Motor changes during sertraline treatment in depressed patients with Parkinson's disease*.
BACKGROUND
Pharmacological interventions to treat depressive symptoms associated with Parkinson's disease (PD) are limited. Whether selective serotonine re-uptake inhibitors increase parkinsonism or have clinically significant interactions with antiparkinsonian drugs is unresolved.


OBJECTIVE
We used a naturalistic approach to prospectively investigate the long-term effects on motor status of adding sertraline in a large sample of community-dwelling PD patients with depressive symptoms.


METHODS
Main outcome measure was the motor part of the Unified PD Rating Scale (UPDRS) at baseline and at 1-, 3-, and 6-month follow-up. Secondary measures were the change in antiparkinsonian drugs expressed as total levodopa equivalent dose and the scores of the Hospital Anxiety and Depression Scale (HADS). Of the 374 patients included, 310 (82%) completed the study.


RESULTS
Treatment with sertraline (mean dose 66.0 +/- 29.8 mg) resulted in improvement in all UPDRS domains along with a significant decrease of the HADS scores. A modest but significant increase of the total dose of levodopa, without significant change of total levodopa equivalent dose, was observed. Almost 8% of patients discontinued medication for adverse events, mainly related to the gastrointestinal system.


CONCLUSIONS
Although worsening of tremor was observed in some patients, active management of depression with sertraline appears to have a positive impact on parkinsonism.
Kulisevsky
J
J
Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain. jkulisevsky@santpau.cat
Pagonabarraga
J
J
Pascual-Sedano
B
B
Gironell
A
A
García-Sánchez
C
C
Martínez-Corral
M
M
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy / Q000209:etiology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000209:etiology; D004298:Dopamine / Q000378:metabolism; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects*; D010300:Parkinson Disease / Q000188:drug therapy / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012701:Serotonin / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D012720:Severity of Illness Index
D018687:Antidepressive Agents, Second-Generation; D000978:Antiparkinson Agents; D004298:Dopamine; D007980:Levodopa; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline