The Treatment Of Depression In Pd
Our PRISMA review included all RCTs for depression in PD, patient-control studies, and case series collected as described above. We focused on efficacy and side effects, and the results of pharmacological and nonpharmacological treatments are summarized below.
Pharmacological treatment
Efficacy of antidepressant medication
We also reviewed published meta-analyses of antidepressants in PD that included several older RCTs. A meta-analysis by Skapinakis and colleagues focused on the efficacy of SSRIs only and included 10 studies that used citalopram, sertraline, fluoxetine, paroxetine, or fluvoxamine. There was no efficacy for SSRIs in patients with PD, with a crude response rate of 34% for SSRIs and 36% for placebo. This response rate is similar to that reported for placebo in meta-analysis for antidepressants in non-PD depression, suggesting that depression in PD is responsive to treatment but that the efficacy is rendered nonsignificant by a high placebo effect. STAR*D , a drug trial for âprimaryâ depression that included patients who had clinical profiles similar to patients who attended general practices, showed a remission rate for citalopram of 27% as measured by the Hamilton Rating Scale for Depression. Skapinakis et al. also concluded that the small number of RCTs that used TCAs does not allow conclusive recommendations regarding this type of antidepressant.
Efficacy of antiparkinsonian medication
Psychotherapy
Repetitive transcranial magnetic stimulation
A New Study Found That Vitamin C And Vitamin E Could Successfully Reduce The Risk Of Parkinsons Disease
The new researchpublished on Jan. 6, 2021 in the journal Neurologywas conducted with 41,058 adults, a mix of men and women ranging in age from 18 to 94 years old, who were studied for an average of 17.6 years. None of the participants were previously diagnosed with Parkinsons disease. The participants were divided into three vitamin consumption groups for the study, those with the highest intake, those with moderate intake, and those with the lowest intake. Across the nearly 18-year timespan of the research, 465 peopleor 1.1 percent of participantswere diagnosed with Parkinsons disease.
After looking at the results, the researchers concluded that vitamin C and vitamin E can reduce your risk of Parkinsons disease. Our large study found that vitamin C and vitamin E were each linked to a lower risk of Parkinsons disease, and we found the association may be even stronger when intake of both vitamin C and E is high,Essi Hantikainen, PhD, of one of the co-authors of the study, said in a statement.
Postural Exercises May Reduce Stooping
One of the most noticeable effects of Parkinsons disease can be on a persons posture. Our brains work to alert our bodies to stay upright via automatic impulse, but when you have Parkinsons, this process can be disrupted, leading to a more stooped posture, says the Parkinsons Foundation. This can be exacerbated by muscles becoming stiff, a common issue for people living with Parkinsons.
One of the best ways to combat this head-on is by focusing on postural exercises, performing them repeatedly throughout the day to remind you to stand upright, says Parkinson Society Canada. A simple way to do this is to perform a check-in whenever you pass a wall. Stand with your back to it and straighten out your posture, connecting your lower back, shoulder blades, and the back of your head with the wall. If youre sitting in a chair you can do a similar action, leaning back into it, connecting your shoulder blades with the chairs back, and holding there for a few seconds before releasing and repeating. It may seem small, but frequent repetitions can create improvements over time and refresh your bodys memory for good posture.
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Changing Meds Ups Risk
Between the studys start and follow-up, 23% of women experienced a change in their medication, including 13% of women who switched from nonuse to using any of the medication, and 1o% who stopped using a medication.
Women who experienced a change in medication either an addition or removal also were more likely to develop Parkinsons. This finding is likely due to the fact that degeneration is ongoing and that depression/anxiety are part of a changing, progressing disease, with changing manifestations that can result in changing treatments, the researchers wrote.
The team similarly analyzed a subgroup of women who had been specifically diagnosed with depression, anxiety, or a sleep disorder at the beginning of the study. This group comprised 27,631 women, who were followed for an average of 14.29 years. Ultimately, 1,137 of them developed Parkinsons.
Analyses for this subgroup revealed similar findings to those from the overall sample, with the use of anti-depressants and anti-anxiety medications linked to a higher Parkinsons risk.
While the findings overall link the use of psychotropic medications to Parkinsons onset in older women, a possible explanation is that the underlying psychiatric disorders, namely depression/anxiety, are the actual predisposing factors for , the researchers noted.
Treating Depression In Parkinson’s 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 Parkinson’s 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 Parkinson’s patients may be as treatable as it is in the general population.
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Tips For Coping With Depression
Caring for your mental well-being is key to living well with Parkinson’s. These strategies can help you manage depression:
- Empower yourself with knowledge about PD and its symptoms, including depression.
- Ask for help it takes courage, but it also puts you in control of finding a way to feel better and overcome feelings of helplessness.
- Keep an open mind. Depression is not a personal failing or a sign of weakness, it is a chemical imbalance in the brain.
- Plan short-term goals that you can achieve daily. Makes plans to walk, do a chore or talk to a friend. Small accomplishments contribute to a feeling of self-worth.
- Maintain social ties. Plan to connect with a friend once a week or take on volunteer work.
- Plan something to look forward to. Think about things you can do to enhance your quality of life and plan how to achieve them in small steps.
- If you have stopped or cut back on leisure activities because of Parkinson’s, try to resume one that you enjoyed or find a new one.
- Connect with the PD community. Compare notes on coping with depression with members of a support group.
Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson’s Foundation Center of Excellence.
How Is Depression Diagnosed
Diagnosis is vital to effective treatment and recovery. A person must experience one of the following symptoms most of the time over the previous two weeks:
- Loss of interest or pleasure in activities once enjoyed
In addition, some of the following symptoms must be present:
- Changes in sleep or appetite
- Increased fatigue
- Suicidal thoughts or a wish for death
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Effectiveness On Depressive Symptoms
Considering the results of the present scoping review, the first question that can be answered relates to Bupropion antidepressant effectiveness in patients with PD. Overall, most of the retrieved reports seem to support its use. Indeed, the RCT and three reviewed open-label studies demonstrated a variable degree of the antidepressant effectiveness of Bupropion in patients with PD. Similarly, the majority of case reports who measured depressive outcomes showed improvement of depressive symptoms, while only one reported no changes. Despite diverse methodology and publication biases , we can conclude that Bupropion is potentially a valuable treatment option to target depressive symptoms in patients with PD. This recommendation is supported by the treatment guidelines from the Neurological Association of Madrid , specifically indicating Bupropion for the treatment of apathy associated with PD, though with a low level of evidence and grade of recommendation . Apathy is a common symptom in PD patients, with a frequency reported between 16.5% and 42% of cases of PD . According to these guidelines, Bupropion is the only antidepressant recommended for apathy: thus, it might be particularly useful in PD patients who manifest an intense lack of feelings, emotions, or interests.
Older Antidepressants Work For Parkinson Patients
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NEW YORK People with Parkinsons disease who also suffer from depression may find theyre helped more by an older class of antidepressants than newer types of medication, a small clinical trial sponsored by the National Institutes of Health suggests.
The study found that paroxetine , a so-called SSRI antidepressant, appears to be less effective than the tricyclic antidepressant nortriptyline for treating depression in patients with Parkinsons disease.
Depression in Parkinsons disease is underrecognized, underappreciated and undertreated, lead investigator Dr. Matthew Menza stated in a press release. This study shows that patients should have hope that they can be helped.
SSRIs are usually prescribed for these patients, Menza, at the Robert Wood Johnson Medical School in Piscataway, New Jersey, and his team note in the journal Neurology. However, they theorized that the tricyclic class of drugs would be more effective than SSRIs, because of the way they work.
The investigators randomly assigned 52 patients with Parkinsons disease and major depression to treatment with nortriptyline, paroxetine CR , or an inactive placebo.
Only 34 patients completed the 8-week trial, but based on the available data nortriptyline was seen to be superior to placebo for the change in a standard depression rating scale, whereas paroxetine CR was not.
Furthermore, only nortriptyline was superior to placebo in improving sleep, anxiety, and social functioning.
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Depression In Pd Versus Other Illnesses
Whether depression is found more frequently in PD relative to other non-neurological illnesses is unclear. If PD patients are at greater risk for developing depression, then the affective disturbances found in PD can be related to neurological disease as opposed to a psychosocial stress response in reaction to having a chronic and disabling illness. Several studies examined rates of depression between PD patients and other disabled clinical populations. Again, the collective evidence does not support either a biomedical or psychological interpretation. For instance, three separate studies found that PD patients were significantly more depressed than paraplegics, amputees, and patients suffering from various medical/surgical conditions . However, the comparison groups in these studies were not equivalent to the PD sample with respect to age and duration of illness.
Parkinsons Medication And Alcohol: The Final Word
Whether or not you should drink alcohol while being treated for Parkinsons disease will depend on the medication youre taking. It is worth discussing this issue with your doctor, especially if you have concerns about alcohol dependence or addiction.
General health guidelines state that you should avoid drinking alcohol with any medication that makes you drowsy, sleepy or impairs your concentration. That said, many people with Parkinsons disease find that the occasional glass of wine is not harmful, as long as their doctor has agreed that they can drink in moderation.
You should always speak to your doctor before you mix Parkinsons disease medication and alcohol for the first time. You should never drive or operate heavy machinery when you have been drinking alcohol, and you should make sure you are in safe surroundings to minimize the risk of falls or injury.
APA ReferenceSmith, E. . Can You Drink Alcohol with Parkinsons Disease Medication?, HealthyPlace. Retrieved on 2021, August 28 from https://www.healthyplace.com/parkinsons-disease/treatment/can-you-drink-alcohol-with-parkinsons-disease-medication
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Meds Ease Depression In Parkinsons Patients Without Worsening Other Symptoms
- Meds Ease Depression in Parkinsons Patients Without Worsening Other Symptoms
Todays anti-depressant medications can ease depression in Parkinsons patients without worsening other symptoms of the disease, according to a study published online in Neurology®, the medical journal of the American Academy of Neurology.
Depression is the number-one factor negatively affecting the quality of life for people with Parkinsons disease, said Irene Hegeman Richard, M.D., who led the study. It causes a great deal of suffering among patients. The great news here is that its treatable. And when the depression is treated adequately, many of the other symptoms become much more manageable for patients, added Richard, a neurologist at the University of Rochester Medical Center.
The findings are good news for patients with Parkinsons disease, a chronic neurologic disorder best known for causing slow movement, stiffness, balance problems and other motor difficulties. However, about half of Parkinsons patients also struggle with depression.
Its very important to note that these patients are not depressed simply because they are dealing with a chronic neurological condition, said Richard. Rather, the depression is caused by the underlying disease process, which also causes problems with movement and balance.
Data Charting And Collating Summarizing And Reporting Results
The research team investigators collectively developed the data-charting form to determine which variables to extract. This form was revised during meetings throughout the stages of the review, and uncertainty was resolved with periodic team meetings and the involvement of a fourth investigator . The following variables were extracted from each study: author, year and country of publication, characteristics of patients investigated , Bupropion primarily indication and dosage, results on effectiveness and safety.
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Aerobic Exercises Like Cycling Provide Benefits
If its been a while since you got your bike out, its time to dust off the spokes and grease up the chain. For people with Parkinsons, cycling is an excellent way to exercise, thanks largely to the fact that it delivers a comprehensive aerobic workout. Aerobic exercise is particularly important for individuals with Parkinsons disease to do, not only because it keeps your cardiovascular system and function healthy and improves flexibility , but it also appears to have potent effects on brain function.
A study published in the Annals of Neurology examined the effects of aerobic exercise on the brain, using participants with Parkinsons who took part in stationary bike training three times a week over six months. At the end of the study period, the results looked pretty good. Participants had notably lower brain atrophy, stronger neural connections that led to better motor skills, and better cognitive control when compared to individuals who did different types of exercise for the same period. Not bad, right? And if that wasnt enough, cycling regularly may also improve the gait of people with Parkinsons, according to a further review published in npj Parkinsons Disease, with the reviews authors concluding that cycling provided an overall better quality of life.
Foods Containing Nutrients That People May Be Deficient In
Some research suggests that people with Parkinsons often have certain nutrient deficiencies, including deficiencies in iron, vitamin B1, vitamin C, zinc, and vitamin D.
The above study points out that some of these deficiencies may be associated with neuroinflammation and neurodegeneration, which are key factors in Parkinsons.
Therefore, people with Parkinsons may wish to consume more of the following foods.
Foods containing iron
The following foods are good sources of iron:
- certain fortified foods
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How Can People Cope With Parkinsons Disease
While PD usually progresses slowly, eventually daily routines may be affectedfrom socializing with friends to earning a living and taking care of a home. These changes can be difficult to accept. Support groups can help people cope with the diseases emotional impact. These groups also can provide valuable information, advice, and experience to help people with PD, their families, and their caregivers deal with a wide range of issues, including locating doctors familiar with the disease and coping with physical limitations. A list of national organizations that can help people locate support groups in their communities appears at the end of this information. Individual or family counseling may also help people find ways to cope with PD.
People with PD may also benefit from being proactive and finding out as much as possible about the disease in order to alleviate fear of the unknown and to take a positive role in maintaining their health. Many people with PD continue to work either full- or part-time, although they may need to adjust their schedule and working environment to accommodate their symptoms.
Selective Serotonergic Reuptake Inhibitors
More studies have focused on proving efficacy of tricyclic antidepressants than SSRIs, but SSRIs are reported to have lower side effects, supporting their use in PD patients: they do not affect cardiac conduction, decrease seizure threshold, exert significant quinidine-like effects, or alter blood pressure.22 The main contraindication is the potential competition for metabolism by the cytochrome P450 system sertraline has relatively fewer inhibitory effects than fluoxetine and paroxetine on this system of enzymes.22 Each antidepressant medication should have a six-week trial at the maximum tolerated therapeutic dosage or at the appropriate plasma level.
Table I summarizes interactions between antiparkinsonism and antidepressant medications. As seen in Table II, fluoxetine may worsen parkinsonism all SSRIs may cause akathisia. Both side effects respond to reduction of the SSRI.22
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Treatment Of Depression In The Patient With Parkinson’s Disease
Parkinson’s disease is a common neurological illness, with a prevalence of approximately 100/100,000. Among neurological conditions, PD is the most commonly encountered extrapyramidal movement disorder. The cardinal manifestations of PD result from loss of dopaminergic neurons in the substantia nigra and include resting tremor resembling pill-rolling, slowing of movement , poor balance due to impairment of postural reflexes, and rigidity. The natural history of the illness is long, but two-thirds of PD patients are at least partially disabled five years after onset.1