Are older antidepressants better for depression in Parkinson's disease?

December 17, 2008

A new study shows that antidepressant drugs which only affect serotonin, often used as first choice treatments, may not be best for depression in people with Parkinson's disease. The new research is published in the December 17, 2008, online issue of Neurology, the medical journal of the American Academy of Neurology. Depression affects up to 50 percent of people with Parkinson's disease.

The study is the first to compare an older antidepressant that targets two receptors in the brain with a newer generation serotonin only-based drug and placebo. It is also the largest placebo-controlled study for Parkinson's disease depression.

In the study, scientists gave 52 people diagnosed with Parkinson's disease and depression either nortriptyline, a tricyclic antidepressant (TCA), paroxetine CR, a selective serotonin reuptake inhibitor (SSRI) or a placebo pill. Tricyclics affect both norepinephrine and serotonin, two different receptors in the brain. The people were tested for improvement of depression symptoms at two, four and eight weeks after starting treatment.

The study found that the people who took nortriptyline were nearly five times more likely to see improvement in depression symptoms when compared with the people who took paroxetine CR.

"I think that this study shows a number of important things. First, that people with Parkinson's disease can respond to antidepressants. This is important because depression in Parkinson's disease is underrecognized, underappreciated and undertreated. Commonly, the attitude is, of course you're depressed, you have a serious illness. This study shows that patients should have hope that they can be helped," said study author Matthew Menza, MD, a Professor of Psychiatry and Neurology with UMDNJ-Robert Wood Johnson Medical School in Piscataway, NJ. "Second, the study suggests that we may need to use medications that affect both serotonin and norepinephrine, not just serotonin, in the brain to be successful in treating depression related to Parkinson's disease."

Menza also says that in addition to the older antidepressant, nortriptyline, that was tested in the study, there are newer mediations that affect both serotonin and norepinephrinem, and these need to be tested.

Tricyclic antidepressants are one of the older classes of antidepressants and have been used since the 1950s. Tricyclics have an increased risk of overdose and death due to toxic effects on the heart and brain. "People on a tricyclic antidepressant should have their dosages monitored closely by their doctor," said Menza.

Source: American Academy of Neurology

Explore further: Can some types of fat protect us from brain disease?

Related Stories

Can some types of fat protect us from brain disease?

September 8, 2016

An intriguing finding in nematode worms suggests that having a little bit of extra fat may help reduce the risk of developing some neurodegenerative diseases, such as Huntington's, Parkinson's and Alzheimer's diseases.

Challenging Parkinson's dogma

October 24, 2012

Scientists may have discovered why the standard treatment for Parkinson's disease is often effective for only a limited period of time. Their research could lead to a better understanding of many brain disorders, from drug ...

Recommended for you

Hormone that controls maturation of fat cells discovered

October 25, 2016

Scientists at the Stanford University School of Medicine have discovered a hormone that controls the first step in the maturation of fat cells. Its actions help explain how high-fat diets, stress and certain steroid medications ...

The tale of the bats, dark matter and a plastic surgeon

October 25, 2016

What happens when a plastic surgeon meets a bat expert zoologist and a paleobiologist? No, it's not a strange Halloween story about spooky bat dinosaurs but rather, a story about a new discovery about bats which may unlock ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.