Prevalence, Clinical Manifestations, Etiology, and Treatment of Depression in Parkinson's Disease

Abstract

To determine the extent to which depression complicates Parkinson's disease (PD), the authors analyzed the literature on depression in PD in order to report on its prevalence, clinical manifestations, and treatment. By means of MEDLINE literature searches, the analysis focused on 45 PD depression studies conducted from 1922 through 1998. The results indicate that the prevalence of depression is 31% for all PD patients. The clinical manifestations of PD depression include apathy, psychomotor retardation, memory impairment, pessimism, irrationality, and suicidal ideation without suicidal behavior. PD depression is effectively treated with a variety of antidepressants, most commonly at present the selective serotonin reuptake inhibitors. Anecdotal evidence supports the use of sertraline to treat PD depression.

The neuropathological basis for depression in Parkinson's disease

“…For patients that were "not" clinically diagnosed with depression (n = 9) by a consulting psychiatrist, we verified the presence orabsence of depression by examining their clinical/medical records, nursing protocols, use of antidepressant medications, and social work progress notes. In line with previous reports on the prevalence of depression in PD [2], we observed that approximately half (55%) of our patients suffered with clinical depression (n = 11), ranging from moderate to severe.…”

“…PD had generally been characterized as a movement disorder, but non-motor abnormalities, including depression and dementia [1], are now more recognized and are widespread in PD. Depression occurs frequently in this population with a prevalence estimated at 30-40% [2]. Unfortunately, however, only 20% of all depressed PD patients receive treatment for their depression [3].…”

Neural stem cells in Parkinson’s disease: a role for neurogenesis defects in onset and progression

“…The disease is characterized by its locomotor phenotypes, which include resting tremors, difficulty initiating movement, postural instability, bradykinesia and rigidity as well as the formation of intracytoplasmic inclusions or protein aggregates called Lewy bodies, containing insoluble a-synuclein (SNCA) protein. Several non-motor symptoms of PD have also been described, including anhedonia [4][5][6][7][8], depression [9], anxiety [10], olfactory deficits [11][12][13], sleep disturbances [14,15] and cognitive dysfunction [16][17][18]. These non-motor symptoms often precede the prototypical motor symptoms of PD by years or even decades [19,20].…”

Executive function in Parkinson’s disease: contributions of the dorsal frontostriatal pathways to action and motivation

“…For example, a recent study of PD participants reported impaired feedback-based learning for those with co-morbid clinical depression (Herzallah et al, 2010). Depression is reported by 30%-40% of patients (Slaughter, Slaughter, Nichols, Holmes, & Martens, 2001) and may be linked to this diminished sensitivity to reward (Eshel & Roiser, 2010). Thus, depressive symptoms may modulate the way in which rewards are experienced by those with PD; in turn, this may produce a deficit in using the rewarding/punishing aspects of feedback as a motivator for improving performance.…”