Depression in Parkinson's disease: diagnosis and treatment.
The prevalence of non-motor symptoms in Parkinson's disease (PD) is high. Depression varies from 20 to 50% of the PD patients, and is associated with increasing disability. The key characteristics of depression are anhedonia and low mood. The recommended scales for screening purposes are: HAM-D, BDI, HADS, MADRS and GDS. As for measurement of severity: HAM-D, MADRS, BDI and SDS. In cases with mild depression, non-pharmacological intervention is the treatment of choice. In moderate depression, antidepressants are required. The choice of an antidepressant should be based mainly on the comorbidities and unique features of the patient. Evidence for antidepressant effectiveness is seen mostly with amitriptyline and nortriptyline, but one should be cautious in elderly patients. Other antidepressants that can be prescribed are: citalopram, escitalopram, sertraline, bupropion, trazodone, venlafaxine, mirtazapine and duloxetin. The dopaminergic agonist pramipexole is a treatment option.
Neurologista, Mestre em Clínica Médica, Universidade Federal do Rio de Janeiro (UFRJ). Médico do Serviço de Neurologia do Hospital Universitário Clementino Fraga Filho (HUCFF/UFRJ), Rio de Janeiro RJ, Brazil. flaviohenrique@ufrj.br
Flavio Henrique de Rezende
FH
Costa
Ana Lucia Zuma
AL
Rosso
Henryk
H
Maultasch
Denise Hack
DH
Nicaretta
Maurice Borges
MB
Vincent
D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy; D015444:Exercise / Q000523:psychology; D006801:Humans; D010300:Parkinson Disease / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000706:statistics & numerical data
D000928:Antidepressive Agents