Abstract
Major and minor forms of depression are significant contributors to Parkinson's disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson's disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson's disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson's comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.
Highlights
Neuropsychiatric disorders such as depression very often accompany core motor impairments of Parkinson’s disease (PD) [1]
Consensus and controversial topics related to pathophysiological mechanisms of depression in PD, clinical parameters, and connections with other nonmotor symptoms as well as treatment options are addressed in depth in separate sections. is information can be used as guidance for other physicians given that diagnosis of depression in the context of PD is generally challenging and there are no specific guidelines available
Older age, and brain structural factors together with neurotransmitter depletion could contribute to the development of depression in the context of PD. us, PD patients should be systematically screened for depression and anxiety, the diagnostic of which can be aided using clinical scales such as the GDS
Summary
Neuropsychiatric disorders (and nonmotor symptoms more widely) such as depression very often accompany core motor impairments of Parkinson’s disease (PD) [1]. More and more, they are perceived as significant contributors to PD morbidity and caregiver burden as they have a major impact on patient’s function, quality of life, and long-term outcomes. Up to half of PD patients suffer from major or minor forms of depression at a given time during the disease course, and they have been widely studied in this context, they remain both underrecognized and undertreated [2, 3]. Information on the management of depression and PD comorbid patients is usually extrapolated from depression, geriatrics, or PD clinical practice guidelines (CPGs), which leads to an increased variability of habits and disagreement among physicians [5, 7]
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