Managing depression in Parkinson’s patients risk factors and clinical pearls.pdfVIP

329ISSN 1758-2024Neurodegen. Dis. Manage. (2014) 4(4), 329–336 part of 10.2217/NMT.14.31 ? 2014 Future Medicine Ltd REVIEW Managing depression in Parkinson’s patients: risk factors and clinical pearls Rachel Biemiller1 Irene Hegeman Richard*,1 1University of Rochester, Rochester, NY, USA *Author for correspondence: Tel.: +1 585 341 7500; Fax: +1 585 276 1870; Irene_richard@URMC. Practice points Depression Parkinson’s disease ● Depressed mood is a stronger indicator than anhedonia for depression. ● Apathy may be a core feature of Parkinson’s disease (PD) and does not necessarily indicate depression. ● Negative emotions are more likely to indicate depression than apathy. ● PD symptoms and depression symptoms can be similar. ● Mood symptoms can fluctuate with motor symptoms. ● Depression and anxiety frequently overlap. Diagnosis ● Use an inclusive approach. ● Evaluate in the ‘on’ state. ● Get input from care partner. ● Use depressed mood as a core symptom. ● Use a rating scale to screen for depression or to rate severity of depressive symptoms. Treatment ● Pramipexole – use if mood fluctuates with motor symptoms. ● Tricyclic antidepressants – effective but poorly tolerated due to side effects. ● Selective serotonin/noreinephrine reuptake inhibitors – currently first line therapy. ● Use cognitive behavioral therapy alone or in addition to pharmacotherapy. Future research needs ● A better understanding of the role of anxiety in depression in PD is needed. ● More research into treatment options for refractory depression and anxiety. ● The role of surgical and other non-pharmacologic interventions should be further investigated. For reprint orders, please contact: reprints@ 330 Neurodegen. Dis. Manage. (2014) 4(4) Review Biemiller Richard future science group Parkinson’s disease (PD) is a neurodegenerative process, which typically affects older adults. Over the next few decades, this population is expected to increase. A study by