Abstract
BackgroundDepression is a common non-motor symptom in patients with Parkinson's disease (PD). There are many kinds of antidepressants being used, such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and Dopamine agonists which are suggested as alternative antidepressants for the treatment of depression in PD. Which one should we choose first? Literatures have shown inconsistent results.MethodsWe conducted a network meta-analysis of randomized controlled trials to compare the efficacy and acceptability of therapeutic methods for the treatment of depression in Parkinson's disease.ResultsWe used the odds ratios (OR) as effect size firstly and the results indicated no statistical significance between each compared intervention. Then we used the logarithm of the individual odds ratios as effect size. With efficacy of TCAs as the standard of comparison, the degree of incoherence (a measure of how closely the entire network fits together) was small (ω = 4.824827e-05). The logor were: SSRIs −0.69 (95% CI −1.28– −0.10); Pramipexole −0.73 (−1.71– −0.26); Pergolide −1.97 (−3.67– 0.27); SNRIs −0.86 (−1.86– 0.15); Placebo −1.24 (−1.99– −0.50). With Placebo as the standard of comparison, the logor were: TCAs 1.24 (0.50– 1.99); SSRIs 0.55 (−0.03– 1.13); Pramipexole 0.51 (−0.12– 1.15); Pergolide −0.73 (−2.25– 0.80); SNRIs 0.38 (−0.42– 1.19); TCAs, pramipexole, pergolide and SNRIs showed better profile of acceptability, leading to significant fewer discontinuations than that of SSRIs.ConclusionsThere is insufficient evidence to support antidepressant efficacy for SSRIs, pramipexole, pergolide and SNRIs. TCAs might be the best choice when starting antidepressant treatment in patients of Parkinson's disease because it has the most favorable balance between benefits and acceptability, followed by pramipexole and SNRIs, SSRIs might be the last choice.
Highlights
Depressive disorders as well as depressive symptoms are common in Parkinson’s disease (PD) and are important factors affecting quality of life
Inconsistent, several scales were used by different clinicians, such as Hamilton depression rating scale (HDRS), Montgomery–Asberg depression rating scale (MADRS), BDI and others PD patients might be in different stages: early or advanced; Heterogeneous degree of depression Short term, generally lasting less than 4 months Three studies were allowed to use antidepressants other than the study medication; four studies were not allowed; four studies were not available There can be a substantial information loss when continuous outcome variables are dichotomized while tricyclic antidepressants (TCAs) always being thought to have severe side effects
A survey of physicians in the Parkinson Study Group found that 26% PD patients received antidepressants for depression and 51% physicians used selective serotonin reuptake inhibitors (SSRIs) as their first choice [48]
Summary
Depressive disorders as well as depressive symptoms are common in Parkinson’s disease (PD) and are important factors affecting quality of life. There are many pharmaceutical therapy options for depression in Parkinson’s disease (PD): such as TCAs, SSRIs, SNRIs and Dopamine agonists which are being suggested as alternative antidepressants for these patients. SSRIs are the most commonly prescribed antidepressants in patients with depression in PD[3], while a metaanalysis in 2010 by Petros Skapinakis and colleagues suggested that there was insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. There are many kinds of antidepressants being used, such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and Dopamine agonists which are suggested as alternative antidepressants for the treatment of depression in PD. Which one should we choose first? Literatures have shown inconsistent results
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