Meds Ease Depression in Parkinson's Patients without Worsening Other Symptoms
April 12, 2012
HOUSTON - Today’s anti-depressant medications can ease depression in Parkinson’s patients without worsening other symptoms of the disease, according to a study published online in Neurology®, the medical journal of the American Academy of Neurology.
“Depression is the number-one factor negatively affecting the quality of life for people with Parkinson’s disease,” said Laura Marsh, M.D., Mental Health Care Line executive at the Michael E. DeBakey VA Medical Center and a co-investigator in the study. “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.”
The findings are good news for patients with Parkinson’s disease, a chronic neurologic disorder best known for causing slow movement, stiffness, balance problems and other motor difficulties. However, about half of Parkinson’s patients also struggle with depression.
“It’s very important to note that these patients are not depressed simply because they are dealing with a chronic neurological condition,” said Marsh. “Rather, the depression is caused by the underlying disease process, which also causes problems with movement and balance.”
While older medications known as tricyclics help treat depression in such patients, those drugs can have undesirable side effects. That led physicians to try newer antidepressant medications in Parkinson’s patients. But recent smaller studies with these medications had mixed results, leaving some physicians to question whether these drugs were actually of any benefit. In addition, there was some concern that they might worsen patient’s motor symptoms.
With funding from the National Institute of Neurological Disorders and Stroke (NINDS), the Study of Antidepressants in Parkinson’s Disease included 115 people with Parkinson’s disease at 20 sites in the United States, Canada, and Puerto Rico. All the participants had Parkinson’s disease and met the criteria for depression.
About one-third of the participants received paroxetine (brand name Paxil), a selective serotonin reuptake inhibitors (SSRI); one-third received venlafaxine extended release (brand name Effexor), a serotonin and norepinephrine reuptake inhibitor (SNRI); and one-third received a placebo.
On average, the people receiving paroxetine had a 59 percent improvement and those receiving venlafaxine had a 52 percent improvement in their depression severity scores, according to the Hamilton Rating Scale for Depression. People who received the placebo had a 32 percent improvement. Three other depression rating scales showed similar results. The drugs were generally well tolerated and did not lead to any worsening in motor functioning.
Today, people are becoming more knowledgeable that depression is frequently part of the disease, said Marsh, who has witnessed striking improvement in many patients after effective treatment.
“After treatment for depression, patients and their families often see a dramatic difference in how they’re feeling, within a few weeks or months. They have more interest in things. They have more energy; they’re sleeping better. And generally, there is a great sense of relief and a huge burden has been lifted,” said Marsh, who is listed as one of the best doctors in the nation in the field of psychiatry and is also a professor at the Menninger Department of Psychiatry and Behavioral Sciences and in the Department of Neurology at Baylor College of Medicine.
She added that sometimes it can be difficult to spot depression in patients, because some symptoms overlap with other symptoms of Parkinson’s. For instance, Parkinson’s patients will be less animated, their voice will be less expressive, and many will have sleep difficulties – but they may not be depressed. Careful diagnosis is crucial.
In addition to funding from NINDS, the study was supported by the Johns Hopkins University School of Medicine. Wyeth Pharmaceuticals provided venlafaxine XR and Glaxo-Smith Kline provided paroxetine.
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Awarded re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 130,000 Veterans in southeast Texas and provides some of the most complex care within the VA Health Care System. The DeBakey VA employs nearly 3,600 staff and is one of 49 institutions within the prestigious Texas Medical Center*, one of the largest health and research centers in the world. The DeBakey VA is home to a Post Traumatic Stress Disorder Clinic; Network Polytrauma Center; award-winning Cardiac and General Surgery Program; Liver Transplant Center; Epilepsy and Cancer Centers of Excellence; Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research & Development Center of Excellence; Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; Mental Illness Research, Education and Clinical Center; $26.8 million Research and Development Program; and Parkinson’s Disease Research, Education, and Clinical Center. The hospital offers sophisticated, cutting-edge technology such as PET/CT imaging, the Evident™ microwave ablation system, a CyberKnife®, a Varian Trilogy linear accelerator, a Philips Wide Bore Computed Tomography Simulator, the OR•Control System, the Abiomed Impella 2.5 catheter-based heart pump, and the Sapien heart valve. For more than 60 years, the DeBakey VA has served as the primary teaching facility for our major affiliate, Baylor College of Medicine* and operates one of the largest VA residency programs in the nation. Each academic year, more than 2,179 students are trained through 194 affiliation agreements with institutions of higher learning. Including the outpatient clinics in Beaumont, Conroe, Galveston, Houston, Lufkin, Richmond, and Texas City, MEDVAMC outpatient clinics logged almost 1.3 million outpatient visits in fiscal year 2011.