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Current Neurology and Neuroscience Reports

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01-12-2013 | Movement Disorders (SA Factor, Section Editor)

Depression and Parkinson’s Disease: Current Knowledge

Author: Laura Marsh

Published in: Current Neurology and Neuroscience Reports | Issue 12/2013

Abstract

Depressive disturbances are common in patients with Parkinson’s disease (PD) and influence many other clinical aspects of the disease. In addition to causing inherent emotional distress, depressive disorders negatively impact quality of life, motor and cognitive deficits, functional disability, and other psychiatric comorbidities in patients with PD. Knowledge of the pathophysiology of PD depression remains limited. However, clinical studies demonstrate the efficacy of medications and psychotherapies for PD depression, underscoring the importance of their timely detection and concerted management.

Aarsland D, Marsh L, Schrag A. Neuropsychiatric symptoms in Parkinson's disease. Mov Disord. 2009;24:2175–86.PubMedCrossRef

Hely MA, Morris JG, Reid WG, Trafficante R. Sydney multicenter study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20:190–9.PubMedCrossRef

Starkstein SE, Mayberg HS, Leiguarda R, et al. A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1992;55:377–82.PubMedCrossRef

Müller B, Assmus J, Herlofson K, Larsen JP, Tysnes OB. Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease. Parkinsonism Relat Disord. 2013. doi:10.1016/j.parkreldis.2013.07.010.

Hughes TA, Ross HF, Mindham RH, Spokes EG. Mortality in Parkinson's disease and its association with dementia and depression. Acta Neurol Scand. 2004;110:118–23.PubMedCrossRef

Ravina B, Camicioli R, Como PG, et al. The impact of depressive symptoms in early Parkinson disease. Neurology. 2007;69:342–7.PubMedCrossRef

Shulman LM, Taback RL, Rabinstein AA, Weiner WJ. Non-recognition of depression and other non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord. 2002;8:193–7.PubMedCrossRef

Weintraub D, Moberg PJ, Duda JE, et al. Recognition and treatment of depression in Parkinson's disease. J Geriatr Psychiatry Neurol. 2003;16:178–83.PubMedCrossRef

van der Hoek TC, Bus BA, Matui P, et al. Prevalence of depression in Parkinson's disease: effects of disease stage, motor subtype and gender. J Neurol Sci. 2011;310:220–4.PubMedCrossRef

10.

Dobkin RD, Rubino JT, Friedman J, et al. Barriers to mental health care utilization in Parkinson's disease. J Geriatr Psychiatry Neurol. 2013;26:105–16.PubMedCrossRef

11.

Reijnders JS, Ehrt U, Weber WE, et al. A systematic review of prevalence studies of depression in Parkinson's disease. Mov Disord. 2008;23:183–9. quiz 313.PubMedCrossRef

12.

Slaughter JR, Slaughter KA, Nichols D, et al. Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2001;13:187–96.PubMedCrossRef

13.

• Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, et al. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012;78:998–1006. This study analyzed and summarizes the psychometric properties of commonly used depression rating scales in PD patients.PubMedCrossRef

14.

GPDS Steering Committee. Factors impacting on quality of life in Parkinson's disease: results from an international survey. Mov Disord. 2002;17:60–7.CrossRef

15.

Rojo A, Aguilar M, Garolera MT, et al. Depression in Parkinson's disease: clinical correlates and outcome. Parkinsonism Relat Disord. 2003;10:23–8.PubMedCrossRef

16.

Ishihara L, Brayne C. A systematic review of depression and mental illness preceding Parkinson's disease. Acta Neurol Scand. 2006;113:211–20.PubMedCrossRef

17.

• Aarsland D, Pahlhagen S, Ballard CG, et al. Depression in Parkinson disease - epidemiology, mechanisms, and management. Nat Rev Neurol. 2012;8:35–47. This is a detailed review of the pathophysiological mechanisms identified in PD.CrossRef

18.

Brown RG, MacCarthy B, Gotham AM, et al. Depression and disability in Parkinson's disease: a follow-up of 132 cases. Psychol Med. 1988;18:49–55.PubMedCrossRef

19.

Menza M, Dobkin RD, Marin H, et al. The impact of treatment of depression on quality of life, disability and relapse in patients with Parkinson's disease. Mov Disord. 2009;24:1325–32.PubMedCrossRef

20.

Ravina B, Elm J, Camicioli R, et al. The course of depressive symptoms in early Parkinson's disease. Mov Disord. 2009;24:1306–11.PubMedCrossRef

21.

Paumier KL, Siderowf AD, Auinger P, et al. Tricyclic antidepressants delay the need for dopaminergic therapy in early Parkinson's disease. Mov Disord. 2012;27:880–7.PubMedCrossRef

22.

Menza MA, Robertson-Hoffman DE, Bonapace AS. Parkinson's disease and anxiety: comorbidity with depression. Biol Psychiatry. 1993;34:465–70.PubMedCrossRef

23.

• Dobkin RD, Menza M, Bienfait KL, et al. Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management. Am J Geriatr Psychiatr. 2011;19:222–9. This was the first major controlled trial of CBT for depression in PD.CrossRef

24.

Dobkin RD, Menza M, Bienfait KL, et al. The impact of antidepressant treatment on cognitive functioning in depressed patients with Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2010;22:188–95.PubMedCrossRef

25.

Alexopoulos GS, Kiosses DN, Heo M, et al. Executive dysfunction and the course of geriatric depression. Biol Psychiatry. 2005;58:204–10.PubMedCrossRef

26.

Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol. 2006;5:235–45.PubMedCrossRef

27.

Mayberg HS, Solomon DH. Depression in Parkinson's disease: a biochemical and organic viewpoint. Adv Neurol. 1995;65:49–60.PubMed

28.

Ehmann TS, Beninger RJ, Gawel MJ, Riopelle RJ. Depressive symptoms in Parkinson's disease: a comparison with disabled control subjects. J Geriatr Psychiatry Neurol. 1990;3:3–9.PubMedCrossRef

29.

• Rod NH, Bordelon Y, Thompson A, et al. Major life events and development of major depression in Parkinson's disease patients. Eur J Neurol. 2013;20:663–70. This is a reminder that life events, and not just PD, influence the development of depressive disturbances.PubMedCrossRef

30.

Matsui H, Nishinaka K, Oda M, et al. Minor depression and brain perfusion images in Parkinson's disease. Mov Disord. 2006;21:1169–74.PubMedCrossRef

31.

Mayberg HS, Starkstein SE, Sadzot B, et al. Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease. Ann Neurol. 1990;28:57–64.PubMedCrossRef

32.

Weintraub D, Newberg AB, Cary MS, et al. Striatal dopamine transporter imaging correlates with anxiety and depression symptoms in Parkinson's disease. J Nucl Med. 2005;46:227–32.PubMed

33.

Vriend C, Raijmakers P, Veltman DJ, et al. Depressive symptoms in Parkinson's disease are related to reduced [123I]FP-CIT binding in the caudate nucleus. J Neurol Neurosurg Psychiatry. 2013. doi:10.1136/jnnp-2012-304811.

34.

Kostic VS, Agosta F, Petrovic I, et al. Regional patterns of brain tissue loss associated with depression in Parkinson disease. Neurology. 2010;75:857–63.PubMedCrossRef

35.

Matsui H, Nishinaka K, Oda M, et al. Depression in Parkinson's disease. Diffusion tensor imaging study. J Neurol. 2007;254:1170–3.PubMedCrossRef

36.

Bohnen NI, Kaufer DI, Hendrickson R, et al. Cortical cholinergic denervation is associated with depressive symptoms in Parkinson's disease and parkinsonian dementia. J Neurol Neurosurg Psychiatry. 2007;78:641–3.PubMedCrossRef

37.

• Huot P, Fox SH. The serotonergic system in motor and non-motor manifestations of Parkinson's disease. Exp Brain Res. 2013;230(4):463–76. This is a detailed review of the evidence, or lack of evidence, for serotonin mechanisms in PD depression.

38.

Politis M, Wu K, Loane C, et al. Depressive symptoms in PD correlate with higher 5-HTT binding in raphe and limbic structures. Neurology. 2010;75:1920–7.PubMedCrossRef

39.

Grachev ID. Dopamine transporter imaging with [123I]FP-CIT (DaTSCAN) in Parkinson's disease with depressive symptoms: a biological marker for causal relationships? J Neurol Neurosurg Psychiatry. 2013. doi:10.1136/jnnp-2013-305380.

40.

Bronstein J, Carvey P, Chen H, et al. Meeting report: consensus statement-Parkinson's disease and the environment: collaborative on health and the environment and Parkinson's Action Network (CHE PAN) conference 26-28 June 2007. Environ Health Perspect. 2009;117:117–21.PubMed

41.

Tan SK, Hartung H, Sharp T, Temel Y. Serotonin-dependent depression in Parkinson's disease: a role for the subthalamic nucleus? Neuropharmacology. 2011;61:387–99.PubMedCrossRef

42.

Bejjani BP, Damier P, Arnulf I, et al. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med. 1999;340:1476–80.PubMedCrossRef

43.

Blomstedt P, Hariz MI, Lees A, et al. Acute severe depression induced by intraoperative stimulation of the substantia nigra: a case report. Parkinsonism Relat Disord. 2008;14:253–6.PubMedCrossRef

44.

• Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syndrome in Parkinson disease. Arch Neurol. 2010;67:58–63. This is an example of keen and consistent clinical observations resulting in the description of a relatively common and challenging, but previously unrecognized, clinical syndrome.PubMedCrossRef

45.

Arabia G, Grossardt BR, Geda YE, et al. Increased risk of depressive and anxiety disorders in relatives of patients with Parkinson disease. Arch Gen Psychiatry. 2007;64:1385–92.PubMedCrossRef

46.

Kasten M, Kertelge L, Bruggemann N, et al. Nonmotor symptoms in genetic Parkinson disease. Arch Neurol. 2010;67:670–6.PubMedCrossRef

47.

Belarbi S, Hecham N, Lesage S, et al. LRRK2 G2019S mutation in Parkinson's disease: a neuropsychological and neuropsychiatric study in a large Algerian cohort. Parkinsonism Relat Disord. 2010;16:676–9.PubMedCrossRef

48.

Marras C, Schule B, Munhoz RP, et al. Phenotype in parkinsonian and nonparkinsonian LRRK2 G2019S mutation carriers. Neurology. 2011;77:325–33.PubMedCrossRef

49.

Srivastava A, Tang MX, Mejia-Santana H, et al. The relation between depression and parkin genotype: the CORE-PD study. Parkinsonism Relat Disord. 2011;17:740–4.PubMedCrossRef

50.

Mossner R, Henneberg A, Schmitt A, et al. Allelic variation of serotonin transporter expression is associated with depression in Parkinson's disease. Mol Psychiatry. 2001;6:350–2.PubMedCrossRef

51.

Menza MA, Palermo B, DiPaola R, et al. Depression and anxiety in Parkinson's disease: possible effect of genetic variation in the serotonin transporter. J Geriatr Psychiatry Neurol. 1999;12:49–52.PubMedCrossRef

52.

Burn DJ, Tiangyou W, Allcock LM, et al. Allelic variation of a functional polymorphism in the serotonin transporter gene and depression in Parkinson's disease. Parkinsonism Relat Disord. 2006;12:139–41.PubMedCrossRef

53.

Dissanayaka NN, Silburn PA, O'Sullivan JD, Mellick GD. Serotonin and dopamine transporter genes do not influence depression in Parkinson's disease. Mov Disord. 2009;24:111–5.PubMedCrossRef

54.

Zhang JL, Yang JF, Chan P. No association between polymorphism of serotonin transporter gene and depression in Parkinson's disease in Chinese. Neurosci Lett. 2009;455:155–8.PubMedCrossRef

55.

Starkstein SE, Merello M, Jorge R, et al. A validation study of depressive syndromes in Parkinson's disease. Mov Disord. 2008;23:538–46.PubMedCrossRef

56.

Cheng EM, Tonn S, Swain-Eng R, et al. Quality improvement in neurology: AAN Parkinson disease quality measures: report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2010;75:2021–7.PubMedCrossRef

57.

Marsh L, McDonald WM, Cummings J, Ravina B. Provisional diagnostic criteria for depression in Parkinson's disease: report of an NINDS/NIMH work group. Mov Disord. 2006;21:148–58.PubMedCrossRef

58.

Leentjens AF, Dujardin K, Marsh L, et al. Symptomatology and markers of anxiety disorders in Parkinson's disease: a cross-sectional study. Mov Disord. 2011;26:484–92.PubMedCrossRef

59.

Nazem S, Siderowf AD, Duda JE, et al. Suicidal and death ideation in Parkinson's disease. Mov Disord. 2008;23:1573–9.PubMedCrossRef

60.

Weintraub D, Duda JE, Carlson K, Luo P, Sagher O, Stern M, et al. Suicide ideation and behaviours after STN and GPi DBS surgery for Parkinson's disease: results from a randomised, controlled trial. J Neurol Neurosurg Psychiatry. 2013;84(10):1113–8.

61.

Engmann B. Bipolar affective disorder and Parkinson's disease. Case Rep Med. 2011;2011:154165.PubMed

62.

Racette BA, Hartlein JM, Hershey T, et al. Clinical features and comorbidity of mood fluctuations in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2002;14:438–42.PubMedCrossRef

63.

Leentjens AF, Dujardin K, Marsh L, et al. Anxiety and motor fluctuations in Parkinson's disease: a cross-sectional observational study. Parkinsonism Relat Disord. 2012;18:1084–8.PubMedCrossRef

64.

Riedel O, Klotsche J, Spottke A, et al. Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson's disease. J Neurol. 2010;257:1073–82.PubMedCrossRef

65.

Starkstein SE, Bolduc PL, Mayberg HS, et al. Cognitive impairments and depression in Parkinson's disease: a follow up study. J Neurol Neurosurg Psychiatry. 1990;53:597–602.PubMedCrossRef

66.

Leentjens AF, Lousberg R, Verhey FR. Markers for depression in Parkinson's disease. Acta Psychiatr Scand. 2002;106:196–201.PubMedCrossRef

67.

Marsh L, Williams JR, Rocco M, et al. Psychiatric comorbidities in patients with Parkinson disease and psychosis. Neurology. 2004;63:293–300.PubMedCrossRef

68.

Starkstein SE, Preziosi TJ, Bolduc PL, Robinson RG. Depression in Parkinson's disease. J Nerv Ment Dis. 1990;178:27–31.PubMedCrossRef

69.

Starkstein SE, Petracca G, Chemerinski E, et al. Depression in classic versus akinetic-rigid Parkinson's disease. Mov Disord. 1998;13:29–33.PubMedCrossRef

70.

Frisina PG, Borod JC, Foldi NS, Tenenbaum HR. Depression in Parkinson's disease: health risks, etiology, and treatment options. Neuropsychiatr Dis Treat. 2008;4:81–91.PubMed

71.

Weintraub D, Burn DJ. Parkinson's disease: the quintessential neuropsychiatric disorder. Mov Disord. 2011;26:1022–31.PubMedCrossRef

72.

Devos D, Dujardin K, Poirot I, et al. Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study. Mov Disord. 2008;23:850–7.PubMedCrossRef

73.

Dobkin RD, Menza M, Allen LA, et al. Telephone-based cognitive-behavioral therapy for depression in Parkinson disease. J Geriatr Psychiatry Neurol. 2011;24:206–14.PubMedCrossRef

74.

Richard IH, McDermott MP, Kurlan R, et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease. Neurology. 2012;78:1229–36.PubMedCrossRef

75.

Veazey C, Cook KF, Stanley M, et al. Telephone-administered cognitive behavioral therapy: a case study of anxiety and depression in Parkinson's disease. J Clin Psychol Med Settings. 2009;16:243–53.PubMedCrossRef

76.

Dobkin RD, Menza M, Allen LA, et al. Cognitive-behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial. Am J Psychiatry. 2011;168:1066–74.PubMedCrossRef

77.

• Armento M, Stanley M, Marsh L, et al. Cognitive behavioral therapy (CBT) for depression and anxiety in Parkinson’s disease: a clinical review. J Park Dis. 2012;2:135–51. This is a systematic review of CBT studies in PD.

78.

Gaynes BN, Rush AJ, Trivedi MH, et al. The STAR*D study: treating depression in the real world. Cleve Clin J Med. 2008;75:57–66.PubMedCrossRef

79.

Price A, Rayner L, Okon-Rocha E, et al. Antidepressants for the treatment of depression in neurological disorders: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2011;82:914–23.PubMedCrossRef

80.

• van der Marck MA, Bloem BR, Borm GF, et al. Effectiveness of multidisciplinary care for Parkinson's disease: a randomized, controlled trial. Mov Disord. 2013;28:605–11. The results of this study underscore the importance of collaborative multidisciplinary care.PubMedCrossRef

81.

Barone P, Poewe W, Albrecht S, et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson's disease: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2010;9:573–80.PubMedCrossRef

82.

Andersen J, Aabro E, Gulmann N, et al. Anti-depressive treatment in Parkinson's disease. A controlled trial of the effect of nortriptyline in patients with Parkinson's disease treated with L-DOPA. Acta Neurol Scand. 1980;62:210–9.PubMedCrossRef

83.

Menza M, Dobkin RD, Marin H, et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology. 2009;72:886–92.PubMedCrossRef

84.

Seppi K, Weintraub D, Coelho M, et al. The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson's disease. Mov Disord. 2011;26 Suppl 3:S42–80.PubMedCrossRef

85.

Skapinakis P, Bakola E, Salanti G, et al. Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. BMC Neurol. 2010;10:49.PubMedCrossRef

86.

Arbouw ME, Movig KL, Neef C, et al. Influence of initial use of serotonergic antidepressants on antiparkinsonian drug use in levodopa-using patients. Eur J Clin Pharmacol. 2007;63(2):181–97.PubMedCrossRef

87.

Richard IH, Kurlan R, Tanner C, et al. Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson's disease. Parkinson Study Group. Neurology. 1997;48:1070–7.PubMedCrossRef

88.

Olanow CW, Rascol O, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson's disease. N Engl J Med. 2009;361:1268–78.PubMedCrossRef

89.

Imamura K, Okayasu N, Nagatsu T. The relationship between depression and regional cerebral blood flow in Parkinson's disease and the effect of selegiline treatment. Acta Neurol Scand. 2011;124:28–39.PubMedCrossRef

90.

Leentjens AF. The role of dopamine agonists in the treatment of depression in patients with Parkinson's disease: a systematic review. Drugs. 2011;71:273–86.PubMedCrossRef

91.

Barone P, Scarzella L, Marconi R, et al. Pramipexole versus sertraline in the treatment of depression in Parkinson's disease: a national multicenter parallel-group randomized study. J Neurol. 2006;253:601–7.PubMedCrossRef

92.

Rektorova I, Rektor I, Bares M, et al. Pramipexole and pergolide in the treatment of depression in Parkinson's disease: a national multicentre prospective randomized study. Eur J Neurol. 2003;10:399–406.PubMedCrossRef

93.

Pahwa R, Stacy MA, Factor SA, et al. Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease. Neurology. 2007;68:1108–15.PubMedCrossRef

94.

Navan P, Findley LJ, Jeffs JA, et al. Randomized, double-blind, 3-month parallel study of the effects of pramipexole, pergolide, and placebo on Parkinsonian tremor. Mov Disord. 2003;18:1324–31.PubMedCrossRef

95.

da Silva TM, Munhoz RP, Alvarez C, et al. Depression in Parkinson's disease: a double-blind, randomized, placebo-controlled pilot study of omega-3 fatty-acid supplementation. J Affect Disord. 2008;111:351–9.PubMedCrossRef

96.

Pal E, Nagy F, Aschermann Z, et al. The impact of left prefrontal repetitive transcranial magnetic stimulation on depression in Parkinson's disease: a randomized, double-blind, placebo-controlled study. Mov Disord. 2010;25:2311–7.PubMedCrossRef

97.

Boggio PS, Fregni F, Bermpohl F, et al. Effect of repetitive TMS and fluoxetine on cognitive function in patients with Parkinson's disease and concurrent depression. Mov Disord. 2005;20:1178–84.PubMedCrossRef

98.

Fregni F, Santos CM, Myczkowski ML, et al. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2004;75:1171–4.PubMedCrossRef

99.

Faber R, Trimble MR. Electroconvulsive therapy in Parkinson's disease and other movement disorders. Mov Disord. 1991;6:293–303.PubMedCrossRef

100.

Holtzheimer PE, Mayberg HS. Deep brain stimulation for psychiatric disorders. Annu Rev Neurosci. 2011;34:289–307.PubMedCrossRef

101.

Sproesser E, Viana MA, Quagliato EM, de Souza EA. The effect of psychotherapy in patients with PD: a controlled study. Parkinsonism Relat Disord. 2010;16:298–300.PubMedCrossRef

102.

Serfaty MA, Haworth D, Blanchard M, et al. Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Arch Gen Psychiatry. 2009;66:1332–40.PubMedCrossRef

103.

Mohr DC, Likosky W, Bertagnolli A, et al. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol. 2000;68:356–61.PubMedCrossRef

Title: Depression and Parkinson’s Disease: Current Knowledge
Author: Laura Marsh
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Neurology and Neuroscience Reports / Issue 12/2013
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI: https://doi.org/10.1007/s11910-013-0409-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Depression and Parkinson’s Disease: Current Knowledge

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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