CAS  Google Scholar 

  39. Shulman LM, Taback RL, Bean J, Weiner WJ (2001) Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord 16:507–510

    Article  PubMed  CAS  Google Scholar 

  40. Starkstein SE, Mayberg HS, Leiguarda R, Preziosi TJ (1992) A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 55:377–382

    PubMed  CAS  Google Scholar 

  41. Steur EN, Ballering LA (1997) Moclobemide and selegiline in the treatment of depression in Parkinson's disease. J Neurol Neurosurg Psychiatry 63:547

    Article  PubMed  CAS  Google Scholar 

  42. Tandberg E, Larsen JP, Aarsland D, Cummings JL (1996) The occurrence of depression in Parkinson's disease. A community-based study. Arch Neurol 53:175–179

    PubMed  CAS  Google Scholar 

  43. Tesei S, Antonini A, Canesi M, Zecchinelli A, Mariani CB, Pezzoli G (2000) Tolerability of paroxetine in Parkinson's disease: a prospective study. Mov Disord 15:986–989

    Article  PubMed  CAS  Google Scholar 

  44. Weintraub D, Morales KH, Moberg PJ, Bilker WB, Balderston C, Duda JE, Katz IR, Stern MB (2005) Antidepressant studies in Parkinson's disease: a review and meta-analysis. Mov Disord 20:1161–1169

    Article  PubMed  Google Scholar 

  45. Weisskopf M, Chen H, Schwarzschild M, Kawachi I, Ascherio A (2003) Prospective study of phobic anxiety and risk of Parkinson's disease. Mov Disord 18:646–651

    Article  PubMed  Google Scholar 

  46. Wermuth L, Sorensen P, Timm S, Christensen B,Utzon N, Boas J, Dupont E, Hansen E Magnussen I, Nikkelsen B, Worm-Petersen J, Lauritzen L, Bayer L, Bech P (1998) Depression in idiopathic Parkinson's disease treated with citalopram. Nord J Psychiatry 52:163–169

    Article  Google Scholar 

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  1. Dept. of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Werner Poewe M.D.

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Correspondence to Werner Poewe M.D..

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Poewe, W. Depression in Parkinson's disease. J Neurol 254 (Suppl 5), 49–55 (2007). https://doi.org/10.1007/s00415-007-5008-4

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  • DOI: https://doi.org/10.1007/s00415-007-5008-4

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