Background
Methods
Search strategy
Inclusion and exclusion criteria
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Study design: randomised controlled trial.
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Participants: Study participants were required to have a clinical diagnosis of idiopathic Parkinson's disease and also a clinical diagnosis of depression (as defined by the authors of the trials). Both gender and all ages are included.
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Pharmacological intervention: Included studies were required to have at least one arm in which an SSRI was given as the main treatment. Acceptable comparator groups included placebo or other antidepressant treatment such as other antidepressant medications or other biological or psychological treatments (e.g. electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS) or cognitive behavioural therapy).
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Outcome measurement: assessment of the change in the score of the depression rating scale used in each study and/or assessment of the response to the treatment as defined in each study.
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Depression was not assessed with a validated instrument (e.g. Hamilton Depression Rating Scale, Beck Depression Inventory e.t.c.).
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The study did not report a binary outcome (response vs non-response) or such an outcome was not possible to be extracted from the paper or by directly contacting the authors of the study.
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The comparator was not placebo or a drug officially licensed for the treatment of depression.
Data extraction, outcome measurement and assessment of methodological quality
Statistical Analysis
Results
Search strategy results
Description of studies
Study/Country | SSRI/dosage | Comparator | N (% male) | Mean age (age range or SD) | Duration of study | Mean duration of PD (SD) | Hoehn and Yahr stage mean (SD) | Depression Scale | Treatment responders (response rate) | Dropouts |
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Devos et al. (2008)/France [22] | citalopram (20 mg/day) | 1. placebo 2. desipramine (75 mg/day) | 48 (NA) | 61.8 (56-68) | 4 weeks | 8 years | NA | MADRS | citalopram: 8/15 (53%) placebo: 4/16 (25%) desipramine: 11/17 (65%) | 3 |
Wermuth et al. (1998)/Denmark [21] | citalopram (10-20 mg/day) | placebo | 37 (43%) | 64 (44-79) | 6 weeks (acute phase) | NA | I-III (range) | HDRS | citalopram: 2/18 (11%) placebo: 3/19 (16%) | 7 |
Antonini et al. (2006)/Italy [19] | sertraline (50 mg/day) | amitriptyline (25 mg/day) | 31 (45%) | S: 71.8 (6.5) a C: 68.5 (6.6) a
| 12 weeks | S: 7.5 years (3.4) a C: 7.3 years (4.5) a
| S: 2.0 ( 0.7) a C: 2.4 (0.6) a
| HDRS | sertraline: 10/16 (63%) amitriptyline: 8/15 (53%) | 8 |
Barone et al. (2006)/Italy [20] | sertraline (mean dose: 48.1 ± 5.9 mg/day) | pramipexole (mean dose: 3.24 ± 1.3 mg/day) | 67 (52%) | S: 68.1 (6.5) C: 64.8 (8.3) | 12 weeks | NA | S: 2.5 (median) C: 2 (median) | HDRS | sertraline: 16/34 (47%) pramipexole: 23/33 (70%) | 8 |
Leentjens et al. (2003)/The Netherlands [14] | sertraline (25-100 mg/day) | placebo | 12 (67%) | 67 (7.8) | 10 weeks | NA | I-IV (range) | MADRS | sertraline: 3/6 (50%) placebo: 4/6 (67%) | 0 |
Fregni et al. (2004)/USA [25] | fluoxetine (20 mg/day) | rTMS (15 Hz) | 43 (62%) a
| S: 66.0 (8.5) a C: 65.3 (7.8) a
| 8 weeks | NA | S: 2.1 (1.2) a C: 2.1 (1.2) a
| HDRS | fluoxetine: 9/21 (43%) rTMS: 9/22 (41%) | 1 |
Serrano-Duenas (2002)/Ecuador [23] | fluoxetine (mean dose: 27.3 mg/day) | amitriptyline (mean dose: 35.2 mg/day) | 77 (56%) | 68.2 (4.5) | 12 months | 6.9 years (0.8) | II | HDRS | NA | 19 |
Avila et al. (2003)/Spain [24] | fluoxetine (mean dose: 25 mg/day) | nefazodone (mean dose: 200 mg/day) | 16 (44%) | 70.4 (59-78) | 12 weeks | 5 years | S: 2.6 (0.8) C: 2.3 (0.5) | BDI | NA | 3 |
Menza et al. (2008)/USA [26] | paroxetine CR (mean dose: 28.4 mg/day) | 1. placebo 2. nortriptyline (mean dose: 48.5 mg/day) | 52 (52%) | 62.2 (8.7) | 8 weeks | 6.6 years | 2.2 | HDRS | paroxetine: 2/18 (11%) placebo: 4/17 (24%) nortriptyline 9/17 (53%) | 18 |
Rabey et al. (1996)/Israel [27] | fluvoxamine (mean dose: 78 mg/day) | amitriptyline (mean dose: 69 mg/day) | 47 (NA) | 75 (NA) | 16 weeks | 7 years | NA | HDRS | fluvoxamine: 12/20 (60%) amitriptyline: 15/27 (56%) | 20 |