Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management.
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.
Dobkin
Roseanne DeFronzo
RD
Department of Psychiatry UMDNJ, Robert Wood Johnson Medical School, NJ 08854, USA. dobkinro@umdnj.edu
Menza
Matthew
M
Bienfait
Karina L
KL
Gara
Michael
M
Marin
Humberto
H
Mark
Margery H
MH
Dicke
Allison
A
Friedman
Jill
J
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
D000928:Antidepressive Agents; D010919:Placebos; D017374:Paroxetine; D009661:Nortriptyline
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