Objective: To elucidate the most acceptable and effective treatments for the management of depression in Parkinson’s disease (PD) using a systematic review approach.

Background: Depression is frequently reported as a significantly debilitating co-morbidity by PD patients. The treatment of depression in PD has been examined in a number of studies, however, no general consensus on best clinical practise has been agreed upon by the medical and scientific community. Obtaining a clearer understanding of the most effective and tolerable treatments will result in better quality-of-life and prognoses for PD patients with depression. Moreover, this information may aid in the development of recognised guidelines for the treatment of depression in PD.

Method: A systematic review of studies, up to 31 December 2018, investigating the efficacy, efficiency and side-effect profile of pharmacological and non-pharmacological treatments for depression in PD was undertaken. PubMed, Cochrane, Web of Science and MEDLINE databases were used to identify relevant randomised control trials, cohort studies and case-control studies for inclusion.

Results: Evidence suggests that citalopram, paroxetine, venlafaxine, nortriptyline, desipramine and pramipexole may be effective pharmacological agents for the treatment of depression in PD, however, studies tended to be limited by small sample sizes and/or relatively short treatment periods. For non-pharmacological interventions, cognitive behavioural therapy and exercise seem effective, however, these therapeutic approaches appear to be more suitable in cases of mild-to-moderate depression. Moreover, given the demands of these options, they are likely better suited to patients with less advanced PD symptoms. ECT looks promising however, most available information comes from single-case studies in patients with severe and/or treatment-resistant depression. Alternative brain stimulation techniques, including DBS and TMS, have produced inconclusive and conflicting evidence.

Conclusion: Although a number of different interventions for the treatment of depression in PD have been investigated, the existing literature is limited. To draw definitive conclusions, larger randomised control trials, examining all available antidepressant treatments and considering the heterogeneity of depression and PD, need to be undertaken. This abstract was also submitted for presentation at the 2019 European Academy of Neurology Conference.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treating-depression-in-parkinsons-disease-a-systematic-literature-review/