P03-380 - The Efficacy of Psychopharmacologic Treatment in Depressive Disorder Associated with Parkinson's Disease Dementia

Abstract

Objective: To evaluate the comparative efficacy of 3 antidepressants, each representative of a distinct psychopharmacologic class, in the treatment of depressive disorders associated to Parkinson disease with dementia (PDD). Methods: A group of 23 patients, mean age 72.1, diagnosed with PDD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with escitalopram (mean dose 15 mg daily, n=7), duloxetine (mean dose 45 mg daily, n=8) or trazodone (mean dose 150 mg daily, n=8). All patients received treatment for PDD with rivastigmine or donepezil continuously, for at least 12 months. The distribution of patients on the antidepressant treatment was randomized, in a single-blind manner. Patients were evaluated monthly, for 6 months, using Montgomery Asberg Depression Rating Scale, Hamilton Rating Scale for Depression-17 items, Clinical Global Impression-Improvement and Mini Mental Status Examination. Results: Patients treated with duloxetine had the most significant improvement in the depressive symptoms, as the endpoint MADRS (-18.6+/-2.3, p< 0.01), HAMD (-13.2+/-1.1, p< 0.01) and CGI-I (-3.2+/-0.5, p< 0.01) scores reflected. The differences between escitalopram and trazodone didn't reach a significant level but, overall, both improved the depressive symptoms compared to baseline (p< 0.05). The difference between duloxetine and the other two antidepressants became significant after 8 weeks (p< 0.01). The severity of dementia symptoms didn't vary significantly between the three groups at endpoint. Conclusion: Duloxetine had proven itself more efficient than escitalopram and trazodone in the improvement of the depressive symptoms in PDD.

Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis

“…The highest level of evidence for antidepressants was from a randomized trial of citalopram in DLB (51) and an unpublished trial of duloxetine, escitalopram, and trazodone in PDD (52). Citalopram does not appear to be efficacious or well tolerated in DLB, with 10 of 14 participants (71.4%) withdrawing because of adverse effects (51).…”

“…Citalopram does not appear to be efficacious or well tolerated in DLB, with 10 of 14 participants (71.4%) withdrawing because of adverse effects (51). In a trial of antidepressants for depression in PDD, the Montgomery-Åsberg Depression Rating Scale score was reduced (218.6 points) in participants who were treated with duloxetine (N58) (52). Individuals receiving escitalopram (N57) and trazodone (N58) were reported to have had reductions in depressive symptoms, but scores were not provided.…”

Efficacy and tolerability of antidepressants in Parkinson's disease: A systematic review and network meta‐analysis

“…Two studies were government funded, but with industry‐supplied medications . Two studies were exclusively government funded, and 8 studies did not report a source of funding …”

“…Twelve studies were 2-arm randomized trials; however, there were seven 3-arm trials [21][22][23][24][25][26][27] and one 7-arm trial. 28 The trials had a combination of no-treatment (n = 3), placebo (n = 12), and active treatment only comparison groups (n = 5).…”

“…28 The trials had a combination of no-treatment (n = 3), placebo (n = 12), and active treatment only comparison groups (n = 5). The included studies contained arms evaluating the efficacy of multiple antidepressant classes: SSRIs (n = 12), 22,23,25-34 selective norepinephrine reuptake inhibitors (SNRIs, n = 4), 24,26,27,35 tricyclics (n = 6), 22,25,28,29,36,37 monoamine oxidase inhibitors (MAOIs, n = 3), 21,38,39 serotonin antagonist and reuptake inhibitors (SARIs), 34,40 and other drugs including mirtazapine, 23 combined atomoxetine and rivastigmine, 24 bupropion, 32 and trazodone. 27…”