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Paxil Parkinson’s

admin — Tue, 07 Jun 2011 16:09:30 +0000

Parkinson’s disease (also known as Parkinson disease, Parkinson’s, idiopathic parkinsonism, primary parkinsonism, PD, or paralysis agitans) is a degenerative disorder of the central nervous system. It results from the death of dopamine-containing cells in the substantia nigra, a region of the midbrain; the cause of cell-death is unknown. Early in the course of the disease, the most obvious symptoms are movement-related, including shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, cognitive and behavioural problems may arise, with dementia commonly occurring in the advanced stages of the disease. Other symptoms include sensory, sleep and emotional problems. PD is more common in the elderly with most cases occurring after the age of 50.

The main motor symptoms are collectively called parkinsonism, or a “parkinsonian syndrome”. Parkinson’s disease is often defined as a parkinsonian syndrome that is idiopathic (having no known cause), although some atypical cases have a genetic origin. Many risk and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers. The pathology of the disease is characterized by the accumulation of a protein called alpha-synuclein into inclusions called Lewy bodies in neurons, and from insufficient formation and activity of dopamine produced in certain neurons of parts of the midbrain. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation.

Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use of levodopa and dopamine agonists. As the disease progresses and dopamine neurons continue to be lost, a point eventually arrives at which these drugs become ineffective at treating the symptoms and at the same time produce a complication called dyskinesia, marked by involuntary writhing movements. Diet and some forms of rehabilitation have shown some effectiveness at alleviating symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. Research directions include a search of new animal models of the disease and investigations of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.

Conditions associated with motor impairment and other symptoms of Parkinson’s disease may need a variety of treatments.

Depression. Although depression is very common in PD, there have been surprisingly few controlled studies. Antidepressants used for PD include tricyclics, particularly amitriptyline (Elavil). Some studies have found that selective serotonin-reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) — may worsen symptoms of Parkinson’s. Doctors should monitor patients taking SSRIs.

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Depression Often Untreated In Parkinson’s Disease Patients

admin — Wed, 10 Feb 2010 13:34:06 +0000

While depression appears to be common in early Parkinson’s disease (PD), it is often not treated or diagnosed, according to newly released research. A contingent of researchers from across North America found that just over 27 per cent of PD subjects screened positive for depression, while 40 per cent of subjects’ depression went untreated.

This study, authored by Bernard Ravina, MD at the University of Rochester and funded by the National Institutes of Health in the USA, is the first to systematically examine the impact of depressive symptoms in early, untreated PD. Previous research has found that depression, in some form, affects up to 50 per cent of patients with PD and is associated with increased disability and reduced quality of life.

“Our results show that depression in PD appears to be under diagnosed, especially at the early stages of PD. That may be because symptoms of depression, such as fatigue and insomnia, may be attributed to PD rather than as symptoms of depression,” said Dr. Richard Camicioli, assistant neurology professor at the University of Alberta and a co-author of the study. “As seen in this study, many treated patients remained depressed and may require more intensive psychiatric treatment.”

Depression was also found to be associated with impairment on daily life activities, such as eating, bathing and dressing.

“Over time it appears that depression does not actually influence the progression of motor signs, but increases the disability associated with a given level of observational motor signs of PD,” said Camicioli.

For this study, 413 early, untreated PD subjects were administered the 15-item Geriatric Depression Scale (GDS-15), a validated screening tool to assess for depressive symptoms and the use of antidepressant or referral for further psychiatric health evaluation as a marker for the treatment of depression.

In another study based on data collected at the University of Alberta and funded by the Canadian Institutes of Health Research, Dr. Richard Carmiciolo has also found that depressive symptoms were the largest influence on health-related quality of life in older people with Parkinson’s disease.

“While we found that depression is common in early Parkinson’s disease diagnosis, we’ve also uncovered that depressive symptoms have the most significant influence on health-related quality of life in older people with Parkinson’s disease,” said Camicioli “That is why it is crucial for health care professionals to make an effort to detect, diagnose, and properly treat depression in Parkinson patients.”

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Older Antidepressants Better For Depression In Parkinson

admin — Mon, 08 Feb 2010 14:43:29 +0000

Are Older Antidepressants Better For Depression In Parkinson’s Disease?

A new study shows that antidepressant drugs which only affect serotonin, often used as first choice treatments, may not be best for depression in people with Parkinson’s disease. The new research is published in the December 17, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology. Depression affects up to 50 percent of people with Parkinson’s disease.

The study is the first to compare an older antidepressant that targets two receptors in the brain with a newer generation serotonin only-based drug and placebo. It is also the largest placebo-controlled study for Parkinson’s disease depression.

In the study, scientists gave 52 people diagnosed with Parkinson’s disease and depression either nortriptyline, a tricyclic antidepressant (TCA), paroxetine CR, a selective serotonin reuptake inhibitor (SSRI) or a placebo pill. Tricyclics affect both norepinephrine and serotonin, two different receptors in the brain. The people were tested for improvement of depression symptoms at two, four and eight weeks after starting treatment.

The study found that the people who took nortriptyline were nearly five times more likely to see improvement in depression symptoms when compared with the people who took paroxetine CR.

“I think that this study shows a number of important things. First, that people with Parkinson’s disease can respond to antidepressants. This is important because depression in Parkinson’s disease is underrecognized, underappreciated and undertreated. Commonly, the attitude is, of course you’re depressed, you have a serious illness. This study shows that patients should have hope that they can be helped,” said study author Matthew Menza, MD, a Professor of Psychiatry and Neurology with UMDNJ-Robert Wood Johnson Medical School in Piscataway, NJ. “Second, the study suggests that we may need to use medications that affect both serotonin and norepinephrine, not just serotonin, in the brain to be successful in treating depression related to Parkinson’s disease.”

Menza also says that in addition to the older antidepressant, nortriptyline, that was tested in the study, there are newer mediations that affect both serotonin and norepinephrinem, and these need to be tested.

Tricyclic antidepressants are one of the older classes of antidepressants and have been used since the 1950s. Tricyclics have an increased risk of overdose and death due to toxic effects on the heart and brain. “People on a tricyclic antidepressant should have their dosages monitored closely by their doctor,” said Menza.

The study was supported by the National Institute for Neurological Disorders and Stroke (NINDS).

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Depression May Be Early Sign of Parkinson’s

admin — Mon, 25 Jan 2010 15:23:08 +0000

Depression disease may be an early symptom of Parkinson’s disease, according to research that will be presented at the American Academy of Neurology’s 59th Annual Meeting in Boston.

The study looked at whether people who are taking antidepressant medications are more likely to develop Parkinson’s disease than people who are not taking the medications. It found that, in the year before their Parkinson’s disease was diagnosed, people who were taking antidepressants were nearly twice as likely to develop Parkinson’s disease as those who were not taking antidepressants.

“This should not be interpreted as evidence that antidepressants cause Parkinson’s disease,” said Miguel Hernan, MD, DrPH, of Harvard School of Public Health in Boston. “The relationship is only apparent in the year before the onset of the disease, which suggests that depression is an early symptom of the disease.”

For the study, researchers examined a database of more than three million people in the United Kingdom and identified 1,052 people with Parkinson’s disease and matched them with 6,634 people without the disease. Then they looked at antidepressant use before the onset of Parkinson’s disease.

The increased risk of developing Parkinson’s in the year before diagnosis was true for both men and women, across age groups, and for those who used both types of antidepressants, tricyclic antidepressants and SSRIs, or selective serotonin reuptake inhibitors.

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