WEDNESDAY, April 11 (HealthDay News) -- Some of the newer
antidepressants can help treat depression in people with
Parkinson's disease without aggravating other disease symptoms such
as tremor or rigidity, researchers have found.
Nearly 1 million people in the United States are living with
Parkinson's disease, a progressive movement disorder marked by
tremor, slowness and/or rigidity. Parkinson's disease and
depression tend to travel together, and there has been concern that
some of the medications used to treat depression may worsen motor
symptoms.
A new study published online April 11 and in the April 17 print
issue of
Neurology shows that this is not the case, at least when it
comes to the antidepressants Paxil (paroxetine) and Effexor
(venlafaxine).
Paxil is in the class of drugs known as SSRIs (selective
serotonin reuptake inhibitors) while Effexor is an SNRI (serotonin
and norepinephrine reuptake inhibitor).
In the new study of 115 people with Parkinson's disease,
participants received Paxil, Effexor or an inactive "placebo" pill.
The researchers followed-up with patients for 12 weeks and found
that both antidepressants improved symptoms of depression without
worsening some of the motor symptoms associated with the
disease.
On average, those people who took Paxil had a 59 percent
improvement and those receiving Effexor had a 52 percent
improvement in scores on a standardized tool measuring depression.
People who received the placebo had a 32 percent improvement. Three
other depression-rating scales showed similar results.
The drugs did not lead to any worsening in motor symptoms, the
investigators noted. Use of antidepressants did not improve anxiety
levels, thought processes or overall health-related quality of life
among the study participants.
Sleep problems were among the most commonly reported side
effects. Weight gain was seen with Paxil and at the final study
visit, an increase in sitting blood pressure was seen with Effexor,
according to the report.
"Depression is the number-one factor negatively affecting the quality of life for people with Parkinson's disease," study author Dr. Irene Hegeman Richard, a neurologist at the University of Rochester Medical Center in Rochester, N.Y., said in a university news release. "It causes a great deal of suffering among patients. The great news here is that it's treatable. And when the depression is treated adequately, many of the other symptoms become much more manageable for patients."
Depression in Parkinson's disease is caused by the underlying
disease process, not the stress of dealing with a chronic disease,
she said.
Commenting on the study, Dr. Joe Verghese, a neurologist at the
Albert Einstein College of Medicine in New York City, said the
study provides good news for people with Parkinson's disease and
depression. "There is always a concern that we may upset the
applecart in Parkinson's by adding a new medication."
Dr. Roy Alcalay, an assistant professor of neurology at Columbia
University Medical Center in New York City, agreed that treating
depression in Parkinson's disease can be a delicate balance. "The
new study validates what we have been doing," he said. "The
medications used to treat depression in the general population work
as well for Parkinson's disease, and there is no evidence that they
have bad side effects on motor symptoms."
While the new study only looked at two antidepressants, "this
doesn't mean that others don't work," Alcalay said. As to the
robust placebo effect seen in the new study, he said that "just
thinking that they are getting treated often helps people with
depression."
Treating depression in Parkinson's is important, Alcalay said,
and "the study helps us do so in a more educated way."
The U.S. National Institutes of Health/National Institute of
Neurological Disorders and Stroke and the Johns Hopkins University
School of Medicine funded the study. Wyeth Pharmaceuticals provided
Effexor XR and the placebo, while GlaxoSmithKline provided
Paxil.
More information
Learn more about
Parkinson's disease at the U.S. National Institute
of Neurological Disorders and Stroke.