A meta-analysis of randomised placebo-controlled treatment trials for depression and anxiety in Parkinson's disease.

Lakkhina Troeung,Natalie Gasson,Sarah J Egan,Xiang Yang Zhang

doi:10.1371/journal.pone.0079510

Lakkhina Troeung, Natalie Gasson + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0079510

Copy DOI

Journal: PloS one	Publication Date: Nov 13, 2013
Citations: 152	License type: CC BY 4.0

Affiliation: Curtin University

Abstract

BackgroundPsychopharmacotherapy currently constitutes the first-line treatment for depression and anxiety in Parkinson’s disease (PD) however the efficacy of antidepressant treatments in PD is unclear. Several alternative treatments have been suggested as potentially more viable alternatives including dopamine agonists, repetitive transcranial magnetic stimulation, and cognitive behavioural therapy (CBT).MethodA meta-analysis of randomised placebo-controlled trials for depression and/or anxiety in PD was conducted to systematically examine the efficacy of current treatments for depression and anxiety in PD.ResultsNine trials were included. There was only sufficient data to calculate a pooled effect for antidepressant therapies. The pooled effect of antidepressants for depression in PD was moderate but non-significant (d = .71, 95% CI = −1.33 to 3.08). The secondary effect of antidepressants on anxiety in PD was large but also non-significant (d = 1.13, 95% CI = −.67 to 2.94). Two single-trials of non-pharmacological treatments for depression in PD resulted in significant large effects; Omega-3 supplementation (d = .92, 95% CI = .15 to 1.69) and CBT (d = 1.57, 95% CI = 1.06 to 2.07), and warrant further exploration.ConclusionsThere remains a lack of controlled trials for both pharmacological and non-pharmacological treatments for depression and anxiety in PD which limits the conclusions which can be drawn. While the pooled effects of antidepressant therapies in PD were non-significant, the moderate to large magnitude of each pooled effect is promising. Non-pharmacological approaches show potential for depression in PD however more research is required.

Highlights

Parkinson’s disease (PD) is classically defined as a motor disorder of neurological aetiology
There were 28 randomised controlled trials (RCT) for the treatment of depression in PD, while one RCT was targeted at the treatment of comorbid depression and anxiety [73]
The present analysis showed that the pooled effect of antidepressants for depression in PD was moderate but non-significant (d = .71, 95% CI = –1.33 to 3.08), as was the pooled effect for the current first-line SSRI treatments (d = .57, 95% CI = –1.33 to 2.47)

Summary

Introduction

Parkinson’s disease (PD) is classically defined as a motor disorder of neurological aetiology. Depression and anxiety are the two most clinically significant psychological disturbances in PD and affect up to half of all individuals with PD at some stage of their illness [2]. Research has shown that both depression and anxiety are among the greatest predictors of poor quality of life in PD and consistently rated as more detrimental to well-being and functional ability than motor symptoms [3], even in the most advanced stages of disease where motor symptoms have fully progressed [4]. Psychopharmacotherapy currently constitutes the first-line treatment for depression and anxiety in Parkinson’s disease (PD) the efficacy of antidepressant treatments in PD is unclear. Several alternative treatments have been suggested as potentially more viable alternatives including dopamine agonists, repetitive transcranial magnetic stimulation, and cognitive behavioural therapy (CBT)

Methods

Results

Discussion

Conclusion