Anticholinergic Effects in a Depressed Parkinsonian Patient

Abstract

Depression is commonly associated with idiopathic Parkinson's disease. Various antidepressants can be helpful in the treatment of this type of depression. Anticholinergic medications are at times used for treating the motor symptoms of parkinsonism. While some authors have reported euphorigenic effects from anticholinergics in other groups of patients, generally, they have not been used in the treatment of depression, with or without parkinsonism. In the case presented, a depressed patient with Parkinson's disease on levodopa/carbidopa and fluoxetine was given benztropine for his motor symptoms. The result was some improvement in his motor symptoms and a wide, dose-related spectrum of other central nervous system changes ranging from delirium to mania, hypomania, and euthymia from a "baseline" of residual depression. At a very low dose (0.25 mg per day), benztropine appeared to have an augmenting antidepressant effect that rendered the patient euthymic.

Depression and Parkinson's disease: a conceptual challenge

“…Treatment for motor symptoms with, for instance, dopamine-agonists not only results in less hypokinesia and rigidity, but also in reduced mental retardation and improvement of mood (48). Treatment of tremor with anticholinergic medication may improve mood, but at the same time cause cognitive symptoms (49). All Parkinson medication may induce visual hallucinations or delirium (50).…”

Depression in Parkinson??s Disease

“…[24] One case report described the alleviation of baseline depression in a patient with PD when benzatropine was added to a regimen of levodopa/carbidopa and fluoxetine. [73] The adverse effects of anticholinergic medications make them difficult to use in many elderly patients.…”

Cognitive impairment in parkinson’s disease

“…Drugs with a potential anticholinergic effect have little influence on mood changes, and although in some cases they can lead to mild euphoria, they are relatively ineffective as antidepressants. The possible effects on cognition can vary according to the stage of the disease and the extent to which the extranigral dopaminergic pathways are compromised 6 . Diagnosis of depression in Parkinson's disease can be extremely complicated.…”