title: [A comparison between low doses of amitriptyline and low doses of fluoxetin used in the control of depression in patients suffering from Parkinson's disease]. Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease Comparison of desipramine and citalopram treatments for depression in Parkinson's disease: a double-blind, randomized, placebo-controlled study. Randomized study of sertraline and low-dose amitriptyline in patients with Parkinson's disease and depression: effect on quality of life. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson’s disease The SSRI, Citalopram, Improves Bradykinesia in Patients With Parkinson's Disease Treated with L-Dopa Does Nefazodone Improve Both Depression and Parkinson Disease? A Pilot Randomized Trial
abstract: INTRODUCTION On average 40 % of all patients suffering from Parkinson s disease ( PD ) undergo bouts of depression . It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits , together with hypometabolism in the orbital , cau date nucleus and frontal dorsolateral tract regions . AIMS The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD . PATIENTS AND METHODS The study examined a total of 77 patients ( 34 females and 43 males ) , with an average age of 68.2 years , who had been suffering from PD ( according to the diagnostic criteria of Calne et al , in stage II of Hoehn and Yahr ) for an average of 6.9 years . They were divided r and omly into two groups which received fluoxetin ( 37 patients , dosage : 20 40 mg/day ) or amitriptyline ( 40 patients , dosage : between 25 and 75 mg/day ) . A basal evaluation and four others ( at 3 , 6 , 9 and 12 months of treatment ) were performed , including the STMS ( Short test of mental status ) , the Hamilton scale , and extent of functional disability using the UPDRS . A statistical analysis was performed by comparing the variance of the above mentioned parameters and the c2 test with Yates correction or the Fisher exact two tailed test , to evaluate the reasons for dropping out . In both cases a value of p < 0.05 was accepted as significant . RESULTS 58 patients finished the study . Drop out because of side effects only took place in the group that received amitriptyline ( p < 0.02 ) , which was better than fluoxetin at controlling the depression ( p < 0.009 , 0.001 , 0.002 and 0.00006 ) at 3 , 6 , 9 and 12 months , respectively . CONCLUSIONS At an average dosage of 35.2 mg/day , amitriptyline is effective in controlling the depression presented by patients with PD . However , despite the low dosage , the side effects it caused forced 15 % of the patients ab and on the treatment In addition to treating the motor symptoms of Parkinson ’s disease , the dopamine agonist pramipexole has shown an antidepressant effect . The trials , however , included patients with motor complications , raising the question of whether the antidepressant benefit represented only a treatment – related motor improvement . To address this issue , we have conducted a 14–week r and omized trial comparing pramipexole with an established antidepressant in patients without motor complications . At seven Italian centers , 67 Parkinsonian out patients with major depression but no history of motor fluctuations and /or dyskinesia received open – label pramipexole ( at 1.5 to 4.5 mg/day ) or sertraline ( at 50 mg/day ) . In both groups , the Hamilton Depression Rating Scale ( HAM – D ) score decreased throughout 12 weeks of treatment , but in the pramipexole group the proportion of patients who recovered , as defined by a final HAM – D score ≤ 8,was significantly higher , at 60.6 % versus 27.3 % ( p = 0.006 ) . Patients ’ self – ratings improved in both groups . All adverse events were mild or moderate , but five patients ( 14.7 % ) withdrew from the sertraline group . Despite the absence of motor complications , the pramipexole recipients showed improvement on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) motor subscore . We conclude that dopamine agonists may be an alternative to antidepressants in Parkinson ’s disease Depression is one of the most common psychiatric disturbances in Parkinson 's disease ( PD ) . Recent review s have highlighted the lack of controlled trials and the ensuing difficulty in formulating recommendations for antidepressant use in PD . We sought to establish whether antidepressants provide real benefits and whether tricyclic and selective serotonin reuptake inhibitor ( SSRI ) antidepressants differ in their short-term efficacy , because the time to onset of therapeutic benefit remains an important criterion in depression . The short-term efficacy ( after 14 and 30 days ) of two antidepressants ( desipramine , a predominantly noradrenergic reuptake inhibitor tricyclic and citalopram , a SSRI ) was assessed in a double-blind , r and omized , placebo- controlled study of 48 nondemented PD patients suffering from major depression . After 14 days , desipramine prompted an improvement in the Montgomery Asberg Depression Rating Scale ( MADRS ) score , compared with citalopram and placebo . Both antidepressants produced significant improvements in the MADRS score after 30 days . Mild adverse events were twice as frequent in the desipramine group as in the other groups . A predominantly noradrenergic tricyclic antidepressant induced a more intense short-term effect on parkinsonian depression than did an SSRI . However , desipramine 's lower tolerability may outweigh its slight short-term clinical advantage We assessed the effect of 3-month treatment of sertraline ( 50 mg ) or low-dose amitriptyline ( 25 mg ) on depression and quality of life in 31 patients with Parkinson 's disease in a prospect i ve single-blind r and omized study . Both drugs significantly reduced the Hamilton Depression Rating Scale ( HDRS-17 ) score . Completion rate was 75 % for sertraline ( 12 of 16 ) and 73 % for amitriptyline ( 11 of 15 ) . Responder rate ( HDRS-17 score reduction > /= 50 % ) was 83.3 % for sertraline and 72.7 % for amitriptyline . Sertraline but not amitriptyline treatment determined a significant benefit on quality of life ( PDQ-39 scale ) . We found no change in Unified Parkinson 's Disease Rating Scale scores . However , the improvement in specific PDQ-39 subscores ( mobility , activities of daily living , and stigma ) suggests that depression affects patient self-perception of motor function and further emphasizes the need for its treatment Objective : To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation ( rTMS ) in treating depression in patients with Parkinson ’s disease . Methods : 42 patients were enrolled into two groups : group 1 , active rTMS ( 15 Hz rTMS for 10 days ) and placebo drug treatment ; group 2 , sham rTMS and fluoxetine 20 mg/day . A specially design ed sham coil was used for sham stimulation . The unified Parkinson ’s disease rating scale ( UPDRS ) , activities of daily living ( ADL ) , Hamilton rating scale for depression ( HRSD ) , Beck depression inventory ( BDI ) , and mini-mental state examination ( MMSE ) were assessed by a rater blinded to treatment arm . Results : HRSD and BDI were improved to the same extent in both groups after two weeks of treatment ( 38 % and 32 % for group 1 , 41 % and 33 % for group 2 , respectively ) . At week 8 there was a tendency for worse motor UPDRS scores in group 2 ( NS ) . ADL showed improvement at week 8 only in group 1 . MMSE improved in both groups after treatment , but faster in group 1 than in group 2 . There were fewer adverse effects in group 1 than in group 2 . Conclusions : rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement , with fewer adverse effects Idiopathic Parkinson 's disease ( IPD ) is characterized by motor signs such as akinesia , rigidity , and often tremor at rest . In addition to these symptoms , depression is a common finding affecting 40 % of patients with IPD . This study evaluates the effect of the selective serotonin reuptake inhibitor , citalopram , on motor and nonmotor symptoms of depressed and nondepressed patients with IPD . Forty-six nondemented patients with IPD ( 24 men , 22 women ; mean age 64 ± 5.3 years ; mean ± SD disease duration , 6.4 ± 3.2 years ; mean ± SD Hoehn-Yahr stage , 2.8 ± 1.2 ) were included in the study . Patients were divided in two subgroups : depressed ( n = 18 ) and nondepressed ( n = 28 ) . Citalopram was added in an unblinded manner , starting with 10 mg/d , and , after a week , increased up to 20 mg/d in the depressed subgroup ( n = 18 ) and in half of the nondepressed subgroup ( n = 14 ) . Parkinsonian and depressive symptoms were evaluated before and after 1 and 4 months of treatment . Statistical evaluation was made by analysis of variance for repeated measures . Citalopram  did not worsen motor performance in IPD , but improved bradykinesia and finger taps after 1 month and 4 months of treatment both in patients with and without depression ( p < 0.05 versus baseline ) . A clear improvement in mood was also observed in 15 of 16 patients with depression . Although case reports indicate that citalopram can potentially worsen the motor symptoms in patients with PD , to date this effect has not been confirmed . Many of the symptoms , typically associated with depression , can be observed in nondepressed patients with IPD , because signs thought to represent depression can be produced by Parkinson 's disease . In this study , we observed that when combined with levodopa , citalopram  induces an improvement of motor performance , in particular of subscores 23 and 31 of Unified Parkinson 's Disease Rating Scale both in depressed and in nondepressed patients with IPD Some of the selective serotonin reuptake inhibitors (SSRI)-induced motor side effects are mediated by stimulating 5-HT2 receptors in the basal ganglia , probably because serotonin inhibits the subsequent neuronal dopamine release . We hypothesized that nefazodone , a serotonin 2 antagonist/reuptake inhibitor ( SARI ) that selectively blocks 5-HT2 receptors , could disrupt the aforementioned inhibitory pathway . Therefore , increased dopamine levels in the postsynaptic milieu and an improvement in the motor symptoms in depressed patients with Parkinson disease ( PD ) should be observed . This study was design ed to determine whether nefazodone has a dual activity as an antidepressant and as an agent capable of reducing the extrapyramidal symptoms in depressed parkinsonian patients . Depressed patients with PD were r and omly assigned to 2 therapeutic groups : nefazodone or fluoxetine . Patients were evaluated by a psychiatrist and were blindly assessed by a neurologist with an array of scales . Patients on nefazodone ( n = 9 ) showed a significant improvement over time in the total Unified Parkinson Disease Rating Scale score ( UPDRS ) ( part II + part III ) ( P = 0.004 ) and in the UPDRS subscore part III ( P = 0.003 ) . None of these scores changed over time in the fluoxetine group ( n = 7 ) . Both , nefazodone and fluoxetine were equally effective as antidepressants : Beck Depression Inventory scores significantly improved ( P < 0.001 ) , with no significant differences between treatment groups ( P = 0.97 ) . If our results can be confirmed in a larger clinical trial , nefazodone ought to be considered over fluoxetine given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms in depressed PD patients
target: An acceptability analysis showed that SSRIs were generally well tolerated .
  Conclusions These results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD .
background: Background Selective serotonin reuptake inhibitors ( SSRIs ) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson 's Disease ( PD ) but data on their efficacy are controversial .