Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

Petros Skapinakis,Venetsanos Mavreas,Glyn Lewis,Eleni Bakola,Athanasios P Kyritsis,Georgia Salanti

doi:10.1186/1471-2377-10-49

Petros Skapinakis, Venetsanos Mavreas + Show 4 more

Open Access

https://doi.org/10.1186/1471-2377-10-49

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Journal: BMC Neurology	Publication Date: Jun 21, 2010
Citations: 136	License type: cc-by

Affiliation: University of Bristol, University of Ioannina

Abstract

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials to investigate the efficacy and acceptability of SSRIs in the treatment of depression in PD.ResultsTen studies were included. In the comparison between SSRIs and Placebo (n = 6 studies), the combined risk ratio (random effects) was 1.08 (95% confidence interval: 0.77 - 1.55, p = 0.67). In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37). An acceptability analysis showed that SSRIs were generally well tolerated.ConclusionsThese results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded. The comparison between SSRIs and TCAs is based on only three studies and further trials with more pragmatic design are needed.

Highlights

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial
Regarding depression in the context of PD, a recent survey in the U.S showed that 63% of the prescriptions for depression in PD were for Selective Serotonin Reuptake Inhibitors (SSRI) and only 7.5% for tricyclic antidepressants (TCAs) [7]
We retrieved the full text of 24 articles for a more detailed evaluation and 14 of them were excluded: 13 studies were uncontrolled; one study - [18] - randomized PD patients to citalopram or placebo only if they were non-depressed while the depressed participants did not have a control

Summary

Introduction

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial. The impact of depression in the quality of life of patients with PD has been recently recognized even in community-based patients and is independent of disease severity and other clinical or demographic variables [2,3]. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors [SSRIs). These drugs are the most commonly prescribed antidepressants in patients with depression in general [6]. The preference of SSRIs over the older TCAs is supposedly based on their similar efficacy but better tolerability, especially when compared with tertiary amines, such as amitriptyline or imipramine [8]

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