[A comparison between low doses of amitriptyline and low doses of fluoxetin used in the control of depression in patients suffering from Parkinson's disease].
BACKGROUND
On average 40% of all patients suffering from Parkinson s disease (PD) undergo bouts of depression. It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits, together with hypometabolism in the orbital, caudate nucleus and frontal dorsolateral tract regions.


OBJECTIVE
The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD.


METHODS
The study examined a total of 77 patients (34 females and 43 males), with an average age of 68.2 years, who had been suffering from PD (according to the diagnostic criteria of Calne et al, in stage II of Hoehn and Yahr) for an average of 6.9 years. They were divided randomly into two groups which received fluoxetin (37 patients, dosage: 20 40 mg/day) or amitriptyline (40 patients, dosage: between 25 and 75 mg/day). A basal evaluation and four others (at 3, 6, 9 and 12 months of treatment) were performed, including the STMS (Short test of mental status), the Hamilton scale, and extent of functional disability using the UPDRS. A statistical analysis was performed by comparing the variance of the above mentioned parameters and the c2 test with Yates correction or the Fisher exact two tailed test, to evaluate the reasons for dropping out. In both cases a value of p< 0.05 was accepted as significant.


RESULTS
58 patients finished the study. Drop out because of side effects only took place in the group that received amitriptyline (p< 0.02), which was better than fluoxetin at controlling the depression (p< 0.009, 0.001, 0.002 and 0.00006) at 3, 6, 9 and 12 months, respectively.


CONCLUSIONS
At an average dosage of 35.2 mg/day, amitriptyline is effective in controlling the depression presented by patients with PD. However, despite the low dosage, the side effects it caused forced 15% of the patients abandon the treatment.
Serrano-Dueñas
M
M
Servicio de Neurología. Hospital Carlos Andrade Marin, Quito, Ecuador. serranom@pi.pro.ec
D000368:Aged; D000639:Amitriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D000639:Amitriptyline; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors