Abstract
The high prevalence of major depressive disorder in people with Parkinson’s disease (PD), its negative impact on health-related quality of life and the low response rate to conventional pharmacological therapies call to seek innovative treatments. Here, we review the new approaches for treating major depressive disorder in patients with PD within the framework of the network model of depression. According to this model, major depressive disorder reflects maladaptive neuronal plasticity. Non-invasive brain stimulation (NIBS) using high frequency repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex has been proposed as a feasible and effective strategy with minimal risk. The neurobiological basis of its therapeutic effect may involve neuroplastic modifications in limbic and cognitive networks. However, the way this networks reorganize might be strongly influenced by the environment. To address this issue, we propose a combined strategy that includes NIBS together with cognitive and behavioral interventions.
Highlights
Reviewed by: Elisa Di Rosa, University of Padova, Italy Wolf-Julian Neumann, Charité - University Medicine Berlin, Germany
Major depressive disorder is common in Parkinson’s disease (PD), a progressively debilitating neurological disorder affecting over 1 million individuals in the United States and approximately 6 millions worldwide
High frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) can influence distant brain regions that are compromised in major depressive disorder suggesting that its therapeutic effect may operate by modulating functional connectivity in broad cortical networks, notably the default mode and the central executive networks (Liston et al, 2014)
Summary
Major depressive disorder is a widely distributed chronic condition. While 1-year prevalence estimates of this entity round 5–10%, the lifetime prevalence reaches up to 15–20%. Major depressive disorder is characterized by high relapsing rates: 22–50% of patients suffer recurrent episodes within 6 months after recovery (World Health Organization, 2004). It is associated with compromised quality of life, increased health care costs, and greater risk for a widespread medical conditions, coronary heart disease. PD-dep has been speculated to have some distinctive features when compared with major depressive disorder in non-PD patients, including relatively high levels of anxiety, preservation of short-term memory and no association with severity of motor symptoms. PD-dep negatively impacts motor and cognitive abilities (Marsh, 2013) Despite their major repercussion, affective disturbances in PD have received less attention compared to motor and cognitive dysfunctions
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