What Is The Best Antidepressant For Parkinson’s

Treatment Of Off Time

• Entacapone is a catechol-O-methyl transferase inhibitor. The enzyme that blocks dopamine is degraded by this inhibitor, thereby extending the effects of levodopa.

• The break down of dopamine that is naturally produced in the brain and produced from levodopa is also delayed or slowed down by rasagiline.

The Importance Of Diagnosing Depression

Treatment of depression in patients with PD may significantly slow cognitive decline, deterioration in Activities of Daily Living and progression to the more advanced of the Hoehn and Yahr stages. A longitudinal study by Starkstein and colleagues showed that patients with major depression and PD showed a significantly greater decline in ADLs over a 1-year period than patients with PD with minor depression only or no depression. Patients with major depression and PD had significantly longer durations of illness, but when patients were matched for duration and followed longitudinally, those with major depression worsened to a significantly greater extent. Cost-benefit analyses of antidepressant treatment in patients with PD are urgently needed.

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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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Psychosocial Reactivity And Depression

Psychosocial variables, such as coping style and amount of social support, may predict depression more reliably than severity, illness duration, and functional disability . For instance, examined the influence of psychosocial variables in predicting depression in PD patients. Overall, the best predictors of depression were functional disability, low self-esteem, and avoidant coping. These variables accounted for 46% of the variance in depression. Furthermore, positive affect and cognitive coping significantly predicted lower depression. This study found that disease-related variables do not predict a large portion of the variance in the depression that is experienced in PD. The observed inconsistent findings suggest that the reactivity model is in need of revision and should also include psychosocial variables .

In summary, as evidence does not permit discrete choice between the biomedical or psychological position with respect to the etiology of PD depression, a more parsimonious perspective should include a combination of endogenous and exogenous factors . Therefore, we further examined the literature on treatment options for PD depression to understand its etiology towards improving quality of life for this neuropsychiatric population.

Symptoms Of Depression In Parkinsons Disease

The symptoms of depression in PD can be difficult to tease apart from the symptoms of PD itself.

For example, apathy, which is a lack of energy or interest in everyday activities, is a symptom of various mental health disorders, including depression. Apathy is also common in patients with PD, whether or not they have depression.

Fatigue is another common and disabling symptom of PD that may also occur with depression. The fatigue of PD can worsen underlying depression or vice versa, creating a vicious cycle that can be challenging to untangle and treat.

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Treating Depression In Parkinson’s Disease: Study Results

Patients in all three treatment groups, including the placebo group, showed improvement on a commonly used scale to gauge depression known as the Hamilton Rating Scale.

Those on antidepressants improved more than did those on placebo, Richard says.

On average, those getting Paxil had a 59% improvement. Those taking Effexor had a 52% improvement. Those who got the placebo had a 32% improvement.

Richard evaluated their depression using three other scales and found similar results.

There was no effect on movement ability.

Richard can’t say which antidepressant type is better for treating depression in Parkinson’s disease, she says. The study did not do a head-to-head comparison of the two types.

Each type, SSRI and SNRI, includes many different medicines, so patients have a choice, she says.

Both medicines studied are available as generics, Richard says. At the doses studied, the cost would be about $20 to $30 a month.

Patients reported side effects such as insomnia, constipation, sexual dysfunction, and fatigue. Three patients, including one in the placebo group, had serious side effects. These included chest pressure, bowel obstruction, and heart rhythm problems.

However, only the patient with heart rhythm problems withdrew.

Wyeth Pharmaceuticals provided the venlafaxine XR. Glaxo SmithKline provided the paroxetine.

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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So What Does Nutrition Have To Do With Parkinsons

1. The neurotransmitter dopamine is made in the body from amino acids which are the building blocks of protein. Every time we eat a protein rich food we take in protein, which the body breaks down into its component amino acids. Two amino acids are converted in the body into L-Dopa, which is then converted into dopamine in the brain.

2. Nutrient co-factors are required for each stage of this conversion process, so deficiencies of these may reduce dopamine production.

3. L-dopa medication competes for absorption with dietary amino acids, therefore the timing of taking L-dopa and the eating of protein needs to be managed for optimal absorption and effectiveness of the drug and the reduction of side-effects.

Therefore, the nutritional therapy approach to Parkinsons includes:

1. Supporting dopamine production by ensuring adequate precursors and co-factors

2. Considering drug-nutrient interactions to enhance effectiveness and reduce side-effects

3. Optimising nutritional status and addressing co-morbidities . These co-morbidities include constipation, depression, fatigue, and insomnia.

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 .

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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.

Focus On Depression In Parkinsons Disease: A Delphi Consensus Of Experts In Psychiatry Neurology And Geriatrics

Luis Agüera-Ortiz

1Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain

2Centro de Investigacion Biomedica en Red de Salud Mental , Madrid, Spain

3Movement Disorders Unit, Servicio de Neurología, Hospital Clínico San Carlos, Complutense University, Madrid, Spain

4Movement Disorders Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain

5Service of Psychiatry, University Hospital Ramón y Cajal. CIBERSAM, IRYCIS. University of Alcalá, Madrid, Spain

6Service of Neurology, HGU Gregorio Marañón, Madrid, Spain

7Memory Disorders Unit, HM Hospitales, Madrid, Spain

8Service of Psychiatry, Hospital Universitario San Jorge, Huesca, Spain

9Neurological Rehabilitation Unit, Clínica Ubarmin, Pamplona, Navarra, Spain

10Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain

Abstract

1. Introduction

Neuropsychiatric disorders such as depression very often accompany core motor impairments of Parkinsons disease . More and more, they are perceived as significant contributors to PD morbidity and caregiver burden as they have a major impact on patients function, quality of life, and long-term outcomes. In fact, it has been suggested that PD should be classified as a neuropsychiatric disease itself rather than a movement disorder .

2. Materials and Methods

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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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Good News For Parkinsons Patients: Drugs May Ease Depression Without Worsening Motor Problems

The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, concussion, Parkinsons disease and epilepsy.

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Jarrow Formulas Cdp Choline Supports Brain Function 250 Mg 60 Caps

4.0 Promising

Citicoline was originally used in the treatment of strokes. Since then it has been touted as a remedy for age related memory lsoss as well as a treatment for everything from brain trauma to Parkinsons. the supplement itself is simple ato take. I observed no negative side effects. My mother had a stroke and I am interested in anything that could possibly prevent that happening to me. I have a good memory so I cant rsay Ive seen any difference with respect to that. I have been sleeping better. I am an exceptionally light sleeper and it is rare for me to get uninterrupted sleep. This does seem to help with that. Jarrow is a reliable company and I have had good results with other of their supplements. so while I cant report any definitive benefit, I am not yet done with the bottle and it holds promise.

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This is an incredible supplement for Parkinsons disease. It helps my medication last about 3x as long and has helped in reducing my symptoms significantly. Also helped a friend of mine who had complications from a concussion. An amazing brain supplement

5.0 Citicoline Benefits are well Worth a Try

Product works fine, however, it was for my husband who had Parkinsons related Dementia. Unfortunately, he passed on 6/22/13 from complications with Parkinsons.

5.0 Good product, Good Brand

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Impact Of Diet On Parkinsons Medications

Taking certain foods may interfere with the efficacy of drugs used in Parkinsons disease. This is especially true for high-protein foods. Their consumption may affect the bodys ability to absorb levodopa, which is the most prescribed drug in Parkinsons disease. Its therefore good to take levodopa 30 60 minutes before eating the high-protein foods.

However, for some patients it causes nausea, and taking levodopa on an empty stomach might not be a good idea. In that case, taking levodopa with a small snack can enhance the absorption of the drug in the blood.

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How Is Depression Diagnosed

Diagnosis is vital to effective treatment and recovery. A person must experience one of the following symptoms most of the time over the previous two weeks:

• Loss of interest or pleasure in activities once enjoyed

In addition, some of the following symptoms must be present:

• Changes in sleep or appetite
• Increased fatigue
• Suicidal thoughts or a wish for death

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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How To Take Antidepressants

Your doctor will prescribe an antidepressant that he or she thinks is a good medication to treat your symptoms. It can take time, usually two to four weeks, for an antidepressant to become effective, so be sure to follow instructions carefully. The different classes of antidepressants work differently and have varied side effects, so it may take several tries to find the right medication and dosage to manage your symptoms.6 Do not stop taking the medication without speaking to your medical team. In some cases, antidepressants lose their effectiveness over time so be sure to discuss with your doctor if you begin to experience symptoms that have been previously managed by your medication.

Depression In Pd Versus Other Illnesses

Whether depression is found more frequently in PD relative to other non-neurological illnesses is unclear. If PD patients are at greater risk for developing depression, then the affective disturbances found in PD can be related to neurological disease as opposed to a psychosocial stress response in reaction to having a chronic and disabling illness. Several studies examined rates of depression between PD patients and other disabled clinical populations. Again, the collective evidence does not support either a biomedical or psychological interpretation. For instance, three separate studies found that PD patients were significantly more depressed than paraplegics, amputees, and patients suffering from various medical/surgical conditions . However, the comparison groups in these studies were not equivalent to the PD sample with respect to age and duration of illness.

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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®