title: Antidepressive treatments for Parkinson's disease: A systematic review and meta-analysis.
abstract: BACKGROUND
  Depression affects 50-70% of patients with Parkinson's disease resulting in significant comorbidity, executive dysfunction, and poorer quality of life. Divergent results from studies of different treatments preclude definite treatment recommendations.
  
  
  OBJECTIVE
  To perform a systematic review and meta-analysis of published randomized controlled trials (RCTS) evaluating the efficacy of pharmacologic and behavioral interventions, and repetitive transcranial magnetic stimulation (rTMS) for depression among patients with idiopathic Parkinson's disease.
  
  
  METHODS
  Trial registers and the following databases were searched: PubMed, CINAHL, EMBASE, and PsycInfo. Bibliographies of relevant articles were cross-referenced.
  
  
  METHODS
  RCTs comparing pharmacologic, behavioral, or rTMS with a placebo/other drugs or methods with no restrictions on participant age, gender, and duration or setting of treatment were included. Eligibility assessment was performed independently. Identified records were sequentially screened according to eligibility criteria. Differences in mean depression score and 95% confidence intervals were calculated.
  
  
  RESULTS
  A total of 893 idiopathic Parkinson's disease patients with clinical depression across 20 RCTs were included. The overall standard mean difference for all pharmacologic interventions was 0.30 (95% CI -0.00, 0.61, p = 0.054). On stratification, there was a distinct difference in effect between antidepressants (SMD of 0.54, 95%CI 0.24, 0.83, p = 0.000) and non-antidepressants (SMD of -0.29, 95% CI -0.86, 0.29, p = 0.328). Behavioral interventions demonstrated significant efficacy with an effect size of 0.87 (95% CI 0.41, 1.33, p = 0.000).
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that pharmacologic treatment with antidepressant medications, specifically the selective serotonin reuptake inhibitors (SSRIs), and behavioral interventions (CBT) significantly improved depression among Parkinson's disease patients.
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: elayno@psych.umaryland.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Bomasang-Layno
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Fadlon
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Murray
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; Depression; Meta-analysis; Parkinson's disease; Systematic review; Treatment