Depression and Parkinson?s disease

Abstract

Depression, the most common psychiatric complication in Parkinson's disease (PD), affects 40-50 % of PD patients [1]. However, exact epidemiological data are missing. Rates of depression in PD vary between 4 % and 70 % depending on diagnostic criteria and selection of the study population. Application of structured diagnostic interviews (e. g. SCID, MINI, NPI) in non-selected populations would be desirable. Severity of depression and anxiety appears to correlate with disability and reduced quality of life in PD patients. Depression and anxiety appear to be underdiagnosed and undertreated in PD [7], even though adequate diagnosis and treatment affect the course of the disease.The profile of depressive symptoms observed in PD is not identical to that reported in patients with primary depression. Distinctive features of depression in PD include elevated levels of dysphoria, irritability, little guilt or feelings of failure, and a low suicide rate despite a high frequency of suicidal ideation. Diagnosis of depression in PD is complicated by overlapping symptoms of the two disorders. Symptoms of depression including psychomotor slowing and retardation; reduced mimics and apathy may be indistinguishable from neurological motor deficits in PD. Diagnosis of depression in PD is almost exclusively based on subjectively experienced depressive symptoms including: (1) feeling of emptiness and hopelessness, (2) reduced reactivity to emotional stimuli, (3) loss of the ability to enjoy and feel pleasure (anhedonia).Observer-and self-rating depression scales (HAMD, BDI) have been validated in order to assess severity and its course in depressed patients with PD. However, because of overlapping clinical symptoms, available rating scales may not reliably measure severity of depression.Quality of life is rather reduced by subjectively expe-■ Abstract Depression occurs in approximately 45 % of all patients with Parkinson's disease (PD), reduces quality of life independent of motor symptoms and seems to be underrated and undertreated.

Depression in patients with Parkinson’s disease and the associated features

“…Some researches showed that most PD patients with depression have a course of PD more than five years and the occurrence of depression was relatively correlated with wearing-off and motor fluctuation [16] . Our findings further supported the notion and demonstrated that depression actually reflected the advancement of PD and sub-depression could be deemed as the prodrome of depression, a notion that is shared by many other scholars [17,18] . Depression is a direct result of the advancing neuro-degenerative process within frontal-subcortical systems when the disease affects the serotoninergic and dopaminergic pathways [19,20] .…”

Dopaminergic Medication in Parkinson’s Disease and Problem Gambling

“…Depression is also one of the most common non-motor symptoms of Parkinson's disease and many participants, in both samples, reported taking adjunct antidepressant medication. There is a lack of controlled studies on antidepressant therapy in Parkinson's' disease and very limited systematic research into the efficacy of dopaminergic medication on depression (Lemke et al 2004). Anxiety symptoms also commonly occur in Parkinson's disease patients and have been associated with fluctuations in medication status (Pandya et al 2008).…”

Long-Term L-DOPA Treatment Causes Indiscriminate Increase in Dopamine Levels at the Cost of Serotonin Synthesis in Discrete Brain Regions of Rats

“…The frequently observed side effects of long-term L-DOPA treatment are the wearing off phenomenon, on-off fluctuations, dyskinesia, and psychosis (Lemke et al 2004;Hui et al 2005). Of these, dyskinesia is the most common complication, for which etiology is very complex and unknown, but stimulation of D 1 and D 2 receptors for DA plays a key role (Nutt 1990).…”