Depression in Parkinson’s disease

Abstract

Depression is common in Parkinson's disease (PD), and its identification and treatment are critically important in disease management. Despite depression's high prevalence and major impact on patient quality of life, questions remain regarding its epidemiology and preferred treatment. The authors of this paper summarize available information on the epidemiology of depression in PD, review treatment options, and discuss possible interactions between antidepressants and other agents. This information may help guide clinical treatment and define the need for further studies.

High-Frequency Stimulation of the Subthalamic Nucleus and l-3,4-Dihydroxyphenylalanine InhibitIn VivoSerotonin Release in the Prefrontal Cortex and Hippocampus in a Rat Model of Parkinson's Disease

“…This effect may participate in the emergence of cognitive and depressive disorders after short-and long-term treatment in PD (Zesiewicz and Hauser, 2002;Scholtissen et al, 2006). Finally, we provide evidence that the combined approaches, while not aggravating the decrease in 5-HT release, could limit side effects associated with excessive DA transmission in the brain.…”

“…While the two different approaches are very efficient in improving the motor symptoms of the disease, their motor benefits are burdened by the occurrence of psychiatric side effects, including cognitive impairments and mood disorders (Piasecki and Jefferson, 2004;Haber and Brucker, 2009;Van Rooden et al, 2009). Compelling evidence indicates that the serotonergic system, considered as an etiologic and pathophysiological factor in PD (Zesiewicz and Hauser, 2002;Scholtissen et al, 2006), plays a role in cognitive and mood disorders (Piñeyro and Blier, 1999;Bhagwagar et al, 2002). Changes in serotonergic function could participate in nonmotor side effects induced by antiparkinsonian therapies (Melamed et al, 1996).…”

Contribution of Serotonergic Transmission to the Motor and Cognitive Effects of High-Frequency Stimulation of the Subthalamic Nucleus or Levodopa in Parkinson’s Disease

“…Both antiparkinsonian approaches reduce 5-HT release in the PFC, HIPP and striatum through distinct mechanisms (cf. paragraphs II and III; [62]), an effect that may participate in the emergence of cognitive and depressive complications [9,56,178]. The combination of both approaches did not further inhibit 5-HT release in limbic structures [62] suggesting that it may not exacerbate the occurrence of these unwanted nonmotor side effects associated with a decreased 5-HT function while limiting cognitive side effects such as pathological gambling or psychosis associated with excessive DA transmission [179][180][181].…”

Neuropsychiatric aspects of Parkinson’s disease: Recent advances

“…Recently, a 4-week open-label study of reboxetine, a norepinephrine reuptake inhibitor, showed it was effective and generally well tolerated in PD-related major depression, but one patient developed psychosis [57]. Prospective open-label studies using selective serotonin reuptake inhibitors (SSRIs; paroxetine and sertraline) also report reduced depressive symptoms [58]. The open-label design limits generalization of the data.…”