Data Extraction And Analyses
The following data were extracted from the selected articles: authors, type of study, participant characteristics, intervention type, diagnostic criteria, primary and secondary outcomes measures, efficacy and safety of the intervention, and summary measures, including risk ratio and difference in means.
Section Iv: Treatment Of Depression In Pd Patients
The benefits of depression treatment are still unclear with the current available data . A couple of meta-analysis of randomized clinical trials by Bomasang-Layno et al. and Mills et al. found that pharmacological therapy of depression in PD ameliorates this condition , while Troeung and colleagues determined a modest yet not a statistically significant effect of antidepressants compared with placebo . Other more sceptical authors argue that antidepressants ensure only partial success and that poor adherence to treatment is associated to an increase in all-cause mortality in PD patients . Overall, there is a need of comparative RCT to consistently pinpoint treatment efficacy and select one drug over another .
No conclusions could be drawn on whether agomelatine and trazodone constitute good treatment choices in this context . There is still little evidence on both drugs, but it is thought that agomelatine may bear double therapeutic potential as a safe antidepressant and a circadian rhythm regulator due to its novel melatonergic mechanism of action .
When Should I Talk To My Healthcare Provider
Talk to your healthcare providers about your mood at every appointment. Talking about it regularly will prompt you to open up. And it will help your healthcare providers notice symptoms of depression early so they can provide care.
If you start to think about hurting yourself, call a healthcare provider immediately. You can also call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.
In an emergency, call 911.
A note from Cleveland ClinicDepression from Parkinsons disease isnt a sign of weakness or something you have to live with. Its related to chemical changes in your brain, and treatments can help. Talk to your healthcare provider about your mood, especially if you feel down for weeks at a time. Several strategies can help you feel better. You can still take part in things you enjoy and better manage the symptoms of Parkinsons disease.
Last reviewed by a Cleveland Clinic medical professional on 12/20/2020.
References
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Brain Chemistry In Parkinsons Disease
Parkinsons disease is caused by a lack of dopamine production in the pars compacta region of the brain.
Dopamine helps to regulate the way a person moves. Reduced dopamine leads to the physical symptoms of Parkinsons disease.
Reduced levels of serotonin can affect a persons mood and may cause them to experience depression.
Depression In Parkinsons Disease
Diagnosis and management of depression in Parkinsons disease is important for two main reasons: firstly, depression is common in PD , and secondly depression causes significant morbidity in terms of quality of life, disability , and carer stress. This effect is independent from the effect of motor disability.
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Helping Parkinsons Patients With Depression
Due to changes that Parkinsons causes in the chemistry of the brain, depression is a common side effect. Even though at least half of those with PD suffer with depression, most go undiagnosed or are under-treated. This short article explains the physiological and psychological factors that contribute to depression, the most common symptoms and numerous treatment options.
Mood Changes In Parkinson’s
When faced with a diagnosis of Parkinson’s disease , it is understandable to feel depressed or anxious. But mood disorders such as depression and anxiety are clinical symptoms of Parkinson’s, just as are slowness of movement and tremor. In fact, up to half of all people with Parkinson’s may suffer from depression and/or anxiety at some point during the course of their disease. Like all symptoms of PD, mood changes are different for different people. Some people with depression feel sad and lose interest in things they used to enjoy, while others feel irritable and have difficulty sleeping. People with anxiety often feel overly worried or concerned, or say they are “on edge.”
The good news: Over the past decade, researchers have placed increasing focus on these aspects of PD, and today we have a better understanding of how to treat mood disorders in Parkinson’s.
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What Is The Outlook For Depression With Parkinsons Disease
Many people with Parkinsons disease have depression but dont get help for it. They may not notice their symptoms, or may think the symptoms are unavoidable with Parkinsons.
What they may not realize is that medications, therapy and lifestyle changes can help. Many people find some relief from depression. And that helps reduce their symptoms of Parkinsons disease.
Whats The Link Between Parkinsons Disease And Depression
Parkinsons disease is a neurological condition caused by the loss of dopamine cells in the brain. As many people know, PD causes motor symptoms such as tremor, rigidity and slowed movement, but it can also be responsible for dementia, psychosis, anxiety and depression.
It is estimated that over 50% of people with PD will experience depression at some stage. Common symptoms of Parkinsons disease depression include:
- Loss of interest in hobbies and day-to-day activities
- Low energy
- Persistent low mood and apathy not seeing the point in anything
- Pessimistic feelings or views about the world
- Thoughts of self-harm or suicide, known as suicidal ideation
If you experience the symptoms of Parkinsons disease depression, its important to report them to your doctor so you can access help and support. Parkinsons can take its toll physically and emotionally, but there is no need to suffer in silence. Depression is common in those with and without Parkinsons disease, and there are plenty of ways to treat it.
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Treating Depression In Parkinsons Disease: Study Results
Patients in all three treatment groups, including the placebo group, showed improvement on a commonly used scale to gauge depression known as the Hamilton Rating Scale.
Those on antidepressants improved more than did those on placebo, Richard says.
On average, those getting Paxil had a 59% improvement. Those taking Effexor had a 52% improvement. Those who got the placebo had a 32% improvement.
Richard evaluated their depression using three other scales and found similar results.
There was no effect on movement ability.
Richard cant say which antidepressant type is better for treating depression in Parkinsons disease, she says. The study did not do a head-to-head comparison of the two types.
Each type, SSRI and SNRI, includes many different medicines, so patients have a choice, she says.
Both medicines studied are available as generics, Richard says. At the doses studied, the cost would be about $20 to $30 a month.
Patients reported side effects such as insomnia, constipation, sexual dysfunction, and fatigue. Three patients, including one in the placebo group, had serious side effects. These included chest pressure, bowel obstruction, and heart rhythm problems.
However, only the patient with heart rhythm problems withdrew.
Wyeth Pharmaceuticals provided the venlafaxine XR. Glaxo SmithKline provided the paroxetine.
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Treating Depression In Parkinson’s Disease
Depression in people with Parkinson’s is still under-recognized and under-treated, Richard tells WebMD.
As doctors have become more aware of how common it is, she says, they have struggled with how best to treat it.
Older antidepressants known as tricyclic antidepressants are sometimes used, she says. But their use is linked with certain types of heart problems and other side effects.
Richard’s team studied paroxetine and venlafaxine extended release , comparing it to placebo.
Paroxetine is an SSRI , which affects levels of the hormone serotonin in the brain, improving mood.
Venlafaxine extended release is an SNRI . It works by balancing the two hormones to improve mood.
The 115 patients all had both Parkinson’s and clinical depression. Patients had to be at least 30 years old and free of dementia. They were treated at 20 different centers in the U.S., Canada, and Puerto Rico from June 2005 through March 2009.
The patients were assigned to one of three groups: paroxetine, venlafaxine, or placebo.
The patients took a maximum of 40 milligrams of paroxetine or 225 mg of venlafaxine daily.
The researchers evaluated their depression at the start and throughout the 12-week study. They looked to see if the treatment affected their movement ability.
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Parkinsons Disease And Depression: Causes And Treatments
Parkinson’s disease and depression are incredibly common, but that doesn’t make them easy to live with. Depression can occur as the result of the emotional challenges of Parkinson’s disease as well as from chemical changes in the brain or medication side-effects. Depression in Parkinson’s disease can be treated much the same as for the general population, with some exceptions. Let’s explore everything we know about Parkinson’s disease and depression, including causes, symptoms and treatments.
Association Between Depression And Other Non
The association of depression with other neuropsychiatric non-motor symptoms is particularly frequent in PD, which is considered as indirect evidence of co-occuring, and possibly intricately linked or synergistic pathophysiological mechanisms.
Anxiety is long recognized as one of the most frequent comorbid conditions accompanying depression , although both conditions may exist on their own . As such, risk factors are partly distinct in depression with or without anxiety, and, in particular, anxiety may be more frequent in patients aged < 60 years at diagnosis, and be related to motor fluctuations . Furthermore, the prevalence of depressive disorder is greater in patients with non-specific anxiety subtypes . In addition, anxiety is an important risk factor when considering incident depression, besides insomnia . Apathy is also frequently associated with depression, leading to consider a hypodopaminergic neuropsychiatric triad consisting of apathy, depression and anxiety in PD . However, association of depression on one side, with apathy and anxiety on the other side, is complex, as symptoms most frequently co-exist , although they also occur in isolation , which may indicate overlapping and also distinct pathophysiological mechanisms related to distinct prognostic outcomes .
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How Is Depression Treated In People With Parkinsons Disease
Depression can make the symptoms of Parkinsons disease worse. Its important to identify and treat depression as soon as possible.
Several strategies can improve your mood and your movement. Theyre much more effective when used together. Treatments for depression when you have Parkinsons include:
- Medications: Many medications can help treat depression. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are the most common type prescribed to people with Parkinsons disease. Your healthcare provider can recommend the right medication for your particular needs.
- Psychological therapy: Counseling, or talk therapy, can help you manage the emotional challenges that come with Parkinsons disease. For example, cognitive-behavioral therapy can help you unlearn negative thoughts and behaviors. Instead, youre encouraged to focus on positive emotions and actions. CBT can help you understand your self-worth, maintain your relationships and solve problems. Support groups, in person or online, can also provide emotional therapy.
Theres increasing evidence that regular exercise and leading a healthy lifestyle also helps lessen feelings of depression in Parkinsons disease. Check with your doctor about the types of exercise you can do safely without injuring yourself. Eat a well-balanced diet, limit alcohol and dont smoke, as well.
How Can I Notice Depression Symptoms Earlier
The earlier you notice and report symptoms of depression, the earlier your healthcare providers can help you. Consider the following:
- Ask a friend or family member to look out for any changes in your mood, since you might not notice.
- Bring a loved one to your appointments. They can contribute to conversations about your mood.
- Ask a healthcare provider to screen you for depression at least once a year. Many questionnaires and tools are able to identify depression.
- Talk with your healthcare providers about your mood at every appointment. Mention if your mood has changed since your last appointment or if you have any symptoms of depression.
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Treating Depression In Parkinsons Disease: Perspective
The study has critical information for patients and caregivers, says Michael S. Okun, MD, national medical director of the National Parkinson Foundation. He reviewed the findings.
The bottom-line message is that treatment for depression in Parkinsons disease matters, he says. An important aspect of this particular study was that it had a placebo group, and that the investigators showed that either antidepressant performed better than placebo for Parkinson patients.
An editorial that accompanies the study concludes that depression in Parkinsons patients may be as treatable as it is in the general population.
Natural Treatment For Parkinsons #1 Cannabis/medicalmarijuana:
Cannabis, aka medical marijuana, is an incredibletreatment for Parkinsons disease. You can have a Parkinsons patient shakingviolently and uncontrollably, and yet within 30-40 minutes of self-administering with some cannabis, their symptoms will almost completely disappear. Watch this short 2minute video from Parkinsons sufferer, Ian Frizell, who shows you what he waslike before self-medicating with cannabis and then again after. The change is truly astonishing!
Taylor French is another Parkinsons patient thatundergoes a remarkable transformation once he ingests what he calls nutritional vegetable extract . This guy has an advanced form ofParkinsons and is normally confined to a wheelchair with limited use of hisbody due to stiff and rigid muscles . But after ingestingsome cannabis hes able to walk, and incredibly, in his video he even getsinto his car and drives off down the road!
You can view it here
Elyse Del Francia also tells the story of her Parkinsonssuffering husband, and the time she decided to smother his morning pancakes withsome canabutter. She said
Within45 minutes of eating a pancake with marijuana on it, he stopped shaking. Thatwas my lightbulb moment. Thats when I knew that I was onto something thatwould relieve his pain and suffering, because its horrible, horrible, to haveParkinsons Disease and not have any relief. I feel that this is something thathelps so many people in so many ways with pain and suffering.5
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Ask The Md: Depression And Anxiety In Parkinsons Disease
This 4-minute video is a summary of depression and anxiety symptoms in Parkinsons disease by Dr. Rachel Dolhun. She packs a lot of information into such a short time, explaining precisely how both can be managed with medication, talk therapy and/or behavioral strategies, such as regular exercise and social activities.
Psychosocial Reactivity And Depression
Psychosocial variables, such as coping style and amount of social support, may predict depression more reliably than severity, illness duration, and functional disability . For instance, examined the influence of psychosocial variables in predicting depression in PD patients. Overall, the best predictors of depression were functional disability, low self-esteem, and avoidant coping. These variables accounted for 46% of the variance in depression. Furthermore, positive affect and cognitive coping significantly predicted lower depression. This study found that disease-related variables do not predict a large portion of the variance in the depression that is experienced in PD. The observed inconsistent findings suggest that the reactivity model is in need of revision and should also include psychosocial variables .
In summary, as evidence does not permit discrete choice between the biomedical or psychological position with respect to the etiology of PD depression, a more parsimonious perspective should include a combination of endogenous and exogenous factors . Therefore, we further examined the literature on treatment options for PD depression to understand its etiology towards improving quality of life for this neuropsychiatric population.
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Difficulties In Diagnosing Depression In Patients With Parkinson’s
- Certain symptoms of depression overlap with symptoms of PD for example, sleep problems and feeling slowed down occur in both conditions.
- Some experts think that depression in PD often involves frequent, shorter changes in mood versus a constant state of sadness daily.
- Many people with PD express less emotion due to the effect the disease has on the muscles of the face. This symptom, called facial masking, makes a person unable to express emotion through facial expressions.
- Many people with Parkinsons do not seek treatment because they often do not recognize they have a mood problem or are unable to explain symptoms. For these reasons, it is helpful to ask a caregiver or loved one if he or she has noticed any changes commonly reported in depression.
Symptoms Of Depression In Ms
Like Parkinsons disease, vegetative or somatic symptoms do not tend to be good diagnostic discriminators for depression in MS. Some vegetative symptoms may be specifically related to fatigue rather than depression, but this area is fraught with methodological and conceptual difficulties. One study has indicated that disinterest in sex was uniquely related to depression in MS . Important clues to depression in MS are illustrated in table 4.
Important clues to depression in multiple sclerosis
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Preventing And Treating Depression After Stroke
A recently published Cochrane review examined trials that looked at interventions to prevent depression after stroke. They found 12 trials that fulfilled the criteria for inclusion . None of the included drug trials indicated a prophylactic effect of antidepressant medication, compared to placebo. However, one trial of psychotherapy had a small but significant effect size.
Since that review was published, a more recent study has compared the effect of early versus late antidepressant treatment on a functional outcome measure in 62 stroke patients. They found that early, prophylactic treatment led to an enhanced functional outcomean effect that persisted over the two years of the study.
Treatment trials have indicated that SSRI treatments and other antidepressants are superior to placebo. There have also been small trials supporting the use of transcranial magnetic stimulation.