Patterns and Predictors of Depression Treatment among Older Adults with Parkinson’s Disease and Depression in Ambulatory Care Settings in the United States

Abstract

Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD) in the United States (US). The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005–2011) from the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratio = 1.743, 95% CI 1.376–2.209), while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratio = 0.559, 95% CI 0.396–0.790) to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.

Exploring Treatment for Depression in Parkinson’s Patients: A Cross-Sectional Analysis

“…Reports of prevalence of depression among PD patients vary greatly throughout the literature, depending on how depressive symptoms or disorders are classified and the study population. In this analysis, 26.46% of the survey sample screened positive for depression, a significant difference compared to 9.94% of those not classified as PD patients (Table 2), consistent with previously reported ranges [2][3][4][5][6]. The prevalence of depression among non-PD patients in our study is similar to the reported prevalence of depression in the general population (8.1%; [28]).…”

“…Parkinson's disease (PD) is a chronic neurodegenerative disease with characteristic motor and non-motor symptoms affecting 572 per 100,000 people aged 45 or older and projected to impact 1,238,000 U.S. individuals by 2030 [1]. Depression is a highly prevalent comorbidity of PD, with prevalence estimates ranging from 22% to 91% [2][3][4] and estimates of concomitant anti-parkinsonian and antidepressant use in older adults ranging from 25% to 58% of patients [5,6], with selective serotonin reuptake inhibitors emerging as the most frequently used antidepressant [5,6]. Moreover, depression is a key predictor of health-related quality of life, with increasing severity corresponding to decreased quality of life [7,8].…”

“…Although current literature indicates a continued unmet need for treatment among depressed Parkinson's patients, few studies address the use of antidepressants in younger patients prescribed anti-parkinsonian medication or directly compare depression treatment in Parkinson's patients with the general population. Additionally, depression treatment in recent studies of Parkinson's patients has been defined primarily by pharmacologic treatment [6], although psychotherapeutic approaches are also available for depression treatment [7,21] and endorsed by a physician focus group [22].…”

Microglial Phagocytosis of Neurons: Diminishing Neuronal Loss in Traumatic, Infectious, Inflammatory, and Autoimmune CNS Disorders

“…Impaired neuronal function (1–4), from neuroinflammation or other causes, is a known driver of depression and related neuropsychiatric problems (5–11) that often accompany complex CNS disorders, including TBI (12, 13) and CNS disorders with autoimmune components (14), such as multiple sclerosis (MS) (15, 16), Parkinson’s disease (PD) (17–19), and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) (20). A recent twin study by Huang, et al, suggests that the causal connection between depression and neuroinflammation may be bidirectional.…”

Efficacy of non-pharmacological interventions for depression in individuals with Parkinson's disease: A systematic review and network meta-analysis

“…Interestingly, our results indicate that most nonpharmacological interventions examined in our study had no significant effect on alleviating depressive disorders. This may be due to the use of antidepressant medications and the progression of PD (Schrag et al, 2001;Bhattacharjee et al, 2018;Demarco et al, 2021). Moreover, depression in PD patients is associated with cognitive impairment.…”