Beyond the iron mask: towards better recognition and treatment of depression associated with Parkinson's disease.
Identifieur interne : 000783 ( Ncbi/Curation ); précédent : 000782; suivant : 000784Beyond the iron mask: towards better recognition and treatment of depression associated with Parkinson's disease.
Auteurs : David J. Burn [Royaume-Uni]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2002.
English descriptors
- KwdEn :
- Antidepressive Agents (therapeutic use), Antidepressive Agents, Second-Generation (therapeutic use), Antidepressive Agents, Tricyclic (therapeutic use), Brain (metabolism), Depressive Disorder (diagnosis), Depressive Disorder (drug therapy), Depressive Disorder (etiology), Depressive Disorder (psychology), Humans, Parkinson Disease (complications), Parkinson Disease (metabolism), Parkinson Disease (psychology), Psychiatric Status Rating Scales, Quality of Life, Serotonin Uptake Inhibitors (therapeutic use), Treatment Outcome.
- MESH :
- chemical , therapeutic use : Antidepressive Agents, Antidepressive Agents, Second-Generation, Antidepressive Agents, Tricyclic, Serotonin Uptake Inhibitors.
- complications : Parkinson Disease.
- diagnosis : Depressive Disorder.
- drug therapy : Depressive Disorder.
- etiology : Depressive Disorder.
- metabolism : Brain, Parkinson Disease.
- psychology : Depressive Disorder, Parkinson Disease.
- Humans, Psychiatric Status Rating Scales, Quality of Life, Treatment Outcome.
Abstract
This review examines the frequency of depression complicating Parkinson's disease (PD), its aetiology and clinical features, and also how it may be recognised and treated. Studies investigating the frequency of depression in PD have yielded figures ranging between 2.7% and 70%. Methodological differences account for much of the disparity. The aetiology of depression in PD is complex, and probably relates to both biological and exogenous factors. Dysfunction of multiple neurotransmitter systems, including the serotonergic system, may be involved. Mood disturbances resulting from deep brain stimulation of the subthalamic nucleus may provide a fruitful area for future research, and assist our understanding of the neural networks involved in mediating depression. Several recent studies have confirmed that depression in the PD patient is a major determinant of quality of life and that this is closely related to dysfunction in other clinically important health areas. The validity for many existing scales in the screening, diagnosis, and monitoring of depression in the PD patient has not been established. The Montgomery-Asberg Depression Rating Scale and the Hamilton Rating Scale for Depression appear to have good diagnostic sensitivity and specificity when compared with DSM-IV criteria. Recommendations for the optimal drug treatment of depression in PD are difficult to give, due to an inexplicable dearth of sizeable, placebo-controlled studies. A majority of physicians would probably now opt for a selective serotonin reuptake inhibitor in the depressed PD patient. There is no good evidence that these drugs are associated with a worsening of motor features, but they should probably not be coprescribed with selegiline, because of the risk of causing a potentially serious serotonin syndrome. Several studies have suggested that depression in the PD patient is associated with a more rapid deterioration in cognitive and motor functions, perhaps as a surrogate marker for more extensive brainstem cell loss.
DOI: 10.1002/mds.10114
PubMed: 12112190
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pubmed:12112190Le document en format XML
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<author><name sortKey="Burn, David J" sort="Burn, David J" uniqKey="Burn D" first="David J" last="Burn">David J. Burn</name>
<affiliation wicri:level="1"><nlm:affiliation>Neurology, Regional Neurosciences Centre, Newcastle General Hospital, and University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom. d.j.burn@ncl.ac.uk</nlm:affiliation>
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<front><div type="abstract" xml:lang="en">This review examines the frequency of depression complicating Parkinson's disease (PD), its aetiology and clinical features, and also how it may be recognised and treated. Studies investigating the frequency of depression in PD have yielded figures ranging between 2.7% and 70%. Methodological differences account for much of the disparity. The aetiology of depression in PD is complex, and probably relates to both biological and exogenous factors. Dysfunction of multiple neurotransmitter systems, including the serotonergic system, may be involved. Mood disturbances resulting from deep brain stimulation of the subthalamic nucleus may provide a fruitful area for future research, and assist our understanding of the neural networks involved in mediating depression. Several recent studies have confirmed that depression in the PD patient is a major determinant of quality of life and that this is closely related to dysfunction in other clinically important health areas. The validity for many existing scales in the screening, diagnosis, and monitoring of depression in the PD patient has not been established. The Montgomery-Asberg Depression Rating Scale and the Hamilton Rating Scale for Depression appear to have good diagnostic sensitivity and specificity when compared with DSM-IV criteria. Recommendations for the optimal drug treatment of depression in PD are difficult to give, due to an inexplicable dearth of sizeable, placebo-controlled studies. A majority of physicians would probably now opt for a selective serotonin reuptake inhibitor in the depressed PD patient. There is no good evidence that these drugs are associated with a worsening of motor features, but they should probably not be coprescribed with selegiline, because of the risk of causing a potentially serious serotonin syndrome. Several studies have suggested that depression in the PD patient is associated with a more rapid deterioration in cognitive and motor functions, perhaps as a surrogate marker for more extensive brainstem cell loss.</div>
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