Older drug seen better for Parkinson's depression

By Karla Gale

NEW YORK (Reuters Health) - People with Parkinson's disease who need treatment for depression seem to do better with an older antidepressant than a newer agent, according to a small clinical trial.

"Individuals with depression and Parkinson's disease do respond to antidepressants," Dr. Matthew Menza told Reuters Health. "This is important because depression in Parkinson's disease is often under-recognized, under-appreciated and under-treated. Commonly, the attitude is, 'of course you're depressed, you have a serious illness.' We have now demonstrated that one should be hopeful that treatment will help."

There have been few head-to-head trials of different antidepressants for Parkinson's patients with depression, Menza, of the Robert Wood Johnson Medical School in Piscataway, New Jersey, and his group note in the medical journal Neurology.

To investigate, they compared the older "tricyclic" antidepressant nortriptyline with the newer "SSRI" agent paroxetine in 52 people with Parkinson's disease diagnosed with major depression. Nortriptyline is available in generic form and under the brand name Pamelor, and paroxetine CR is known by the brand names Paxil and Seroxat.

Eighteen patients were assigned to paroxetine, 17 to nortriptyline, and 17 to an inactive "placebo." After 8 weeks, changes on a standard depression rating scale significantly favored nortriptyline, but not paroxetine CR, over placebo.

"Another point that I believe is very important is that nortriptyline was effective for improving a variety of other symptoms common in Parkinson's disease and that cause significant trouble," said Menza. "Sleep and anxiety, for instance, improved significantly. Also, overall quality of life was much better for those whose depression improved."

However, this study is preliminary, he noted, adding that "we are not able to predict who will respond to what treatment."

Many people with Parkinson's and depression "respond very well to psychotherapy or to approaches like exercise and stress reduction," Menza said. "Drug treatment must be tailored to the individual with careful monitoring for tolerability, safety and effectiveness."

SOURCE: Neurology, March 10, 2009.