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Anxiety and Depression in Parkinson’s Disease

  • MOVEMENT DISORDERS (O SUCHOWERSKY, SECTION EDITOR)
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Opinion statement

Anxiety and depression, while very common problems in Parkinson’s disease (PD), have not been subject to adequate treatment trials. While a handful of double blind placebo-controlled trials of depression have been published, only a small number of subjects have been enrolled in most of these. There have been no adequate treatment trials of anxiety. Thus, most practitioners base their treatments on what has been published in the general population and their own personal experience. The data suggest that depression is probably treatable in some cases, but there are no data to support any drug treatment of anxiety. Much of the rationale for treating these disorders is based primarily on side effect profiles rather than efficacy and is almost entirely based on anecdotal experience. Although we lack convincing data, we do believe in the pharmacologic treatment of depression and anxiety and choose medications based on side effect profiles, some of which may be useful. We favor the selective serotonin reuptake inhibitors (SSRIs) in general for both depression and anxiety because of their relative freedom from side effects but will often choose mirtazapine if insomnia or weight loss is a problem, clonazepam for anxiety without depression if an SSRI is insufficient or if REM sleep behavior disorder is a problem, or a tricyclic antidepressant if drooling is troubling and the patient is not demented. Alternatively, we use the serotonin and noradrenaline reuptake inhibitor venlafaxine in those who do not tolerate an SSRI. SSRIs cannot be used for anxiety on an as needed basis, whereas short-acting benzodiazepines may be useful for this purpose. Psychosocial treatments of both depression and anxiety have also been under-studied, with probable benefits and a benign adverse effect profile.

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Conflict of Interest

Atbin Djamshidian has received honoraria from UCB and Genus.

Joseph H. Friedman has served as a consultant for Teva Pharmaceuticals, Addex Pharmaceuticals, Lundbeck, Roche, Pfizer, and Auspex Pharmaceuticals; has received grant support from the National Institutes of Health, EMD Serono, Teva Pharmaceuticals, Schering Plough, and Avid; has received honoraria from Teva Pharmaceuticals, and General Electric Healthcare; and has received royalties from Demos Press.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, 1 Wakefield Street, WC1N1PJ, London, UK

    Atbin Djamshidian MD

  2. Movement Disorders Program of Butler Hospital and Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA

    Joseph H. Friedman MD

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Djamshidian, A., Friedman, J.H. Anxiety and Depression in Parkinson’s Disease. Curr Treat Options Neurol 16, 285 (2014). https://doi.org/10.1007/s11940-014-0285-6

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