Anhedonia, Depression, and Motor Functioning in Parkinson’s Disease During Treatment With Pramipexole

Abstract

Anhedonia, a core symptom of depression, correlates with motor alterations in major depressive disorder and has been assumed to be frequent in depressed patients with Parkinson's disease (PD). In the present study, the authors assessed for the first time frequency of anhedonia in patients with idiopathic Parkinson's disease (N = 657) and the relationship of anhedonia and parkinsonian motor deficits during treatment with pramipexole. Mild depression was present in 47% of the patients and moderate to severe depression in 22%. Anhedonic individuals included 45.7% of all patients and 79.7% of depressed Parkinson's disease patients. Anhedonic Parkinson's disease patients had greater motor deficits, restrictions in activities of daily living, and depression compared to nonanhedonic patients. Frequency of anhedonia and depression was significantly reduced during treatment with pramipexole. Future studies should further investigate antianhedonic efficacy of dopamine agonists including pramipexole in depressed patients with Parkinson's disease.

Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease

“…A randomized, open-label comparative trial reported a significant decrease in Zung depression score after eight months of either pramipexole or pergolide; improvement on the Montgomery-Åsberg Depression Rating Scale was seen only among the pramipexole recipients [19]. Another, observational study involving 657 PD outpatients found that pramipexole improved anhedonia, as evaluated by the Snaith-Hamilton Pleasure Scale [14]. Both studies included PD patients with motor complications such as fluctuations and dyskinesia.…”

“…Both agonists exhibited an antidepressant effect, as measured by the Zung self-rating depression scale, but only pramipexole showed a significant decrease in the average score on the Montgomery-Åsberg Depression Rating Scale. In another study, a prospective observational trial in 657 PD outpatients, pramipexole significantly reduced anhedonia, a core symptom of depression [14].…”

“…In addition, an antidepressant effect has recently been documented in major depressive disorder [3,23] and in bipolar depression [9,27]. An antidepressant effect has also been identified in PD [14,19]. In a prospective randomized study, pramipexole was compared with the ergoline D2 dopamine receptor agonist pergolide [19].…”

Depression and Parkinson?s disease

“…Two controlled studies published recently show antidepressant properties of pramipexole in patients with bipolar II depression. Antidepressive effects of pramipexole have been confirmed in large populations of PD patients during clinical routine using open study designs [5,9]. There is a lack of controlled studies to show the specific effect on depression in PD patients.…”

Cabergoline, a dopamine receptor agonist, has an antidepressant-like property and enhances brain-derived neurotrophic factor signaling

“…Depression is one of the common complications in Parkinson's disease (Yamamoto 2001), and decreased dopamine transmission has been suggested as one of the causes of this phenomenon (Lemke 2008). Indeed, dopamine receptor agonists such as pramipexole and pergolide demonstrated their effectiveness both on depression and motor functioning in patients with Parkinson's disease (Rektorová et al 2003;Lemke et al 2005Lemke et al , 2006Leentjens et al 2009). Patients with treatment-resistant depression were also subjected to administration of dopamine receptor agonist in addition to contemporary antidepressants, and favorable results were reported with regard to pramipexole (Lattanzi et al 2002), bromocriptine (Inoue et al 1996), and pergolide (Izumi et al 2000).…”