Best Antidepressant In Parkinson’s Disease

Evaluated Outcomes And Inclusion Criteria

In the present study, a depression score was applied to evaluate the symptom of depression on patients. The depression score is based on Hamilton depression rating scale, Beck depression inventory, and Unified Parkinson Disease Rating Scale Mental. Unified Parkinson Disease Rating Scale-Activities of daily living for activities of daily living, Unified Parkinson Disease Rating Scale-Motor for motor function, and adverse effect were evaluated as the secondary outcomes.

Inclusion criteria for retrieved studies was as follows: patients should be diagnosed with idiopathic PD symptoms of depression were diagnosed clearly, with severity of depression evaluated by Hamilton depression rating scale, Beck Depression Inventory, or Unified Parkinson Disease Rating Scale Mental study should be performed with a randomized controlled design sufficient data for further analysis should be provided in original articles and patients should not receive irrelevant anti-Parkinson treatment in these studies.

Aerobic Exercises Like Cycling Provide Benefits

If it’s been a while since you got your bike out, it’s time to dust off the spokes and grease up the chain. For people with Parkinson’s, 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 Parkinson’s 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 Parkinson’s 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 wasn’t enough, cycling regularly may also improve the gait of people with Parkinson’s, according to a further review published in npj Parkinson’s Disease, with the review’s authors concluding that cycling provided an overall better quality of life.

Facial Exercises Are Important For Expressiveness

While exercises that benefit your entire body are incredibly useful for people with Parkinson’s, it’s also important to get a little more specific. Facial exercises may be highly beneficial for those with Parkinson’s to combat facial rigidity and “masking,” a loss of expressiveness in the face seen in people with the disease, as the National Institute of Neurological Disorders and Stroke says. Exercising your face may also assist mobility around motor functions like swallowing, and keep your speech clear, says the Cleveland Clinic.

Luckily, too, these exercises are easy to do at home, and often while you’re doing another activity. When you’re eating, for example, try and exaggerate your chewing, making bigger movements with your jaw and chewing for longer. You can do the same thing while you’re speaking, too, opening your mouth wide and being intentionally more expressive with your face. If you’re a reader, saying what you’re reading out loud can be a good way to keep on top of your speech. And if you thought the days of making faces in the mirror were left in your childhood, now is the perfect time to bring them back, with exaggerated expressions helping to keep your face mobile.

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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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Postural Exercises May Reduce Stooping

One of the most noticeable effects of Parkinson’s disease can be on a person’s posture. Our brains work to alert our bodies to stay upright via automatic impulse, but when you have Parkinson’s, this process can be disrupted, leading to a more stooped posture, says the Parkinson’s Foundation. This can be exacerbated by muscles becoming stiff, a common issue for people living with Parkinson’s.

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 you’re sitting in a chair you can do a similar action, leaning back into it, connecting your shoulder blades with the chair’s 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 body’s memory for good posture.

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Incidence And Risk Factors

Longitudinal studies are particularly valuable to decipher the dynamics of depression across PD stages and identify clusters of patients with distinct demographic and clinical characteristics, which may inform the etiopathogenesis of PD-related motor and non-motor symptoms .

Data from clinical trials indicate that incidental depression occurs in about 16% of de novo patients newly diagnosed with PD and previously free of depression, in addition to the 13.8% of patients already suffering from depression at diagnosis . Overall, the incidence rate of depression in newly diagnosed patients is increased twofold in comparison with age-matched non-PD patients , and up to 10 times higher than in the general population aged over 50 years. Female sex is consistently regarded as a risk factor for depression in PD and in the general population . Contrastingly, influence of age at onset is highly dependent on the setting , although patients with depression after diagnosis may be older . Furthermore, non PD-specific risk factors have been shown to be three times more influential for PD depression than PD-specific risk factors . Moreover, personalized prediction of depression using machine learning confirms the influence of non-PD-specific predictors in addition to PD-specific factors . In particular, evidence that RDB represents an important risk factor for depression in PD is accumulating .

Etiology Of Depression In Pd

There have been several explanations for why depression occurs in PD. A psychological explanation suggests that depression is a reaction to the stress of coping with a chronic and progressively disabling disease. A biomedical perspective argues that depression is a primary neurochemical consequence of the neurodegenerative process of PD, attributing depression in PD to deficits in dopaminergic, noradrenergic, and/or serotonergic systems . Evidence from studies that have examined disease correlates of PD, prevalence rates, and brain abnormalities between depressed and non-depressed PD patients have supported both models and are described below.

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Management Of Depression In Parkinsons Disease

Although traditionally considered a purely motor disorder, Parkinsons disease is increasingly recognized as a complex disease process with diverse neuropsychiatric complications in addition to its motor symptomatology. The range of neuropsychiatric complications associated with Parkinsons disease is broad and includes depression, anxiety, apathy, psychosis, cognitive impairment, impulse control disorders, and sleep disturbances. These neuropsychiatric complications become increasingly prevalent over the course of the disease and are often associated with poorer quality of life, increased disability, worse outcomes, and greater caregiver burden . As mental health providers commonly encounter depression in the Parkinsons disease population, it is important to be familiar with available, validated treatment options for this illness.

The Diagnosis Of Depression In Pd

In most recent research studies, depression in PD has been diagnosed based on standardized criteria for major depression, such criteria from the Diagnostic and Statistical Manual of Mental Disorders , fifth edition . The main problem of using these criteria is that some symptoms of depression, such as psychomotor retardation, insomnia, and loss of energy, are also frequently found in PD. A committee convened by the National Institute of Neurological Disorders and Stroke raised the important question of whether DSM criteria for major depression, which were designed for individuals without PD, are valid in the context of a disease with a variety of motor and nonmotor manifestations. The committee recommended that depressed mood must be present and that evaluations should be done in the âonâ state for patients who experience fluctuations. Furthermore, to avoid âfalse-negatives,â the National Institute of Neurological Disorders and Stroke committee suggested using the âinclusive approachâ to diagnosis, which consist of rating the presence of all symptoms of depression, independent of whether they may be related to the motor disorder.

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Association Between Depression And Other Non

The association of depression with other neuropsychiatric non-motor symptoms is particularly frequent in PD, which is considered as indirect evidence of co-occuring, and possibly intricately linked or synergistic pathophysiological mechanisms.

Anxiety is long recognized as one of the most frequent comorbid conditions accompanying depression , although both conditions may exist on their own . As such, risk factors are partly distinct in depression with or without anxiety, and, in particular, anxiety may be more frequent in patients aged < 60 years at diagnosis, and be related to motor fluctuations . Furthermore, the prevalence of depressive disorder is greater in patients with non-specific anxiety subtypes . In addition, anxiety is an important risk factor when considering incident depression, besides insomnia . Apathy is also frequently associated with depression, leading to consider a hypodopaminergic neuropsychiatric triad consisting of apathy, depression and anxiety in PD . However, association of depression on one side, with apathy and anxiety on the other side, is complex, as symptoms most frequently co-exist , although they also occur in isolation , which may indicate overlapping and also distinct pathophysiological mechanisms related to distinct prognostic outcomes .

Comparative Efficacy And Acceptability Of Antidepressants In Parkinson’s Disease: A Network Meta

• Jinling Liu ,

  Contributed equally to this work with: Jinling Liu, Jiangchuan Dong

  Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

• Contributed equally to this work with: Jinling Liu, Jiangchuan Dong

  Affiliation Department of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China

• Affiliation Department of Neurology, Weifang People’s Hospital, Weifang, Shandong, China

• * E-mail:

  Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

• Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

• Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

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Depression Diagnosis Challenges In Pd

Depression in Parkinsons can be hard to recognize. Certain depression symptoms overlap with those of PD. For example, sleep problems and feeling slowed down occur in both conditions.

Some experts think that depression in PD often involves frequent, shorter changes in mood versus a constant state of daily sadness. Other things that can complicate a Parkinsons depression diagnosis include:

• Facial masking, a symptom cause by Parkinsons effect on face muscles that can make it difficult for a person with Parkinsons to visibly express emotion.
• People with Parkinsons often do not recognize they have a mood problem or are unable to explain symptoms, so they dont seek treatment. Its helpful to ask a care partner or loved one if they have noticed any mood changes.

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What Are The Most Common Medicines Used To Treat Pd

Sinemet®

Levodopa is the most commonly prescribed and most effective medicine for controlling the symptoms of PD, particularly bradykinesia and rigidity.

Levodopa is a chemical found naturally in our brains. When given as a medicine, it is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter.

Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances. It is generally recommended that patients take Sinemet on an empty stomach, at least ½ hour before or one hour after meals.

There are two forms of Sinemet: controlled-release or immediate-release Sinemet. Controlled-release Sinemet and immediate-release Sinemet are equally effective in treating the symptoms of PD, but some people prefer the controlled release version. Ask your doctor which approach is best for you.

Dopamine agonists

Dopamine agonists are medicines that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.

Parlodel®, Requip®, and Mirapex® are all dopamine agonists. These medicines might be taken alone or in combination with Sinemet. Generally, dopamine agonists are prescribed first and levodopa is added if the patients symptoms cannot be controlled sufficiently.

Symmetrel®

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Treating Depression In Parkinsons 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 Parkinsons 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 Parkinsons patients may be as treatable as it is in the general population.

Show Sources

Depression In Genetic Pd

Whether genetic forms of PD predispose to depression remains an open question, although monogenic forms of PD resembling idiopathic PD with Lewy-body synucleinopathy represent critical etiopathogenic models.

Depression is frequent in patients with genetic PD , although depression was not related to mutations of parkin, leucine-rich repeat kinase 2 and apolipoprotein E status in a large study gathering 632 families . In addition, a recent study showed that depression severity was similar to healthy controls in both LRRK2 and glucocerebrosidase mutation carriers at risk of PD as well as RBD and impulse control disorders . Nevertheless, prevalence of depression is close to 30% in LRRK2 patients with manifest PD and may predate motor symptoms, similar to patients with idiopathic PD , whereas prevalence of dementia might be lower . Moreover, depression severity increased over 2 years in heterozygous carriers of GBA mutations, who are at high risk of PD, also associated with greater olfactory and cognitive impairment , and depending on the alleles .

Overall, these robust statistical associations and temporal precedence suggest that depression and PD may share common pathophysiological mechanisms , and that association with specific comorbidities and risks factors may reflect different pathological routes .

Table 1 Summary of epidemiological findings for depression in patients with Parkinsons disease

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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.

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.

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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.