title: Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management.
abstract: OBJECTIVE
  Parkinson's disease (PD) is frequently complicated by depression and there is a paucity of controlled research that can inform the management of this disabling nonmotor complaint. A randomized controlled trial of nortriptyline, paroxetine, and placebo for the treatment of depression in PD (dPD) was recently completed. The purpose of this article is to describe the baseline pattern of depressive symptom presentation in PD, the specific symptoms of dPD that improve with pharmacotherapy, and the residual symptoms that remain in patients who meet a priori criteria for response or remission after acute treatment (8 weeks).
  
  
  METHODS
  The Departments of Psychiatry and Neurology at Robert Wood Johnson Medical School, New Jersey.
  
  
  METHODS
  : Fifty-two depressed patients (major depression or dysthymia based on Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) with Parkinson's disease (by research criteria).
  
  
  METHODS
  A randomized controlled trial of nortriptyline, paroxetine, and placebo.
  
  
  METHODS
  The four subscales (core mood, anxiety, insomnia, and somatic) and individual items from the Hamilton Rating Scale for Depression-17 were the focus of this study. These measures were assessed at baseline and Week 8.
  
  
  RESULTS
  Baseline depressive symptoms were unrelated to motor functioning. Treatment response was associated with significant improvements in the core mood, anxiety, insomnia, and somatic symptoms seen in dPD. Residual symptoms, such as sadness and loss of interest, persisted in treatment responders in a milder form than was initially present.
  
  
  CONCLUSIONS
  Antidepressants may influence all symptoms of dPD, including those that share great overlap with the physical disease process. Additional research regarding adjunctive interventions is needed to help optimize the management of dPD.
authors.affiliation: Department of Psychiatry UMDNJ, Robert Wood Johnson Medical School, NJ 08854, USA. dobkinro@umdnj.edu
authors.forename: Roseanne DeFronzo
authors.initials: RD
authors.lastname: Dobkin
authors.forename: Matthew
authors.initials: M
authors.lastname: Menza
authors.forename: Karina L
authors.initials: KL
authors.lastname: Bienfait
authors.forename: Michael
authors.initials: M
authors.lastname: Gara
authors.forename: Humberto
authors.initials: H
authors.lastname: Marin
authors.forename: Margery H
authors.initials: MH
authors.lastname: Mark
authors.forename: Allison
authors.initials: A
authors.lastname: Dicke
authors.forename: Jill
authors.initials: J
authors.lastname: Friedman
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D019263:Dysthymic Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy*; D017374:Paroxetine / Q000627:therapeutic use*; D010919:Placebos; D011569:Psychiatric Status Rating Scales
chemical_list: D000928:Antidepressive Agents; D010919:Placebos; D017374:Paroxetine; D009661:Nortriptyline
references.citation: J Clin Psychol. 2006 Jan;62(1):123-46
references.pmid: 16287149
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Am J Geriatr Psychiatry. 2008 Mar;16(3):201-8
references.pmid: 18310551
references.citation: Neurology. 1967 May;17(5):427-42
references.pmid: 6067254
references.citation: Expert Rev Neurother. 2009 Jul;9(7):975-84
references.pmid: 19589048
references.citation: Int J Geriatr Psychiatry. 2005 Dec;20(12):1196-202
references.pmid: 16315146
references.citation: J Neurol Neurosurg Psychiatry. 1992 May;55(5):377-82
references.pmid: 1602311
references.citation: Am J Psychiatry. 1992 Apr;149(4):443-54
references.pmid: 1372794
references.citation: J Neurol Sci. 2006 Oct 25;248(1-2):151-7
references.pmid: 16797028
references.citation: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references.pmid: 14399272
references.citation: Biol Psychiatry. 1993 Oct 1;34(7):465-70
references.pmid: 8268331
references.citation: Adv Neurol. 1990;53:245-9
references.pmid: 2239463
references.citation: J Psychosom Res. 1998 Jul;45(1):5-13
references.pmid: 9720850
references.citation: Am J Geriatr Psychiatry. 2005 Oct;13(10):844-51
references.pmid: 16223962
references.citation: Neurology. 2009 Mar 10;72(10):886-92
references.pmid: 19092112
references.citation: Am J Geriatr Psychiatry. 2003 May-Jun;11(3):340-8
references.pmid: 12724113
references.citation: Mov Disord. 2009 Jul 15;24(9):1325-32
references.pmid: 19412944
references.citation: BMJ. 1993 May 29;306(6890):1437-40
references.pmid: 8518639
references.citation: J Am Geriatr Soc. 1997 Jul;45(7):844-9
references.pmid: 9215336
references.citation: Dialogues Clin Neurosci. 2008;10(4):419-30
references.pmid: 19170399
references.citation: Am J Geriatr Psychiatry. 2009 Jun;17(6):473-82
references.pmid: 19472438
references.citation: J Affect Disord. 1997 Aug;45(1-2):5-17; discussion 17-8
references.pmid: 9268771
references.citation: J Neuropsychiatry Clin Neurosci. 2010 Spring;22(2):188-95
references.pmid: 20463113
references.citation: J Clin Psychiatry. 2008 Feb;69(2):246-58
references.pmid: 18363453
references.citation: J Affect Disord. 2004 Jun;80(2-3):135-44
references.pmid: 15207926
references.citation: Br J Med Psychol. 1959;32(1):50-5
references.pmid: 13638508
references.citation: J Affect Disord. 2007 Nov;103(1-3):77-82
references.pmid: 17321595
references.citation: Neurology. 2007 Jul 24;69(4):342-7
references.pmid: 17581943
references.citation: Mov Disord. 2008 Oct 15;23(13):1889-96
references.pmid: 18709682
references.citation: Am J Geriatr Psychiatry. 2009 Sep;17(9):802-9
references.pmid: 19700952