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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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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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