Antidepressive treatments for Parkinson's disease: A systematic review and meta-analysis

Emily Bomasang-Layno; Iris Fadlon; Andrea N Murray; Seth Himelhoch

doi:10.1016/j.parkreldis.2015.04.018

Antidepressive treatments for Parkinson's disease: A systematic review and meta-analysis

Parkinsonism Relat Disord. 2015 Aug;21(8):833-42; discussion 833. doi: 10.1016/j.parkreldis.2015.04.018. Epub 2015 May 16.

Authors

Emily Bomasang-Layno¹, Iris Fadlon², Andrea N Murray², Seth Himelhoch²

Affiliations

¹ Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: elayno@psych.umaryland.edu.
² Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 26037457
DOI: 10.1016/j.parkreldis.2015.04.018

Abstract

Context: Depression affects 50-70% of patients with Parkinson's disease resulting in significant comorbidity, executive dysfunction, and poorer quality of life. Divergent results from studies of different treatments preclude definite treatment recommendations.

Objective: To perform a systematic review and meta-analysis of published randomized controlled trials (RCTS) evaluating the efficacy of pharmacologic and behavioral interventions, and repetitive transcranial magnetic stimulation (rTMS) for depression among patients with idiopathic Parkinson's disease.

Data sources: Trial registers and the following databases were searched: PubMed, CINAHL, EMBASE, and PsycInfo. Bibliographies of relevant articles were cross-referenced.

Study selection and data extraction: RCTs comparing pharmacologic, behavioral, or rTMS with a placebo/other drugs or methods with no restrictions on participant age, gender, and duration or setting of treatment were included. Eligibility assessment was performed independently. Identified records were sequentially screened according to eligibility criteria. Differences in mean depression score and 95% confidence intervals were calculated.

Results: A total of 893 idiopathic Parkinson's disease patients with clinical depression across 20 RCTs were included. The overall standard mean difference for all pharmacologic interventions was 0.30 (95% CI -0.00, 0.61, p = 0.054). On stratification, there was a distinct difference in effect between antidepressants (SMD of 0.54, 95%CI 0.24, 0.83, p = 0.000) and non-antidepressants (SMD of -0.29, 95% CI -0.86, 0.29, p = 0.328). Behavioral interventions demonstrated significant efficacy with an effect size of 0.87 (95% CI 0.41, 1.33, p = 0.000).

Conclusions: This meta-analysis demonstrates that pharmacologic treatment with antidepressant medications, specifically the selective serotonin reuptake inhibitors (SSRIs), and behavioral interventions (CBT) significantly improved depression among Parkinson's disease patients.

Keywords: Antidepressants; Depression; Meta-analysis; Parkinson's disease; Systematic review; Treatment.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Cognitive Behavioral Therapy / methods*
Depression / drug therapy*
Depression / etiology
Humans
Parkinson Disease / complications
Parkinson Disease / drug therapy*
Selective Serotonin Reuptake Inhibitors / therapeutic use*

Substances

Serotonin Uptake Inhibitors