Cognitive behavioral therapy improves diverse profiles of depressive symptoms in Parkinson's disease

Abstract

Objective Depression is among the most common and debilitating nonmotor complaints in Parkinson's disease (PD), yet there is a paucity of controlled research to guide treatment. Little research has focused on the extent to which specific depressive symptom profiles may dictate unique clinical recommendations to ultimately improve treatment outcomes. The current study examined the impact of cognitive behavioral therapy (CBT) on different types of depressive symptoms in PD. It was hypothesized that the cognitive (eg, guilt, rumination, and negative attitudes towards self) and behavioral (eg, avoidance and procrastination) symptoms targeted most intensively by the treatment protocol would show the most robust response. The extent to which stabilized antidepressant use moderated specific symptom change was examined on an exploratory basis. Method Eighty depressed people with PD participated in a randomized controlled trial of CBT plus clinical management, versus clinical management only. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores, reflecting depressive symptom heterogeneity in PD, were the focus of this investigation. Results CBT response was associated with significant improvements in mood, sleep, anxiety, and somatic symptoms (HAMD), and negative attitudes toward self, performance impairment, and somatic symptoms (BDI). As hypothesized, the largest effect sizes were observed for cognitive and behavioral (vs somatic) symptoms of depression. Stabilized antidepressant use moderated the effect of CBT on somatic complaints (HAMD and BDI). Conclusions CBT may improve a diverse array of depressive symptoms in PD. Cognitive and behavioral (vs somatic) symptoms showed the greatest change. Combining CBT with antidepressants may help optimize the management of somatic complaints in depression in PD (dPD).

Telephone-based cognitive behavioral therapy for depression in Parkinson disease

“…Though the small number of participants not taking antidepressant medications (n = 22 [30%]) also precludes meaningful exploratory analyses of the effect of ADM on T-CBT response in the current study, evidence from prior work (with a more balanced sample with respect to ADM use) reflected greater benefits of antidepressants for somatic symptoms of dPD only, in the context of combined treatment. 47 In addition, prior research has shown that caregiver involvement in dPD treatment enhances patient response, 48 indicating a need for further investigation into the nature and magnitude of this effect.…”

“…Overall, these findings parallel our prior RCT of CBT for dPD, in which targeted cognitive and behavioral symptoms improved more than somatic symptoms. 47 Finally, while remote delivery of interdisciplinary PD services is growing and increasingly recognized as critical for advancing care, limitations remain on insurance coverage for telemental health services like T-CBT. At this time, 36 states and Washington, DC, require private insurers to provide coverage parity for in-person and telemedicine-delivered care, while 21 states and Washington, DC, have such policies in Medicaid, 49 with the availability of specific telemental health services subject to states' scope-of-practice laws.…”

Cognitive and Physical Intervention in Metals’ Dysfunction and Neurodegeneration

“…In terms of emotional problems in PD, the most effective seem to be anxiety and depression CBT protocols [152,153] performed independently or combined with pharmacotherapy [154]. Most of the interventions already reported took place in groups or were telephone-based [152].…”

Synthesis and Biological Evaluation of Novel Selenyl and Sulfur-l-Dopa Derivatives as Potential Anti-Parkinson’s Disease Agents

“…Parkinson’s disease (PD) is an extrapyramidal syndrome characterized by muscle stiffness, tremors, and bradykinesia that can evolve to loss of motor control, tremors at rest, and postural instability. Other symptoms may be depression and slowness in speech [1,2].…”