Objective: To longitudinally evaluate the role of depression in the development of impulse control disorders (ICD) in Parkinson’s disease (PD) patients.

Background: Depression has been associated with ICD in cross-sectional PD studies. However, prospective studies addressing the causality of this relationship are lacking.

Method: From Parkinson’s Progression Markers Initiative (PPMI) we included PD patients free of ICDs at baseline according to the Questionnaire for Impulsive-Compulsive Disorders in PD (QUIP). Patients were prospectively evaluated first quarterly and then biannually. Development of ICDs was defined as an increase of QUIP scores during follow up. Using survival proportional hazard models we studied the effect of baseline depression over ICD risk. We also evaluated this effect controlling for dopamine agonist use as a time dependent variable and for other potential confounders.

Results: Among 354 patients, 68 were depressed at baseline. The median follow up was 4.08 years. Depression at baseline was associated with higher ICD risk (hazard ratio, HR: 1.96, 95% CI 1.32-2.9, p<0.001). This risk remained significant after controlling for DA use (HR: 1.97, 95%CI 1.33-2.9, p<0.001), which was also independently linked to ICD development (HR: 1.87 95%CI 1.3-2.7, p<0.001). Hence, depressed patients faced an even higher ICD risk when receiving DA treatment. Controlling for multiple potential confounders also did not alter these results.

Conclusion: In PD, depression predisposes to the development of ICDs. This risk is magnified by DA use. Thus, DA should be used cautiously in depressed PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/depression-as-a-risk-factor-for-impulse-compulsive-disorders-in-parkinsons-disease-a-prospective-survival-study/