Depression in Parkinson's disease: diagnosis and treatment

Abstract

The prevalence of non-motor symptoms in Parkinson's disease (PD) is high. Depression varies from 20 to 50% of the PD patients, and is associated with increasing disability. The key characteristics of depression are anhedonia and low mood. The recommended scales for screening purposes are: HAM-D, BDI, HADS, MADRS and GDS. As for measurement of severity: HAM-D, MADRS, BDI and SDS. In cases with mild depression, non-pharmacological intervention is the treatment of choice. In moderate depression, antidepressants are required. The choice of an antidepressant should be based mainly on the comorbidities and unique features of the patient. Evidence for antidepressant effectiveness is seen mostly with amitriptyline and nortriptyline, but one should be cautious in elderly patients. Other antidepressants that can be prescribed are: citalopram, escitalopram, sertraline, bupropion, trazodone, venlafaxine, mirtazapine and duloxetin. The dopaminergic agonist pramipexole is a treatment option.

Mirtazapine has a therapeutic potency in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mice model of Parkinson’s disease

“…These observations suggest that NaSSA mirtazapine could be a possible novel therapeutic drug for PD, particularly in regard to avoiding the adverse side effects of ʟ-dopa. Depression in PD patients is the most common psychiatric disturbance [48], and SSRIs are now often used for the treatment [49]. Recently, NaSSA is also used and shown to be effective in the treatment of depression in PD patients as well as SSRI [48,50].…”

“…Depression in PD patients is the most common psychiatric disturbance [48], and SSRIs are now often used for the treatment [49]. Recently, NaSSA is also used and shown to be effective in the treatment of depression in PD patients as well as SSRI [48,50]. However, the effect of NaSSA on motor dysfunction in PD patients is still unknown.…”

Detecting depression in Parkinson disease

“…There are many tools available for depression screening in PD; however, it is unclear which of these tools is most accurate. [9][10][11][12] Narrative reviews exist on this topic but a systematic review for examining tools for detecting depression in PD was not identified. 11,13 The objective of this study was to review the diagnostic accuracy of screening tools for the detection of depression in adult outpatients with PD.…”

The Assessment of Non-Motor Symptoms in Idiopathic Parkinson’s Disease

“…i.e. ; female sex, the onset of Parkinson symptoms before the age of and history of depression before IPD [23][24][25] . There was no statistically significant difference between sexes in terms of depressive symptoms (p=0.19).…”