Depression and Parkinson's disease.
Depression occurs in approximately 45% of all patients with Parkinson's disease (PD), reduces quality of life independent of motor symptoms and seems to be underrated and undertreated. Characteristics of symptoms differ from major depression. Because of overlapping clinical symptoms, diagnosis is based on subjectively experienced anhedonia and feeling of emptiness. Available rating scales for major depression may not be adequate to correctly measure severity of depression in PD. Anxiety and depression may manifest as first symptoms of PD many years before motor symptoms. Serotonergic, noradrenergic and dopaminergic mechanisms play key roles in the etiology of depression in PD. Tricyclic and newer, selective antidepressants including serotonin and noradrenaline reuptake inhibitors (SSRI, SNRI) appear to be effective in treating depression in PD. Selective reuptake inhibitors seem to have a favorable side effect profile. Recent controlled studies show antidepressant effects of pramipexole in bipolar II depression. New dopamine agonists pramipexole and ropinirole appear to ameliorate depressive symptoms in PD in addition to effects on motor symptoms. There is a lack of appropriate rating scales and controlled studies regarding depression in PD.
Lemke
Matthias R
MR
Rhine Clinic Bonn, Kaiser-Karl-Ring 20, 53111 Bonn, Germany. mr.lemke@lvr.de
Fuchs
Gerd
G
Gemende
Irene
I
Herting
Birgit
B
Oehlwein
Christian
C
Reichmann
Heinz
H
Rieke
Jürgen
J
Volkmann
Jens
J
D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003866:Depressive Disorder / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects; D004565:Electroconvulsive Therapy / Q000639:trends; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology*; D011613:Psychotherapy / Q000639:trends; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D018491:Dopamine Agonists; D017367:Selective Serotonin Reuptake Inhibitors