Depression and Parkinson's disease: a conceptual challenge

Abstract

The consequences of a different, integrated, neuropsychiatric approach for both diagnosis and treatment are discussed.

Assessment methods and factors associated with depression in Parkinson's disease

“…Added to this is the overlap that exists between the symptoms of depression and those of PD [3]. We examined the validity of three depression rating scales (the Hamilton depression, observer (HAMD) and self-reported (HDI) scales and the self-reported Geriatric Depression Scale (GDS-15)) against a gold standard diagnosis of depressive disorder (major depression, minor depression or dysthymia) based on the Diagnostic and Statistical Manual Edition IV (DSM-IV) criteria [4,5].…”

Conceptualization of depression in Parkinson?s disease

“…Such an approach has limitations, particularly in Parkinson’s disease (PD), due to diagnostic uncertainties in differential diagnosis of idiopathic PD (the major parkinsonian syndrome) from other etiologically distinct parkinsonian syndromes; manifestations of PD which may present as behavioral mimics or phenocopies of depression (Berrios et al 1995) such as apathy; issues of circular/self-referential classification through application of diagnostic criteria for depression in otherwise healthy persons to diagnose depression in PD; and the ongoing debate as to whether a distinct depression in idiopathic PD exists. Indeed, the conceptual challenge of depression in PD has recently been discussed from a semantic and epistemological viewpoint, with reference to the pathophysiology (Leentjens and Verhey 2002). Our focus is somewhat different, and seeks to specifically explore the conceptual and methodological difficulties of defining depression in PD.…”

“…Leentjens and Verhey (2002), assert that Parkinson’s disease is a distinct disease entity in contradistinction to psychiatric syndromal diagnosis such as depression. In contrast, we assert that in clinical practice Parkinson’s disease is a syndrome rather than a disease, given that we are unable to ascertain neurobiological data to confirm the diagnosis.…”

“…Thus, the diagnosis of major depressive disorder is predicated on the presence of five or more symptoms: low mood, anhedonia, sleep disturbances, weight loss, psychomotor agitation, fatigue, guilt, poor concentration, and suicidal ideation present for more than two weeks (DSM-IV) (APA 2000). This syndromal diagnosis has little reference to putative etiopathogenesis or clinical course apart from a duration specific qualifying period and mandatory exclusion factors (Leentjens and Verhey 2002). The assessment of depression in clinical research has been made by means of structured clinical interviews and/or assessment via depression rating scales based on these criteria.…”

“…The diagnostic confusion is further exacerbated by cognitive and physical manifestations of PD which also resemble features of depression, such as impaired concentration, cognitive/psychomotor slowing, brady-kinesia, reduced libido, fatigue, and sleep disturbance (Happe et al 2001; Leentjens and Verhey 2002; Pluck and Brown 2002; Schuurman et al 2002; Lieberman 2003). There may be somatic preoccupations with genuine physical complications such as dizziness, tinnitus, epigastric pain, headaches, bladder, and bowel disturbances (Leentjens and Verhey 2002).…”