A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease

• Published in: Neurology Vol. 78; no. 16; p. 1229
• Main Authors: Richard, I H, McDermott, M P, Kurlan, R, Lyness, J M, Como, P G, Pearson, N, Factor, S A, Juncos, J, Serrano Ramos, C, Brodsky, M, Manning, C, Marsh, L, Shulman, L, Fernandez, H H, Black, K J, Panisset, M, Christine, C W, Jiang, W, Singer, C, Horn, S, Pfeiffer, R, Rottenberg, D, Slevin, J, Elmer, L, Press, D, Hyson, H C, McDonald, W
• Format: Journal Article
• Language: English
• Published: United States 17.04.2012
• Subjects: Adrenergic Uptake Inhibitors - administration & dosage; Adrenergic Uptake Inhibitors - adverse effects; Adrenergic Uptake Inhibitors - therapeutic use; Adult; Antidepressive Agents - administration & dosage; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Cyclohexanols - administration & dosage; Cyclohexanols - therapeutic use; Delayed-Action Preparations - adverse effects; Delayed-Action Preparations - therapeutic use; Depressive Disorder - complications; Depressive Disorder - diagnosis; Depressive Disorder - drug therapy; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Parkinson Disease - complications; Parkinson Disease - drug therapy; Paroxetine - administration & dosage; Paroxetine - adverse effects; Paroxetine - therapeutic use; Psychiatric Status Rating Scales - statistics & numerical data; Serotonin Uptake Inhibitors - administration & dosage; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - therapeutic use; Severity of Illness Index; Venlafaxine Hydrochloride
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0b013e3182516244

To evaluate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) and a serotonin and norepinephrine reuptake inhibitor (SNRI) in the treatment of depression in Parkinson disease (PD). A total of 115 subjects with PD were enrolled at 20 sites. Subjects were randomized to receive an SSRI (paroxetine; n = 42), an SNRI (venlafaxine extended release [XR]; n = 34), or placebo (n = 39). Subjects met DSM-IV criteria for a depressive disorder, or operationally defined subsyndromal depression, and scored >12 on the first 17 items of the Hamilton Rating Scale for Depression (HAM-D). Subjects were followed for 12 weeks (6-week dosage adjustment, 6-week maintenance). Maximum daily dosages were 40 mg for paroxetine and 225 mg for venlafaxine XR. The primary outcome measure was change in the HAM-D score from baseline to week 12. Treatment effects (relative to placebo), expressed as mean 12-week reductions in HAM-D score, were 6.2 points (97.5% confidence interval [CI] 2.2 to 10.3, p = 0.0007) in the paroxetine group and 4.2 points (97.5% CI 0.1 to 8.4, p = 0.02) in the venlafaxine XR group. No treatment effects were seen on motor function. Both paroxetine and venlafaxine XR significantly improved depression in subjects with PD. Both medications were generally safe and well tolerated and did not worsen motor function. This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD.