Abstract
Depression occurs in around 35% of patients with Parkinson disease (PD) and is often persistent. Symptoms of depression can be evident in individuals at the time of diagnosis and might develop in the premotor stage of the disease. The underlying mechanisms of depression in PD are not known in detail, but changes in brain structure, signaling by neurotransmitters, and levels of inflammatory and neurotrophic factors are all suggested to contribute to its development. Psychosocial factors and pain could also have roles in depression. Changes in dopaminergic, noradrenergic and serotonergic systems in patients with PD might help to explain the incidence of depression in these individuals. Antidepressants that have dual serotonergic and noradrenergic effects are the drugs of choice for treating depression in PD. However, antiparkinsonian drugs might have beneficial effects not only on the motor symptoms of disease, but also on a patient's mood. Deep brain stimulation can worsen depression in some patients, but a preliminary study has suggested that transcranial magnetic stimulation could improve symptoms of depression. This Review describes the frequency and course of depression in patients with PD. The mechanisms that underlie depression in this disease are also discussed, and the management strategies for these patients are highlighted.
Key Points
-
Depression occurs in around 35% of patients with Parkinson disease (PD)
-
Mild depression is often persistent in patients with PD, and is a risk factor for moderate to severe depression
-
The etiology of depression in PD is not clear, but changes in neurotransmitter (monoaminergic) signaling and limbic Lewy body pathology might contribute
-
The roles of other pathologies (such as cerebrovascular disease) and neurotrophic changes in depression are not known
-
Pramipexole and nortriptyline are the only agents that have shown antidepressant effects in placebo-controlled clinical trials in patients with PD
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
de Rijk, M. C. et al. Prevalence of Parkinson's disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 54, S21–S23 (2000).
Nilsson, F. M., Kessing, L. V., Sorensen, T. M., Andersen, P. K. & Bolwig, T. G. Major depressive disorder in Parkinson's disease: a register-based study. Acta Psychiatr. Scand. 106, 202–211 (2002).
Lees, A. J., Hardy, J. & Revesz, T. Parkinson's disease. Lancet 373, 2055–2066 (2009).
Karlsen, K. H., Tandberg, E., Aarsland, D. & Larsen, J. P. Health related quality of life in Parkinson's disease: a prospective longitudinal study. J. Neurol. Neurosurg. Psychiatry 69, 584–589 (2000).
Marsh, L., McDonald, W. M., Cummings, J. & Ravina, B. Provisional diagnostic criteria for depression in Parkinson's disease: report of an NINDS/NIMH Work Group. Mov. Disord. 21, 148–158 (2006).
Schrag, A. et al. Depression rating scales in Parkinson's disease: critique and recommendations. Mov. Disord. 22, 1077–1092 (2007).
Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D. & Leentjens, A. F. A systematic review of prevalence studies of depression in Parkinson's disease. Mov. Disord. 23, 183–189 (2008).
Tandberg, E., Larsen, J. P., Aarsland, D. & Cummings, J. L. The occurrence of depression in Parkinson's disease. A community-based study. Arch. Neurol. 53, 175–179 (1996).
Martinez-Martin, P. et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov. Disord. 22, 1623–1629 (2007).
Barone, P. et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov. Disord. 24, 1641–1649 (2009).
Negre-Pages, L. et al. Anxious and depressive symptoms in Parkinson's disease: the French cross-sectionnal DoPaMiP study. Mov. Disord. 25, 157–166 (2010).
Riedel, O., Heuser, I., Klotsche, J., Dodel, R. & Wittchen, H. U. Occurrence risk and structure of depression in Parkinson disease with and without dementia: results from the GEPAD Study. J. Geriatr. Psychiatry Neurol. 23, 27–34 (2010).
Brown, R. G. et al. Depression and anxiety related subtypes in Parkinson's disease. J. Neurol. Neurosurg. Psychiatry (2011).
Kulisevsky, J., Pagonabarraga, J., Pascual-Sedano, B., Garcia-Sanchez, C. & Gironell, A. Prevalence and correlates of neuropsychiatric symptoms in Parkinson's disease without dementia. Mov. Disord. 23, 1889–1896 (2008).
Vanderheyden, J. E. et al. Epidemiology of major depression in Belgian parkinsonian patients. Acta Neurol. Belg. 110, 148–156 (2010).
Ravina, B. et al. The course of depressive symptoms in early Parkinson's disease. Mov. Disord. 24, 1306–1311 (2009).
Aarsland, D. et al. The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 80, 928–930 (2009).
Starkstein, S. E., Mayberg, H. S., Leiguarda, R., Preziosi, T. J. & Robinson, R. G. A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 55, 377–382 (1992).
Ishihara, L. & Brayne, C. A systematic review of depression and mental illness preceding Parkinson's disease. Acta Neurol. Scand. 113, 211–220 (2006).
Jacob, E. L., Gatto, N. M., Thompson, A., Bordelon, Y. & Ritz, B. Occurrence of depression and anxiety before Parkinson's disease. Parkinsonism Relat. Disord. 16, 576–581 (2010).
Alonso, A., Rodriguez, L. A., Logroscino, G. & Hernan, M. A. Use of antidepressants and the risk of Parkinson's disease: a prospective study. J. Neurol. Neurosurg. Psychiatry 80, 671–674 (2009).
Bower, J. H. et al. Anxious personality predicts an increased risk of Parkinson's disease. Mov. Disord. 25, 2105–2113 (2010).
O'Sullivan, S. S. et al. Nonmotor symptoms as presenting complaints in Parkinson's disease: a clinicopathological study. Mov. Disord. 23, 101–106 (2008).
Walter, U. et al. Parkinson's disease-like midbrain sonography abnormalities are frequent in depressive disorders. Brain 130, 1799–1807 (2007).
Braak, H. & Del Tredici, K. Invited Article: Nervous system pathology in sporadic Parkinson disease. Neurology 70, 1916–1925 (2008).
Arabia, G. et al. Increased risk of depressive and anxiety disorders in relatives of patients with Parkinson disease. Arch. Gen. Psychiatry 64, 1385–1392 (2007).
Burn, D. J., Tiangyou, W., Allcock, L. M., Davison, J. & Chinnery, P. F. Allelic variation of a functional polymorphism in the serotonin transporter gene and depression in Parkinson's disease. Parkinsonism Relat. Disord. 12, 139–141 (2006).
Menza, M. A., Palermo, B., DiPaola, R., Sage, J. I., Ricketts, M. H. Depression and anxiety in Parkinson's disease: possible effect of genetic variation in the serotonin transporter. J. Geriatr. Psychiatry Neurol. 12, 49–52 (1999).
Mossner, R. et al. Allelic variation of serotonin transporter expression is associated with depression in Parkinson's disease. Mol. Psychiatry 6, 350–352 (2001).
Dissanayaka, N. N., Silburn, P. A., O'Sullivan, J. D. & Mellick, G. D. Serotonin and dopamine transporter genes do not influence depression in Parkinson's disease. Mov. Disord. 24, 111–115 (2008).
Kasten, M. et al. Nonmotor symptoms in genetic Parkinson disease. Arch. Neurol. 67, 670–676 (2010).
Belarbi, S. et al. LRRK2 G2019S mutation in Parkinson's disease: a neuropsychological and neuropsychiatric study in a large Algerian cohort. Parkinsonism Relat. Disord. 16, 676–679 (2010).
Mayberg, H. S. & Solomon, D. H. Depression in Parkinson's disease: a biochemical and organic viewpoint. Adv. Neurol. 65, 49–60 (1995).
Weintraub, D. et al. Striatal dopamine transporter imaging correlates with anxiety and depression symptoms in Parkinson's disease. J. Nucl. Med. 46, 227–232 (2005).
Matsui, H. et al. Minor depression and brain perfusion images in Parkinson's disease. Mov. Disord. 21, 1169–1174 (2006).
Mayberg, H. S. et al. Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease. Ann. Neurol. 28, 57–64 (1990).
Matsui, H. et al. Depression in Parkinson's disease. Diffusion tensor imaging study. J. Neurol. 254, 1170–1173 (2007).
Kostic, V. S. et al. Regional patterns of brain tissue loss associated with depression in Parkinson disease. Neurology 75, 857–863 (2010).
Limousin, P. et al. Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N. Engl. J. Med. 339, 1105–1111 (1998).
Voon, V. et al. A multicenter study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Brain 131, 2720–2728 (2008).
Follett, K. A. et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N. Engl. J. Med. 362, 2077–2091 (2010).
Bejjani, B. P. et al. Transient acute depression induced by high-frequency deep-brain stimulation. N. Engl. J. Med. 340, 1476–1480 (1999).
Blomstedt, P. et al. Acute severe depression induced by intraoperative stimulation of the substantia nigra: a case report. Parkinsonism Relat. Disord. 14, 253–256 (2008).
Mayberg, H. S. et al. Deep brain stimulation for treatment-resistant depression. Neuron 45, 651–660 (2005).
Bewernick, B. H. et al. Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol. Psychiatry 67, 110–116 (2010).
Paulus, W. & Jellinger, K. The neuropathologic basis of different clinical subgroups of Parkinson's disease. J. Neuropathol. Exp. Neurol. 50, 743–755 (1991).
Berg, D. et al. Depression in Parkinson's disease: brainstem midline alteration on transcranial sonography and magnetic resonance imaging. J. Neurol. 246, 1186–1193 (1999).
Mayeux, R. et al. Clinical and biochemical features of depression in Parkinson's disease. Am. J. Psychiatry 143, 756–759 (1986).
Kostic, V. S. et al. Depression and Parkinson's disease: possible role of serotonergic mechanisms. J. Neurol. 234, 94–96 (1987).
Kuhn, W. et al. Depression in Parkinson's disease: biogenic amines in CSF of “de novo” patients. J. Neural Transm. 103, 1441–1445 (1996).
Leentjens, A. F., Scholtissen, B., Vreeling, F. W. & Verhey, F. R. The serotonergic hypothesis for depression in Parkinson's disease: an experimental approach. Neuropsychopharmacology 31, 1009–1015 (2006).
Kish, S. J. et al. Preferential loss of serotonin markers in caudate versus putamen in Parkinson's disease. Brain 131, 120–131 (2008).
Sharp, S. I. et al. Cortical serotonin1A receptor levels are associated with depression in patients with dementia with Lewy bodies and Parkinson's disease dementia. Dement Geriatr. Cogn. Disord. 26, 330–338 (2008).
Ballard, C. et al. A positive association between 5-HT re-uptake binding sites and depression in dementia with Lewy bodies. J. Affect Disord. 69, 219–223 (2002).
Kerenyi, L. et al. Positron emission tomography of striatal serotonin transporters in Parkinson disease. Arch. Neurol. 60, 1223–1229 (2003).
Guttman, M. et al. Brain serotonin transporter binding in non-depressed patients with Parkinson's disease. Eur. J. Neurol. 14, 523–528 (2007).
Albin, R. L. et al. Spared caudal brainstem SERT binding in early Parkinson's disease. J. Cereb. Blood Flow Metab. 28, 441–444 (2008).
Boileau, I. et al. Elevated serotonin transporter binding in depressed patients with Parkinson's disease: a preliminary PET study with [11C]DASB. Mov. Disord. 23, 1776–1780 (2008).
Politis, M. et al. Depressive symptoms in PD correlate with higher 5-HTT binding in raphe and limbic structures. Neurology 75, 1920–1927 (2010).
Kim, S. E., Choi, J. Y., Choe, Y. S., Choi, Y. & Lee, W. Y. Serotonin transporters in the midbrain of Parkinson's disease patients: a study with 123I-β-CIT SPECT. J. Nucl. Med. 44, 870–876 (2003).
Brooks, D. J. & Pavese, N. Imaging non-motor aspects of Parkinson's disease. Prog. Brain Res. 184, 205–218 (2010).
Beucke, J. C. et al. Serotonergic neurotransmission in early Parkinson's disease: a pilot study to assess implications for depression in this disorder. World J. Biol. Psychiatry 11, 781–787 (2010).
Ng, K. Y., Chase, T. N., Colburn, R. W. & Kopin, I. J. Dopamine: stimulation-induced release from central neurons. Science 172, 487–489 (1971).
Palhagen, S. et al. Monoamines, BDNF, IL-6 and corticosterone in CSF in patients with Parkinson's disease and major depression. J. Neurol. 257, 524–532 (2010).
Torack, R. M. & Morris, J. C. The association of ventral tegmental area histopathology with adult dementia. Arch. Neurol. 45, 497–501 (1988).
Lambert, G., Johansson, M., Agren, H. & Friberg, P. Reduced brain norepinephrine and dopamine release in treatment-refractory depressive illness: evidence in support of the catecholamine hypothesis of mood disorders. Arch. Gen. Psychiatry 57, 787–793 (2000).
Chan-Palay, V. Depression and dementia in Parkinson's disease. Catecholamine changes in the locus ceruleus, a basis for therapy. Adv. Neurol. 60, 438–446 (1993).
Remy, P., Doder, M., Lees, A., Turjanski, N. & Brooks, D. Depression in Parkinson's disease: loss of dopamine and norepinephrine innervation in the limbic system. Brain 128, 1314–1322 (2005).
Bohnen, N. I. et al. Cortical cholinergic denervation is associated with depressive symptoms in Parkinson's disease and parkinsonian dementia. J. Neurol. Neurosurg. Psychiatry 78, 641–643 (2007).
Meyer, P. M. et al. Reduced α4β2-nicotinic acetylcholine receptor binding and its relationship to mild cognitive and depressive symptoms in Parkinson disease. Arch. Gen. Psychiatry 66, 866–877 (2009).
Belmaker, R. H. & Agam, G. Major depressive disorder. N. Engl. J. Med. 358, 55–68 (2008).
Menza, M. et al. The role of inflammatory cytokines in cognition and other non-motor symptoms of Parkinson's disease. Psychosomatics 51, 474–479 (2010).
Pace, T. W. & Miller, A. H. Cytokines and glucocorticoid receptor signaling. Relevance to major depression. Ann. NY Acad. Sci. 1179, 86–105 (2009).
Charlett, A. et al. Cortisol is higher in parkinsonism and associated with gait deficit. Acta Neurol. Scand. 97, 77–85 (1998).
Krishnan, V. & Nestler, E. J. The molecular neurobiology of depression. Nature 455, 894–902 (2008).
Ricci, V. et al. Antidepressant treatment restores brain-derived neurotrophic factor serum levels and ameliorates motor function in Parkinson disease patients. J. Clin. Psychopharmacol. 30, 751–753 (2010).
Svenningsson, P. et al. Alterations in 5-HT1B receptor function by p11 in depression-like states. Science 311, 77–80 (2006).
Zhang, X., Andren, P. E., Greengard, P. & Svenningsson, P. Evidence for a role of the 5-HT1B receptor and its adaptor protein, p11, in L-DOPA treatment of an animal model of Parkinsonism. Proc. Natl Acad. Sci. USA 105, 2163–2168 (2008).
Duric, V. et al. A negative regulator of MAP kinase causes depressive behavior. Nat. Med. 16, 1328–1332 (2010).
Gerfen, C. R., Miyachi, S., Paletzki, R. & Brown, P. D1 dopamine receptor supersensitivity in the dopamine-depleted striatum results from a switch in the regulation of ERK1/2/MAP kinase. J. Neurosci. 22, 42–54 (2002).
Kwok, J. B. et al. GSK3B polymorphisms alter transcription and splicing in Parkinson's disease. Ann. Neurol. 58, 829–839 (2005).
Hoglinger, G. U. et al. Dopamine depletion impairs precursor cell proliferation in Parkinson disease. Nat. Neurosci. 7, 726–735 (2004).
Samuels, B. A. & Hen, R. Neurogenesis and affective disorders. Eur. J. Neurosci. 33, 1152–1159 (2011).
Tsopelas, C. et al. Neuropathological correlates of late-life depression in older people. Br. J. Psychiatry 198, 109–114 (2011).
Iritani, S., Tsuchiya, K., Arai, T., Akiyama, H. & Ikeda, K. An atypical autopsy case of Lewy body disease with clinically diagnosed major depression: a clinical, radiological and pathological study. Neuropathology 28, 652–659 (2008).
Alexopoulos, G. S. et al. 'Vascular depression' hypothesis. Arch. Gen. Psychiatry 54, 915–922 (1997).
Nanhoe-Mahabier, W. et al. Parkinson disease and comorbid cerebrovascular disease. Nat. Rev. Neurol. 5, 533–541 (2009).
Negre-Pages, L., Regragui, W., Bouhassira, D., Grandjean, H. & Rascol, O. Chronic pain in Parkinson's disease: The cross-sectional French DoPaMiP survey. Mov. Disord. 23, 1361–1369 (2008).
Geerlings, S. W., Twisk, J. W., Beekman, A. T., Deeg D. J. & van Tilburg, W. Longitudinal relationship between pain and depression in older adults: sex, age and physical disability. Soc. Psychiatry Psychiatr. Epidemiol. 37, 23–30 (2002).
Ehrt, U., Larsen, J. P. & Aarsland, D. Pain and its relationship to depression in Parkinson disease. Am. J. Geriatr Psychiatry 17, 269–275 (2009).
Brown, R. & Jahanshahi, M. Depression in Parkinson's disease: a psychosocial viewpoint. Adv. Neurol. 65, 61–84 (1995).
Turner, R. J. & Beiser, M. Major depression and depressive symptomatology among the physically disabled. Assessing the role of chronic stress. J. Nerv. Ment. Dis. 178, 343–350 (1990).
MacCarthy, B. & Brown, R. Psychosocial factors in Parkinson's disease. Br. J. Clin. Psychol. 28, 41–52 (1989).
Brown, R. G., MacCarthy, B., Gotham, A. M., Der, G. J. & Marsden, C. D. Depression and disability in Parkinson's disease: a follow-up of 132 cases. Psychol. Med. 18, 49–55 (1988).
Miyasaki, J. M. et al. Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 66, 996–1002 (2006).
Skapinakis, P. 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. 10, 49 (2010).
Banerjee, S. et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicenter, double-blind, placebo-controlled trial. Lancet 378, 403–411 (2011).
Andersen, J., Aabro, E., Gulmann, N., Hjelmsted, A. & Pedersen, H. E. 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. 62, 210–219 (1980).
Menza, M. et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology 72, 886–892 (2009).
Menza, M. et al. The impact of treatment of depression on quality of life, disability and relapse in patients with Parkinson's disease. Mov. Disord. 24, 1325–1332 (2009).
Dobkin, R. D. et al. The impact of antidepressant treatment on cognitive functioning in depressed patients with Parkinson's disease. J. Neuropsychiatry Clin. Neurosci. 22, 188–195 (2010).
Devos, D. et al. Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study. Mov. Disord. 23, 850–857 (2008).
Weintraub, D. et al. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology 75, 448–455 (2010).
Richard, I. H. A multicenter randomized, double-blind, placebo-controlled trial of paroxetine and venlafaxine extended release for depression in Parkinson's disease [abstract P19.8]. Presented at the 2nd World Parkinson Congress (2010).
Raskin, S. & Durst, R. Bupropion as the treatment of choice in depression associated with Parkinson's disease and its various treatments. Med. Hypotheses 75, 544–546 (2010).
Barone, P. et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson's disease: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 9, 573–580 (2010).
Rektorova, I. et al. Effects of ropinirole on nonmotor symptoms of Parkinson disease: a prospective multicenter study. Clin. Neuropharmacol. 31, 261–266 (2008).
Allain, H., Pollak, P. & Neukirch, H. C. Symptomatic effect of selegiline in de novo parkinsonian patients. The French Selegiline Multicenter Trial. Mov. Disord. 8 (Suppl. 1) S36–S40 (1993).
Faber, R. & Trimble, M. R. Electroconvulsive therapy in Parkinson's disease and other movement disorders. Mov. Disord. 6, 293–303 (1991).
Berman, R. M. et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol. Psychiatry 47, 332–337 (2000).
Pal, E., Nagy, F., Aschermann, Z., Balazs, E. & Kovacs, N. The impact of left prefrontal repetitive transcranial magnetic stimulation on depression in Parkinson's disease: A randomized, double-blind, placebo-controlled study. Mov. Disord. 30, 2311–2317 (2010).
Dobkin, R. D., Allen, L. A. & Menza, M. Cognitive-behavioral therapy for depression in Parkinson's disease: a pilot study. Mov. Disord. 22, 946–952 (2007).
Farabaugh, A. et al. Cognitive-behavioral therapy for patients with Parkinson's disease and comorbid major depressive disorder. Psychosomatics 51, 124–129 (2010).
Reynolds, C. F. 3rd et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 281, 39–45 (1999).
Kang, G. A. et al. Clinical characteristics in early Parkinson's disease in a central California population-based study. Mov. Disord. 20, 1133–1142 (2005).
Dooneief, G. et al. An estimate of the incidence of depression in idiopathic Parkinson's disease. Arch. Neurol. 49, 305–307 (1992).
Kulkantrakorn, K. & Jirapramukpitak, T. A prospective study in one year cumulative incidence of depression after ischemic stroke and Parkinson's disease: a preliminary study. J. Neurol. Sci. 263, 165–168 (2007).
Becker, C., Brobert, G. P., Johansson, S., Jick, S. S. & Meier, C. R. Risk of incident depression in patients with Parkinson disease in the UK. Eur. J. Neurol. 18, 448–453 (2011).
Allain, H., Cougnard, J. & Neukirch, H. C. Selegiline in de novo parkinsonian patients: the French selegiline multicenter trial (FSMT). Acta Neurol. Scand. Suppl. 136, 73–78 (1991).
Wermuth, L., Sørensen, P. & Timm, B. Depression in idiopathic Parkinson's disease treated with citalopram. A placebo-controlled trial. Nord. J. Psychiatry 52, 163–169 (1998).
Leentjens, A. F., Vreeling, F. W., Luijckx, G. J. & Verhey, F. R. SSRIs in the treatment of depression in Parkinson's disease. Int. J. Geriatr Psychiatry 18, 552–554 (2003).
Acknowledgements
P. Svenningsson was supported by grants from Vetenskapsrådet and the Swedish Strategic Research Foundation.
Author information
Authors and Affiliations
Contributions
D. Aarsland and P. Svenningsson researched data for the article, contributed to writing the manuscript, and provided substantial contributions to the discussion of the article content and to review and/or editing of the manuscript before submission. S. Påhlhagen and C. G. Ballard contributed to writing the manuscript, and provided substantial contributions to the discussion of content and to the review and/or editing of the manuscript before submission. U. Ehrt researched data for the article, and contributed to writing the article and to review and/or editing of the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
D. Aarsland has been a consultant for DiaGenic, GE Healthcare, Lundbeck and Novartis. He has received speaker honoraria from DiaGenic, GE Healthcare, GlaxoSmithKline, Lundbeck and Novartis. He has received grants for research from Merck Serono. C. Ballard has been a consultant for and received speaker honoraria from Acadia, Esai, Lundbeck and Novartis. He has received grants for research from Acadia and Novartis. P. Svenningsson has received grants for research from Servier and Dainippon. The other authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Aarsland, D., Påhlhagen, S., Ballard, C. et al. Depression in Parkinson disease—epidemiology, mechanisms and management. Nat Rev Neurol 8, 35–47 (2012). https://doi.org/10.1038/nrneurol.2011.189
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneurol.2011.189
This article is cited by
-
Investigation of non-invasive focused ultrasound efficacy on depressive-like behavior in hemiparkinsonian rats
Experimental Brain Research (2024)
-
Prognosis of impulse control disorders in Parkinson’s disease: a prospective controlled study
Journal of Neurology (2024)
-
Deep venous thrombosis and hyponatremia associated with citalopram use for behavioral symptoms in Parkinson’s disease: a case report
BMC Geriatrics (2023)
-
Early onset Parkinson’s disease in the cycle of 3,4-methylenedioxymethamphetamine and substance use: a case report
Journal of Medical Case Reports (2023)
-
Incretin and insulin signaling as novel therapeutic targets for Alzheimer’s and Parkinson’s disease
Molecular Psychiatry (2023)