Review
Copyright ©The Author(s) 2015.
World J Neurol. Mar 28, 2015; 5(1): 17-38
Published online Mar 28, 2015. doi: 10.5316/wjn.v5.i1.17
Table 4 Studies on the effect of antidepressant drugs on depressive symptoms in Parkinson’s disease subjects with depression
DrugStudy designSample sizeStudy objectivesOutcomesAdverse effectsRef.
Fluoxetine23Effects of fluoxetine (up to 40 mg/d) on motor performance20/23 patients experienced no worsening of parkinsonism[167]
Fluoxetine, fluvoxamine, citalopram, and sertralineOpen-label prospective study62 depressed patients with PD (without dementia or motor fluctuation) (15 patients received citalopram, 16 fluoxetine, 16 fluvoxamine, and 15 sertraline)Effects of SSRIs on motor performance and depressive symptoms↓↑ UPDRS scores Significant improvements in depression with all SSRIs[168]
Fluoxetine/amitriptylineRandomized study77 patients with PD (37 received fluoxetine and 40 received amitriptyline)Comparing fluoxetine (20-40 mg/d) and amitriptyline (25-75 mg/d) at low doses on depressive symptomsAmitriptyline better controlled depression at 3, 6, 9 and 12 mo, respectively15% abandoned amitriptyline because of side effects[137]
FluoxetineProspective, controlled, open-label study18 patients with PD and mild depression without dementiaInfluence of fluoxetine (20 mg/d) on motor functionsSignificant improvements in scores of depression and Parkinson’s disability[174]
ParoxetineTo assess the tolerability of paroxetine (20 mg once per day)Improved depression UPDRS scores ↓↑Reversible worsening of tremor in one patient[171]
Paroxetine65 outpatients with PD and depressionTo assess the tolerability of paroxetine (10-20 mg once per day)Improved depression20% stopped paroxetine because of adverse reactions Increased “off” time and tremor in 2 patients (reversible)[170]
Paroxetine CR/nortriptylineRandomized, placebo controlled trial52 patients with PD and depressionTo evaluate the efficacy of paroxetine CR and nortriptyline in treating depressionNortriptyline was superior to placebo for the change in depressive scores Paroxetine CR was not[140]
Paroxetine/venlafaxineRandomized, double-blind, placebo-controlled trial115 subjects with PDTo compare efficacy and safety paroxetine and venlafaxine extended release in treating depression in PDBoth paroxetine and venlafaxine XR significantly improved depression UPDRS scores ↓↑[173]
Citalopram46 non-demented patients with PD. 18 depressed and 28 non-depressedEffect of citalopram on motor and nonmotor symptoms of depressed and nondepressed patients with IPDImprovement in mood in 15/16 patients Motor performance ↓↑ Improved bradykinesia and finger taps in patients with and without depression[169]
CitalopramProspective, open label trial10 patients with PD and major depression, without dementiaEffects of citalopram on depressive symptomsSignificant improvement in depression and in anxiety symptoms and functional impairment[175]
EscitalopramOpen-label study14 Parkinson’s disease patients with major depressionEffects of escitalopram on depressive symptoms↓ in depressive symptomatology score (response and remission rates were only 21% and 14%)[176]
SertralineOpen-label pilot study15 patients with PD and depressionTo evaluate the safety and efficacy of sertraline to treat depression in PDSignificant improvement in depression UPDRS scores ↓↑Side effects in 1/3 2 patients discontinued sertraline[177]
Sertraline Sertraline54 PD patients with depressive disorders 374 PD patients with depressive symptomsComparing efficacy of sertraline in the usual formulation and in the liquid oral concentrate Long-term effects of sertraline on motor statusImproved depression on both formulations Improved clinical global impression-severity of illness scale Improved UPDRS ↓ Anxiety ↓ Depression8% discontinued medication for adverse events (gastrointestinal) Worsening of tremor in some patients[179] [178]
Sertraline/amitriptylineProspective single-blind randomized study31 patients with PD and depressionAssessment of the effect of sertraline (50 mg) or low-dose amitriptyline (25 mg) on depression and quality of life↓ Depression by both drugs Sertraline improved quality of life ↓↑ UPDRS scores[138]
Sertraline/pramipexoleRandomized trial67 outpatients with PD and major depression but no motor fluctuations and/or dyskinesiaTo compare pramipexole with sertralineBoth sertraline and pramipexole improved depression Pramipexole caused more recovery compared to sertraline (60.6% vs 27.3%) Pramipexole improved UPDRS motor subscore14.7% withdrew from the sertraline group[99]
Nefazodone/fluoxetineA pilot randomized trialDepressed patients with PDTo assess the effect of nefazodone on extrapyramidal symptoms in depressed PD patientsNefazodone significantly improved UPDRS score Both nefazodone and fluoxetine were equally effective in treating depression[185]
TrazodoneRandomized trial20 PD patients with and without depressionTo test the ability of trazodone to improve depression and motor functionSignificantly improved depression Improves motor function in depressed patients[186]
VenlafaxineProspective study14 non-fluctuating PD patients with depressionTo investigate the therapeutic efficacy of venlafaxineImproved depression scores UPDRS scores ↓↑[195]
Atomoxetine, a SNRIRandomized placebo- controlled study55 subjects with PD depression atomoxetine or placeboTo assess efficacy of atomoxetine (80 mg/d) in treating depressionFailed to improved depression Improved global cognition Improved daytime sleepiness[196]
DuloxetineNon-comparative, open-label, multi-center study151 patientsTo evaluate the tolerability, safety, and efficacy of duloxetine 60 mg once daily in PD patients with major depressive disorderImproved depressive scores Improved activities of daily living Tremor ↓↑ Rigidity ↓↑8.6% discontinued the study due to side effects[197]