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Richard IH. Depression in Parkinson's Disease. Curr Treat Options Neurol. 2000;2(3):263-274doi: 10.1007/s11940-000-0008-z.
Richard, I. H. (2000). Depression in Parkinson's Disease. Current treatment options in neurology, 2(3), 263-274. https://doi.org/10.1007/s11940-000-0008-z
Richard. "Depression in Parkinson's Disease." Current treatment options in neurology vol. 2,3 (2000): 263-274. doi: https://doi.org/10.1007/s11940-000-0008-z
Richard IH. Depression in Parkinson's Disease. Curr Treat Options Neurol. 2000 May;2(3):263-274. doi: 10.1007/s11940-000-0008-z. PMID: 11096753.
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Curr Treat Options Neurol. 2000 May;2(3):263-274. doi: 10.1007/s11940-000-0008-z.

Depression in Parkinson's Disease.

Current treatment options in neurology

Richard

Affiliations

  1. University of Rochester, Movement Disorder Unit, 601 Elmwood Avenue, Box 673, Rochester, NY 14642, USA. [email protected]

PMID: 11096753 DOI: 10.1007/s11940-000-0008-z

Abstract

Depression is very common in Parkinson's disease (PD), but its severity and particular symptoms vary. It can often be difficult to diagnose because many of the symptoms typically associated with depression (eg, sleep difficulties, fatigue) can be seen in nondepressed patients with PD, and signs thought to represent depression (eg, lack of facial expression, slowness) can be produced by PD itself. Apathy, although a possible feature of depression, can exist apart from depression and is often associated with cognitive impairment. Therefore, when evaluating patients with PD for possible depression, one should concentrate on the psychological or ideational aspects of the illness. One must determine whether the patient feels sad or hopeless or has a marked inability to enjoy life. Once it has been determined that the patient has clinically significant depressive symptoms, it is important to let him or her know that depression is an aspect of PD requiring treatment, just like the motor manifestations of the disease. The idea of adding antidepressant medications and the possibility of psychotherapy should be introduced. A very reasonable first-choice antidepressant is either sertraline or paroxetine. Because of isolated case reports of worsening motor function associated with institution of a selective serotonin reuptake inhibitor (SSRI), one should keep track of when the medication was started so that the patient can be seen again within a month. It is important from a psychological perspective to have regular follow-up visits when treating depression. If the SSRIs are ineffective or not tolerated, nortriptyline is a good next choice. It has fewer anticholinergic effects and is less likely to cause or worsen orthostatic hypotension than other tricyclic antidepressants. Amitriptyline, although an old favorite of neurologists, is very sedating and has too much anticholinergic activity to be well tolerated in the higher doses needed to treat depression. If a patient could benefit from a dopamine agonist from a motor standpoint and his or her depressive symptoms are mild, consider using pramipexole, which may improve mood and motivation (although this has not yet been proven in a well-controlled trial). It is a good idea to keep patients on antidepressant therapy at least 6 months; many patients require long-term treatment. If a patient is severely depressed, he or she should be referred to a psychiatrist, who may consider admission to the hospital and possible electroconvulsive therapy.

References

  1. Mov Disord. 1999 Jan;14(1):155-7 - PubMed
  2. Acta Neurol Scand. 1969;45(1):109-13 - PubMed
  3. J Neuropsychiatry Clin Neurosci. 1996 Fall;8(4):373-82 - PubMed
  4. J Neurol Neurosurg Psychiatry. 1997 Oct;63(4):547 - PubMed
  5. Am J Psychiatry. 1989 Oct;146(10):1352-3 - PubMed
  6. J Clin Psychiatry. 1992 Aug;53(8):278-82 - PubMed
  7. J Neuropsychiatry Clin Neurosci. 1995 Summer;7(3):281-6 - PubMed
  8. Clin Pharmacol Ther. 1996 Apr;59(4):450-7 - PubMed
  9. Convuls Ther. 1997 Dec;13(4):274-7 - PubMed
  10. Neurology. 1997 Oct;49(4):1168-70 - PubMed
  11. Ann Pharmacother. 1994 Mar;28(3):405-6 - PubMed
  12. Can J Neurol Sci. 1994 Aug;21(3):259-61 - PubMed
  13. Mov Disord. 1997 Sep;12(5):756-9 - PubMed
  14. Neurology. 1999 Mar 10;52(4):768-70 - PubMed
  15. Neurology. 1992 Sep;42(9):1813-4 - PubMed
  16. J Neurol Sci. 1999 Jan 15;162(2):179-84 - PubMed
  17. Arch Fam Med. 1998 May-Jun;7(3):274-80 - PubMed
  18. Br Med J. 1965 Jul 3;2(5452):33-4 - PubMed
  19. Neurology. 1993 Jan;43(1):211-3 - PubMed
  20. Arch Gen Psychiatry. 1999 Apr;56(4):315-20 - PubMed
  21. Am J Psychiatry. 1999 Apr;156(4):669; author reply 669-70 - PubMed
  22. Neurology. 1984 Aug;34(8):1092-4 - PubMed
  23. Acta Neurol Scand. 1980 Oct;62(4):210-9 - PubMed
  24. Mov Disord. 1996 Sep;11(5):581-2 - PubMed
  25. Clin Neuropharmacol. 1997 Oct;20(5):419-33 - PubMed
  26. J Psychother Pract Res. 1997 Winter;7(1):47-55 - PubMed
  27. Am J Psychiatry. 1991 Jun;148(6):705-13 - PubMed
  28. Mov Disord. 1999 Jan;14(1):157-8 - PubMed
  29. Pharmacopsychiatry. 1999 Mar;32(2):47-55 - PubMed
  30. Neuroreport. 1999 Feb 25;10(3):589-94 - PubMed
  31. Can J Psychiatry. 1990 Aug;35(6):571-2 - PubMed
  32. Am J Geriatr Psychiatry. 1997 Spring;5(2):97-106 - PubMed
  33. Br J Psychiatry. 1994 May;164(5):665-73 - PubMed
  34. Mov Disord. 1995 May;10(3):355-7 - PubMed
  35. Neurology. 1997 Apr;48(4):1070-7 - PubMed
  36. Arch Neurol. 1992 Mar;49(3):305-7 - PubMed
  37. J Neural Transm Suppl. 1998;52:49-61 - PubMed
  38. J Neurol. 1997 Aug;244(8):493-8 - PubMed
  39. Am J Psychiatry. 1997 Dec;154(12):1752-6 - PubMed
  40. Neurology. 1994 Dec;44(12):2406 - PubMed

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