Pharmacologic Treatment of Anxiety Disorders in Parkinson Disease

Abstract

Objective Neither best practices nor an evidence-base for the pharmacologic treatment of anxiety in Parkinson's disease has been established. This study investigated pharmacologic treatment of anxiety disorders in idiopathic Parkinson's disease and the associated clinical features. Design Cross-sectional. Setting Three community-based movement disorder neurology practices Participants 250 subjects with Parkinson's disease. Measurements Anxiety disorder diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Current medications were provided by the treating neurologists at the time of interview. Results Amongst subjects with anxiety disorders only, 53% were untreated with medications. However, when anxious subjects with comorbid depressive disorders were included, 70.8% were on medications effective for treatment of anxiety. Subjects with anxiety and comorbid depressive disorders were more likely to be treated for their psychiatric disturbances than subjects with anxiety disorders alone (Odds Ratio 8.33) as were subjects with comorbid motor fluctuations (Odds Ratio, 3.65). There were no differences in the types of anti-anxiety medications used in regard to the presence of depression or motor fluctuations. Conclusions These findings suggest that over half of non-depressed Parkinson's disease patients with clinically significant anxiety are untreated with medication. A better understanding of the role of clinical features associated with anxiety in PD, such as depression and motor fluctuations, may improve the recognition and treatment of anxiety disorders in this population.

Prevalence of anxiety in Parkinson's disease: A systematic review and meta‐analysis

“…By demonstrating a high weighted point prevalence rate for anxiety disorders in PD (31%), the present systematic review suggests the need for the efficient identification of anxiety in PD, which occurs at a much higher average prevalence than depressive disorders in PD (17%). Given this high prevalence of anxiety, pharmacological and nonpharmacological treatment of anxiety needs to be further studied and optimized for PD patients …”

“…Given this high prevalence of anxiety, pharmacological and nonpharmacological treatment of anxiety needs to be further studied and optimized for PD patients. 34,55…”

Neuropsychiatric Symptoms in Parkinson Disease and Dementia with Lewy Bodies: What Geriatric Psychiatry Can Learn

“…In “Pharmacologic treatment of anxiety disorders in Parkinson’s disease,” Pontone et al 7 investigated pharmacologic treatment of anxiety disorders in idiopathic PD, examining 250 patients at three community-based movement disorder neurology practices. A current anxiety diagnosis was present in 37% of patients, confirming the high prevalence of anxiety disorders in PD.…”

Prevalence of depression and receipt of antidepressant pharmacotherapy among patients with Parkinson’s disease: a national assessment of US office-based physician visits

“…38 Anxiety disorders occur in up to 40% of patients with PD. 39 This rate is significantly greater than that of the general population of older adults, which is estimated to range from 3.2% to 14.2%. 39 Other common on-and offlabel indications for antidepressant treatment include, but are not limited to, bipolar depression, peripheral neuropathy, smoking cessation, insomnia, fibromyalgia, musculoskeletal pain, migraines, and various eating disorders.…”

“…39 This rate is significantly greater than that of the general population of older adults, which is estimated to range from 3.2% to 14.2%. 39 Other common on-and offlabel indications for antidepressant treatment include, but are not limited to, bipolar depression, peripheral neuropathy, smoking cessation, insomnia, fibromyalgia, musculoskeletal pain, migraines, and various eating disorders. 38,40 In addition to the increase in all-cause antidepressant use, the present study found more than twofold increases in diagnosis of depression (from 4.1% to 8.3%) and in diagnosis of depression plus antidepressant pharmacotherapy (from 3.2% to 7.2%) in office visits made by patients with PD, comparing 1990PD, comparing -1995PD, comparing with 2013PD, comparing -2014.…”