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Fortschr Neurol Psychiatr 2010; 78(8): 456-467
DOI: 10.1055/s-0029-1245535
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Depression beim idiopathischen Parkinson-Syndrom – Teil 2: Therapie und Management

Depression in Parkinson’s Disease – Part 2: Therapy and ManagementA. Storch1 , C. Schneider1 , G. Ebersbach2 , G. Fuchs3 , W. H. Jost4 , P. Odin5 , G. Reifschneider6 , M. Bauer7
  • 1Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Dresden
  • 2Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Beelitz-Heilstätten
  • 3Neurologisches Krankenhaus, Parkinson-Fachklinik, Wolfach
  • 4Deutsche Klinik für Diagnostik (DKD), Wiesbaden
  • 5Neurologische Klinik, Klinikum Bremerhaven Reinkenheide, Bremerhaven
  • 6Neuro Centrum Odenwald, Erbach
  • 7Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Dresden
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Publication History

Publication Date:
06 August 2010 (online)

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Zusammenfassung

In der Therapie depressiver Symptome steht eine Vielzahl verschiedener Methoden und antidepressiver Medikamente zur Verfügung, für die eine Wirksamkeit in klinischen Studien nachgewiesen wurde. Auch in der Behandlung der Depression bei Patienten mit idiopathischem Parkinson-Syndrom (IPS) kommen verschiedene medikamentöse Therapieansätze, Elektrokrampftherapie, Psychoedukation und Psychotherapie zum Einsatz. Jedoch gibt es in dieser speziellen Patientengruppe nur wenige kontrollierte Studien. Zudem fehlt es an systematischem Wissen über die Behandlung. Da jedoch nachgewiesenermaßen eine Depression die Lebensqualität von Parkinson-Patienten erheblich beeinträchtigt, ist eine effiziente Behandlung der depressiven Symptome unbedingt anzustreben. Bisher erhält aber über die Hälfte der Patienten mit IPS und Depression keine ausreichende antidepressive Therapie. Einen Überblick über die verwendeten pharmakologischen, somatischen und psychologischen Therapieansätze bei dieser Patientengruppe sowie Vorschläge für das therapeutische Management gibt diese Übersichtsarbeit zum Thema Depression beim IPS.

Abstract

A good number of different methods and antidepressive agents are now available for the management of depressive symptoms, the efficacy of which has been confirmed by clinical studies. Various approaches – be it medication, electroconvulsive therapy (ECT), psychoeducation and psychotherapy – have also been developed to treat depression in patients with Parkinson’s disease. Unfortunately, only a few controlled studies exist for this very specific group of patients. Systematic knowledge of treatment options, however, is lacking. Efficient management of depressive symptoms is absolutely indispensable considering the proven impact of a depression on the patients’ quality of life. So far, more than half of the patients afflicted with Parkinson’s disease and depression do not receive proper antidepressive therapy. This survey gives an overview on the pharmacological, somatic and psychological procedures of treatment applied in this group of patients, along with useful suggestions.

Schlüsselwörter

Depression - Morbus Parkinson - Antidepressiva - Therapie - Nicht medikamentöse Therapieverfahren - Management

Keywords

depression - Parkinson’s disease - antidepressants - therapy - non-pharmacological treatment - management

Literatur

  • 1 Storch A, Ebersbach G, Fuchs G et al. Depression beim idiopathischen Parkinsonsyndrom. Teil 1: Epidemiologie, Pathophysiologie, Klinik und Diagnostik.  Fortschr Neurol Psychiat. 2008;  76 715-724
    Google Scholar
  • 2 Rub U, Del T K, Schultz C et al. Parkinson’s disease: The thalamic components of the limbic loop are severely impaired by alpha-synuclein immunpositive inclusion body pathology.  Neurobiol Aging. 2002;  23 245-254
    Google Scholar
  • 3 Okun M S, Watts R L. Depression associated with Parkinson’s disease: clinical features and treatment.  Neurology. 2002;  58 S63-S70
    Google Scholar
  • 4 Lieberman A. Managing the neuropsychiatric symptoms of Parkinson’s disease.  Neurology. 1998;  50 S33-S38 ; discussion S 44-S38
    Google Scholar
  • 5 Poewe W, Luginger E. Depression in Parkinson’s disease: impediments to recognition and treatment options.  Neurology. 1999;  52 S2-S6
    Google Scholar
  • 6 Bauer M, Bschor T, Pfennig A et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care World.  J Biol Psychiatry. 2007;  8 67-104
    Google Scholar
  • 7 McDowell I, Newel C. Measuring health. A guide to rating scales and questionaires. 2nd ed. Oxford: Oxford University Press; 1996
    Google Scholar
  • 8 Reiff J, Witt K, Deuschl G. Medikamentöse Therapie depressiver Störungen beim Morbus Parkinson.  Akt Neurol. 2005;  32 77-85
    Google Scholar
  • 9 Mayeux R. Depression in the patient with Parkinson’s disease.  J Clin Psychiatry. 1990;  51 Suppl 20-23 ; discussion 24 – 25
    Google Scholar
  • 10 Schrag A, Barone P, Brown R G et al. Depression rating scales in Parkinson’s disease: critique and recommendations.  Mov Disord. 2007;  22 1077-1092
    Google Scholar
  • 11 Lemke M R, Ceballos-Baumann A O. Depression bei Parkinson-Patienten.  Dtsch Ärztebl. 2002;  99 2625-2631
    Google Scholar
  • 12 Lemke M. Dopaminagonisten als Antidepressiva.  Nervenarzt. 2007;  78 31-38
    Google Scholar
  • 13 Heinz A. Psychopathologische Korrelate dopaminerger Dysfunktion bei alkoholabhängigen und schizophrenen Patienten.  Nervenarzt. 1999;  70 399-407
    Google Scholar
  • 14 Remy P, Doder M, Lees A et al. Depression in Parkinson’s disease: loss of dopamine and noradrenaline innervation in the limbic system.  Brain. 2005;  128 1314-1322
    Google Scholar
  • 15 Rogers D, Costall B, Domeney A M et al. Anxiolytic profile of ropinirole in the rat, mouse and common marmoset.  Psychopharmacology. 2000;  151 91-97
    Google Scholar
  • 16 Maj J, Rogoz Z, Skuza G et al. Antidepressant effects of pramipexole, a novel dopamine receptor antagonist.  J Neural Transm. 1997;  104 525-533
    Google Scholar
  • 17 Willner P, Lappas S, Cheeta S et al. Reversal of stress-induced anhedonia by the dopamine receptor agonist, pramipexole.  Psychopharmacology. 1994;  115 454-462
    Google Scholar
  • 18 Willner P. The mesolimbic dopamine system as a target for rapid antidepressant action.  Int Clin Psychopharmacol. 1997;  12 7-14
    Google Scholar
  • 19 Habermann-Little B. An analysis of the prevalence and etiology of depression in Parkinson’s disease.  J Neurosci Nurs. 1991;  23 165-169
    Google Scholar
  • 20 Cummings J L. Depression and Parkinson’s disease: a review.  Am J Psychiatry. 1992;  149 443-454
    Google Scholar
  • 21 Birkmayer W. Deprenyl (selegiline) in the treatment of Parkinson’s disease.  Acta Neurol Scand Suppl. 1983;  95 103-105
    Google Scholar
  • 22 Pahwa R, Stacy M A, Factor S A et al. Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease.  Neurology. 2007;  68 1108-1115
    Google Scholar
  • 23 Buchwald B, Angersbach D, Jost W H. Improvements in motor and non-motor symptoms in parkinson patients under ropinirole therapy.  Fortschr Neurol Psychiatr. 2007;  75 236-241
    Google Scholar
  • 24 Corrigan M, Denahan A Q, Wright C E et al. Comparison of pramipexole and placebo in patients with major depression.  Depress Anxiety. 2000;  11 58-65
    Google Scholar
  • 25 Zarate C, Payne J L, Singh J et al. Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.  Biol Psychiatry. 2004;  161 54-60
    Google Scholar
  • 26 Moller J C, Oertel W H, Koster J et al. Long-term efficacy and safety of pramipexole in advanced Parkinson’s disease: results from a European multicenter trial.  Mov Disord. 2005;  20 602-610
    Google Scholar
  • 27 Bxarone P, Poewe W, Albrecht S et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson’s disease: a randomised, double-blind, placebo-controlled trial.  Lancet Neurol. 2010;  9 573-580
    Google Scholar
  • 28 Fernandez H H, Merello M. Pramipexole for depression and motor symptoms in Parkinson’s disease: can we kill two birds with one stone?.  Lancet Neurol. 2010;  9 556-557
    Google Scholar
  • 29 Veazey C, Aki S O, Cook K F et al. Prevalence and treatment of depression in Parkinson’s disease.  J Neuropsychiatry Clin Neurosci. 2005;  17 310-323
    Google Scholar
  • 30 Andersen J, Aabro E, Gulmann N et al. Anti-depressive treatment in Parkinson’s disease. A controlled trial of the effect of nortriptyline in patients with Parkinson’s disease treated with L-DOPA.  Acta Neurol Scand. 1980;  62 210-219
    Google Scholar
  • 31 Laitinen L. Desipramine in treatment of Parkinson’s disease. A placebo-controlled study.  Acta Neurol Scand. 1969;  45 109-113
    Google Scholar
  • 32 Strang R. Imipramine in treatment of parkinsonism: a double-blind placebo study.  Br Med J. 1965;  2 33-34
    Google Scholar
  • 33 Devos D, Dujardin K, Poirot I et al. Comparison of desipramine and citalopram treatments for depression in Parkinson’s disease: a double-blind, randomized, placebo-controlled study.  Mov Disord. 2008;  23 850-857
    Google Scholar
  • 34 Menza M, DeFronzo Dobkin R, Marin H et al. A controlled trial of antidepressants in patients with Parkinson disease and depression.  Neurology. 2009;  72 886-892
    Google Scholar
  • 35 Devos D, Dujardin K, Poirot I et al. Comparison of desipramine and citalopram treatments for depression in Parkinson’s disease: a double-blind, randomized, placebo-controlled study.  Mov Disord. 2008;  23 850-857
    Google Scholar
  • 36 Okun M, Fernandez H H. Will tricyclic antidepressants make a comeback for depressed Parkinson disease patients?.  Neurology. 2009;  72 868-869
    Google Scholar
  • 37 Cummings J L, Masterman D L. Depression in patients with Parkinson’s disease.  Int J Geriatr Psychiatry. 1999;  14 711-718
    Google Scholar
  • 38 Wermuth L, Sorensen P S, Timm S et al. Depression in idiopathic Parkinson’s disease treated with citalopram.  Nord J Psychiatry. 1998;  52 163-169
    Google Scholar
  • 39 Leentjens A F, Vreeling F W, Luijckx G J et al. SSRIs in the treatment of depression in Parkinson’s disease.  Int J Geriatr Psychiatry. 2003;  18 552-554
    Google Scholar
  • 40 Linazaroso G. Worsening of Parkinson’s disease by citalopram Parkinsonism.  Relat Disord. 2000;  6 111-113
    Google Scholar
  • 41 Steur E N. Increase of Parkinson disability after fluoxetine medication.  Neurology. 1993;  43 211-213
    Google Scholar
  • 42 Montastruc J, Fabre N, Blin O et al. Does fluoxetine aggravate Parkinson’s disease? A pilot prospective study.  Mov Disord. 1995;  10 355-357
    Google Scholar
  • 43 McCance-Katz E F, Marek K L, Price L H. Serotonergic dysfunction in depression associated with Parkinson’s disease.  Neurology. 1992;  42 1813-1814
    Google Scholar
  • 44 Jimenez-Jimenez F J, Tejeiro J, Martinez-Junquera G et al. Parkinsonism exacerbated by paroxetine.  Neurology. 1994;  44 2406
    Google Scholar
  • 45 Tesei S, Antonini A, Canesi M et al. Tolerability of paroxetine in Parkinson’s disease: a prospective study.  Mov Disord. 2000;  15 986-989
    Google Scholar
  • 46 Richard I, Kurlan R, Tanner C et al. Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson’s disease. Parkinson Study Group.  Neurology. 1997;  48 1070-1077
    Google Scholar
  • 47 Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias.  Neurology. 1999;  53 1154
    Google Scholar
  • 48 Lemke M R. Effect of reboxetine on depression in Parkinson’s disease patients.  J Clin Psychiatry. 2002;  63 300-304
    Google Scholar
  • 49 Normann C, Hesslinger B, Frauenknecht S et al. Psychosis during chronic levodopa therapy triggered by the new antidepressive drug mirtazapine.  Pharmacopsychiatry. 1997;  30 263-265
    Google Scholar
  • 50 Goetz C G, Tanner C M, Klawans H L. Bupropion in Parkinson’s disease.  Neurology. 1984;  34 1092-1094
    Google Scholar
  • 51 Takats A, Tarczy M, Simo M et al. Moclomemide/aurorix treatment in Parkinson’s disease with depression. Abstracts of the 11th Symposium on Parkinson’s disease, Rome, Italy.  New trends in clinical neuropharmacology. 1994;  VIII 260
    Google Scholar
  • 52 Chan-Palay V, Zetzsche T, Savaskan E. Moclobemide in depressed patients with Parkinson’s disease.  Clin Neuropharm. 1992;  15 217B
    Google Scholar
  • 53 Jansen Steur E, Ballering L A. Moclobemide and selegeline in the treatment of depression in Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 1997;  63 547
    Google Scholar
  • 54 Gimenez-Roldan S, Dobato J L, Mateo D. Treatment of depression in Parkinson’s disease with moclobemide: A pilot open-label study.  Parkinsonism Relat Disord. 1997;  3 219-225
    Google Scholar
  • 55 Torun S et al. Moclobemide in depressed patients with Parkinson’s disease. Abstracts of the First Congress of the European Federation of Neurological Societies 1995.  Eur J Neurol. 1995;  2 92
    Google Scholar
  • 56 Linde K, Berner M M, Kriston L. St John’s wort for major depression.  Cochrane Database Syst Rev. 2008;  8 CD000448
    Google Scholar
  • 57 Izzo A, Ernst E. Interactions between herbal medicines and prescibed drugs.  Drugs. 2001;  61 2163-2175
    Google Scholar
  • 58 Fawcett J. Lithium combination in acute and maintenance treatment in unipolar and bipolar depression.  J Clin Psychiatry. 2003;  64 32-37
    Google Scholar
  • 59 Bauer M, Crossley N A, Gerber S et al. The acute antidepressive effects of lithium: from monotherapy to augmentation. In: Bauer M, Grof P, Müller-Oerlinghausen ed, Lithium in neuropsychiatry – a comprehensive guide: Abingdon: Informa Healthcare 2006: 109-128
    Google Scholar
  • 60 Brandt-Christensen M, Kvist K, Nilsson F M et al. Treatment with antidepressants and lithium is associated with increased risk of treatment with antiparkinsonian drugs: a pharmacoepidemiological study.  J Neurol Neurosurg Psychiatry. 2006;  77 781-783
    Google Scholar
  • 61 Furukawa T A, Streiner D L, Young L T. Antidepressant plus benzodiazepine for major depression.  Cochrane Database Syst Rev. 2001;  DOI: 10.1002/14651858.CD001026
    Google Scholar
  • 62 Furukawa T A, Streiner D L, Young L T. Antidepressant and benzodiazepine for major depression.  Cochrane Database Syst Rev. 2002;  DOI: 10.1002/14651858.CD001026
    Google Scholar
  • 63 Valenstein M, Taylor K K, Austin K et al. Benzodiazepine use among depressed patients treated in mental health settings.  Am J Psychiatry. 2004;  161 654-661
    Google Scholar
  • 64 Macht M, Schwarz R, Ellgring H. Patterns of psychological problems in Parkinson’s disease.  Acta Neurol Scand. 2005;  111 95-101
    Google Scholar
  • 65 Ellgring H, Seiler S, Nagel U et al. Psychosocial problems of Parkinson patients: approaches to assessment and treatment.  Adv Neurol. 1990;  53 349-353
    Google Scholar
  • 66 Oertel W, Ellgring H. Parkinson’s disease – medical education and psychosocial aspects.  Patient Educ Couns. 1995;  26 71-79
    Google Scholar
  • 67 Macht M, Ellgring H. Psychologische Intervention bei der Parkinson-Erkrankung. Ein Behandlungsmanual. Stuttgart: Kohlhammer; 2003
    Google Scholar
  • 68 Brand S, Dodel R, Hautzinger M et al. Depression bei M. Parkinson. Diagnostik und Therapie.  Nervenarzt. 2007;  78 715-727
    Google Scholar
  • 69 Faber R, Trimble M R. Electroconvulsive therapy in Parkinson’s disease and other movement disorders.  Mov Disord. 1991;  6 293-303
    Google Scholar
  • 70 Olanow C, Watts R L, Koller W C. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines.  Neurology. 2001;  56 S1-S88
    Google Scholar
  • 71 Andersen K, Balldin J, Gottfries C G et al. A double-blind evaluation of electroconvulsive therapy in Parkinson’s disease with „on-off” phenomena.  Acta Neurol Scand. 1987;  76 191-199
    Google Scholar
  • 72 Epstein C M, Evatt M L, Funk A et al. An open study of repetitive transcranial magnetic stimulation in treatment-resistant depression with Parkinson’s disease.  Clin Neurophysiol. 2007;  118 2189-2194
    Google Scholar
  • 73 Wassermann E M, Lisanby S H. Therapeutic application of repetitive transcranial magnetic stimulation: a review.  Clin Neurophysiol. 2001;  112 1367-1377
    Google Scholar
  • 74 Demet E M, Chicz-Demet A, Fallon J H et al. Sleep deprivation therapy in depressive illness and Parkinson’s disease.  Prog Neuropsychopharmacol Biol Psychiatry. 1999;  23 753-784
    Google Scholar
  • 75 Paus S, Schmitz-Hubsch T, Wullner U et al. Bright light therapy in Parkinson’s disease: a pilot study.  Mov Disord. 2007;  22 1495-1498
    Google Scholar
  • 76 Marsh L, McDonald W M, Cummings J et al. Provisional diagnostic criteria for depression in Parkinson’s disease: report of an NINDS/NIMH Work Group.  Mov Disord. 2006;  21 148-158
    Google Scholar
  • 77 Oertel W H, Reichmann H. Parkinson-Syndrome: Diagnostik und Therapie. In ed Leitlinien für Diagnostik und Therapie in der Neurologie.. 4. überarbeitete Auflage ed. Stuttgart: Georg Thieme Verlag; 2008
    Google Scholar
  • 78 Hirschfeld R. Clinical importance of long-term antidepressant treatment.  Br J Psychiatry. 2001;  42 S4-S8
    Google Scholar
  • 79 Reimherr F, Amsterdam J D, Quitkin F M et al. Optimal length of continuation therapy in depression: a prospective assessment during long-term fluoxetine treatment.  Am J Psychiatry. 1998;  155 1247-1253
    Google Scholar
  • 80 Paykel E, Ramana R, Cooper Z et al. Residual symptoms after partial remission: an important outcome in depression.  Psychol Med. 1995;  25 1171-1180
    Google Scholar
  • 81 Sporn J, Ghaemi S N, Sambur M R et al. Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review.  Ann Clin Psychiatry. 2000;  12 137-140
    Google Scholar
  • 82 Perugi G, Toni C, Ruffolo G et al. Adjunctive dopamine agonists in treatment-resistant bipolar II depression: an open case series.  Pharmacopsychiatry. 2001;  34 399-406
    Google Scholar
  • 83 Lattanzi L, Dell’Osso L, Cassano P et al. Pramipexole in treatment-resistant depression: a 16-week naturalistic study.  Bipolar Disord. 2002;  4 307-315
    Google Scholar
  • 84 Rektorova I, Rektor I, Bares M et al. Pramipexole and pergolide in the treatment of depression in Parkinson’s disease: a national multicentre prospective randomized study.  Eur J Neurol. 2003;  10 399-406
    Google Scholar
  • 85 Reichmann H, Brecht H M, Kraus P H et al. Pramipexol in der Parkinson-Krankheit. Ergebnisse einer Anwendungsbeobachtung.  Nervenarzt. 2002;  73 745-750
    Google Scholar
  • 86 Cassano P, Lattanzi L, Soldani F et al. Pramipexole in treatment-resistant depression: an extended follow-up.  Depress Anxiety. 2004;  20 131-138
    Google Scholar
  • 87 Goldberg J, Burdick K E, Endick C J. Preliminary, randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression.  Am J Psychiatry. 2004;  161 564-566
    Google Scholar
  • 88 Lemke M R, Brecht H M, Koester J et al. Anhedonia, depression, and motor functioning in Parkinson’s disease during treatment with pramipexole.  J Neuropsychiatry Clin Neurosci. 2005;  17 214-220
    Google Scholar
  • 89 Barone P, Scarzella L, Marconi R et al. Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease: a national multicenter parallel-group randomized study.  J Neurol. 2006;  253 601-607
    Google Scholar
  • 90 Rabey J, Orlov E, Korczyn A D. Comparison of fluvoxamine versus amitriptyline for treatment of depression in parkinson’s disease.  Neurology. 1996;  46 A374
    Google Scholar
  • 91 Simons J. Fluoxetine in Parkinson’s disease.  Mov Disord. 1996;  11 581-582
    Google Scholar
  • 92 Ceravolo R, Nuti A, Piccinni A et al. Paroxetine in Parkinson’s disease: effects on motor and depressive symptoms.  Neurology. 2000;  55 1216-1218
    Google Scholar
  • 93 Shulman L, Singer C, Liefert R. Therapeutic effects of sertraline in patients with Parkinson’s disease.  Mov Disord. 1996;  1 12
    Google Scholar

Prof. Dr. med. Alexander Storch

Klinik und Poliklinik für Neurologie der TU Dresden

Fetscherstr. 74

01307 Dresden

Email: Alexander.Storch@neuro.med.tu-dresden.de

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