A trial 1 included a total of 115 patients with Parkison's disease. Patients met DSM-IV criteria for a depressive disorder, or operationally defined subsyndromal depression, and scored >12 on the first 17 items of the Hamilton Rating Scale for Depression (HAM-D). They were randomized to receive an SSRI (paroxetine, maximum daily dosage of 40 mg; n = 42), an SNRI (venlafaxine, maximum daily dosage of 225 mg; n = 34), or placebo (n = 39). They were followed for 12 weeks on medication. The primary outcome measure was a change in the HAM-D score from baseline to week 12. In the paroxetine group mean 12-week reduction in HAM-D score was 6.2 points (97.5% CI 2.2 to 10.3, p = 0.0007) and in the venlafaxine group 4.2 points (97.5% CI 0.1 to 8.4, p = 0.02), as compare with placebo. No treatment effects were seen on motor function.
Comment: The quality of evidence is downgraded by study quality (short follow-up time) and imprecise results (few patients and wide confidence intervals).
A Cochrane review [Abstract] 2 included 3 studies with a total of 106 subjects. In the first arm of the crossover trial with 22 patients in the nortriptyline group showed a larger improvement than placebo group in median depression score in a self-made 31-item depression rating scale after 4 months of treatment but statistical significance was not calculated. A parallel group trial with 37 patients did not show any statistically significant difference between the citalopram and placebo groups in the Hamilton Depression Scale after 1 year of treatment. The third randomized open-label trial compared fluvoxamine versus amitriptyline. Similar numbers of patients in amitriptyline and fluvoxamine groups (60% vs 55%) had a 50% reduction of Hamilton score after 16 months of treatment. Visual hallucinations and confusion were reported in patients with fluvoxamine and amitriptyline. Otherwise, no other major side effects were found in the other two trials.
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment), inconsistency (heterogeneity in interventions and outcomes) and imprecise results (few patients and wide confidence intervals).
Clinical comments: The clinical trial evaluated new antidepressant and found them effective for depression in Parkinson's disease. A Cochrane review evaluated studies on older antidepressants with limited effect for depression in Parkinson's disease.
Primary/Secondary Keywords