Effect of Antidepressants on Psychotic Symptoms in Parkinson Disease: A Review of Case Reports and Case Series

Abstract

Objectives The treatment of Parkinson disease (PD) psychosis remains a challenge. Only a few treatments eliciting significant relief of psychotic symptoms have passed the test of randomized controlled trials. Methods Here, we conducted a review of the literature on the effect of antidepressants on PD psychosis. Because there is no randomized controlled trial that assessed the antipsychotic effects of antidepressants in PD, only case reports, case series, and open-label trials were available to review. Because of the scarce literature, statistical analysis could not be performed. Results The following antidepressants alleviated hallucinations in PD: amoxapine, citalopram, clomipramine, escitalopram, mianserin, mirtazapine, and venlafaxine. The antidepressants were generally well tolerated, with the exception of amoxapine, which exacerbated parkinsonism. Conclusions Whereas the conclusions that can be drawn on the efficacy of antidepressants at reducing PD psychosis are limited because of the poor quality of the reported studies, it is encouraging to notice that there are positive anecdotal reports. Further studies are needed to confirm the potential of these drugs and also to determine if a subtype of patients or of psychotic features may be more likely to be improved by antidepressants.

Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

“… 200 The evidence regarding antidepressant use for PD psychosis is weak, limited to case reports or series. 200 - 203 …”

“…200 The evidence regarding antidepressant use for PD psychosis is weak, limited to case reports or series. [200][201][202][203] Electroconvulsive therapy (ECT) was shown to improve depression, psychosis, and motor symptoms in patients with PD, although the motor improvement was short-lasting. 204,205 Dementia with Lewy Bodies.…”

GPR52 agonists attenuate ropinirole-induced preference for uncertain outcomes.

“…The rationale for testing both these latter compounds was more behavioral than mechanistic, given that both drugs decrease impulsivity or responding for addictive drugs in humans and/or animals (Adams et al, 2017; Graves, Rafeyan, Watts, & Napier, 2012; Mantsch et al, 2010). Both drugs also have the advantage of being safe for human use, and mirtazapine in particular may confer additional benefits in terms of reducing depression, psychosis, and anxiety in PD patients (Sid-Otmane, Huot, & Panisset, 2020). However, similar to the current work, all the data supporting their use currently come from a single study in animals, in which the sample and effect sizes were small.…”

Pharmacological update of mirtazapine: a narrative literature review

“…The effects of MTZ and other antidepressants on mild depression linked to PD were also documented by Costa et al ( 2012 ). Sid-Otmane et al investigated how MTZ and other antidepressants affected PDPsy and found that they effectively reduced hallucinations in PD (Sid-Otmane et al 2020 ). Antidepressant medications, such as MTZ, are effective in treating depression in PD patients as well as insomnia and psychosis, according to Pena et al ( 2018 ).…”