Treatment of depressive symptoms in Parkinson's disease

Abstract

Significant depressive disorders are present in approximately 30-40% of patients with Parkinson's disease (PD). Depressive symptoms are correlated with poor health-related quality-of-life (HRQoL) scores, and are the major determinant of HRQoL. Studies that have evaluated pharmacotherapy for depressive symptoms in PD have shown that there is substantial variability in outcomes. Recently, two double-blind, placebo-controlled studies showed the superiority of nortriptyline and desipramine versus placebo and selective serotonin reuptake inhibitors. The antidepressant effects of dopamine agonists have been explored mainly in open and non-controlled studies. In a 14-week randomized trial comparing pramipexole with sertraline in depressed patients without motor complications, the Hamilton Depression Rating Scale score decreased in both groups; however, in the pramipexole group, the proportion of patients who recovered was significantly higher. Recently, in the first 12-week double-blind placebo-controlled clinical trial in PD patients without motor fluctuations on stable levodopa treatment, pramipexole reduced depressive symptoms as measured by Beck Depression Inventory score, with a significant difference in efficacy in favour of pramipexole. These data suggest that pramipexole might represent an alternative to antidepressant drugs to treat depressive symptoms in PD without adding the risk of antidepressant adverse events, and avoid polypharmacy.