This study explored the therapeutic effect of antidepressants in Parkinson's disease (PD) using a meta-analysis. Altogether, 24 placebo-controlled trials qualified for inclusion and revealed that tricyclic antidepressants (TCAs) had a greater antidepressant effect relative to selective serotonin reuptake inhibitors (SSRIs), <i>Qb</i>(1) = 8.87, p < .01, and the mono-amine-oxidase inhibitor, selegiline, <i>Qb</i>(1) = 7.90, p < .01. Whereas TCAs produced a significant side effect profile (odds ratio = 3.07), adverse events were negligible with SSRIs (odds ratio = 1.83) and selegeline (odds ratio = 1.63). Antidepressants can be beneficial for patients with PD. However, the choice of antidepressants needs to take depressive symptomatologies into account while monitoring side effects. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal»Dissertation Abstracts International: Section B: The Sciences and Engineering
Year»2006
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A meta-analysis of 44 placebo-controlled trials was conducted to examine three issues pertaining to the safety and efficacy of antidepressants in Parkinson's disease (PD). The first examined the magnitude and significance of the effects of antidepressants on depression. The second assessed whether or not antidepressants can provide salutary benefits to PD patients. Finally, the third issue was concerned with the side effect profile of antidepressants. To examine these three issues, a meta-analysis was conducted using Cohen's d as the effect size. The results show that TCAs produced a moderate antidepressant effect (d = .55, p = .01). TCAs also provided salutary benefits on motor outcomes (d = .30, p = .07), headache pain (d = 1.79, p = .00), and global psychological function (d = .81, p = .00). Although a significant effect size result was observed on adverse events (d = -.27, p = .02), they were deemed tolerable because PD patients subjectively evaluated their TCA medication positively (d = 1.02, p = .01). SSRIs produced a robust antidepressant effect on moderately depressed PD patients (d = .44, p < .05). A modestly positive and significant effect size result was observed with SSRIs on motor function (d = .34, p < .05), and there were no significant side effects (d = -.002, p = .50). These results provide evidence that SSRIs can be used to treat depression without the fear of worsening PD. Finally, selegeline did not improve depression when given at a dose where it was influencing dopamine metabolism (i.e., 10 mg daily). However, the MAO-B inhibitor did improve motor function (d = .36, p < .00), global psychological functioning (d = .21, p < .00), and health-related quality of life (d = .23, p < .00). Few effects were observed with selegeline (d = -.07, ns), especially with mortality (d = -.06, p = .10) and depression (d = .15, p = .06). All things considered, the decision to choose between antidepressant classes should be carefully considered and monitored on an individual basis, weighing (and/or ranking) the benefits of improving depressive symptomatology together with the risk of creating and tolerating side effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
BACKGROUND: Monoamine oxidase B (MAO-B) inhibitors slow disease progression in Parkinson's disease (PD) but clinical trials have produced conflicting results.
OBJECTIVES: To assess the evidence from randomised controlled trials for the effectiveness and safety of long-term use of MAO-B inhibitors in early PD.
SEARCH METHODS: We searched the following electronic databases: Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library Issue 11, 2011), MEDLINE (last searched 8th November 2011) and EMBASE (last searched 8th November 2011); and handsearched neurology and movement disorders conference proceedings, checked reference lists of relevant studies and contacted other researchers.
SELECTION CRITERIA: We included all unconfounded randomised controlled trials that compared a MAO-B inhibitor with control, in the presence or absence of levodopa or dopamine agonists, in patients with early PD where treatment and follow up lasted at least one year.
DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the methodological quality, and extracted the data. Some additional data were provided by the original authors. Random-effects models were used to analyse results, where appropriate.
MAIN RESULTS: Twelve trials were included (2514 patients, average follow-up six years), 11 using selegiline. The methodological quality was reasonable although concealment of allocation was definitely adequate in only five trials. MAO-B inhibitors were not associated with a significant increase in deaths (odds ratio (OR) 1.12; 95% confidence interval (CI) 0.90 to 1.41). They provided small benefits over control in impairment (weighted mean difference (WMD) for change in motor UPDRS score 3.79 points less with MAO-B inhibitors; 95% CI 2.27 to 5.30) and disability (WMD for change in UPDRS ADL score 1.49 less; 95% CI 0.49 to 2.49) at one year which may not be clinically significant. There was a levodopa-sparing effect with MAO-B inhibitors, which was associated with a significant reduction in motor fluctuations (OR 0.73; 95% CI 0.58 to 0.91) but not dyskinesia (OR 0.96; 95% CI 0.76 to 1.22). The reduction in motor fluctuations was, however, not robust in sensitivity analyses. There was a trend to more withdrawals due to adverse events with MAO-B inhibitors (OR 1.72; 95% CI 0.98 to 3.01).
AUTHORS' CONCLUSIONS: MAO-B inhibitors (more specifically selegiline which contributes most of the data) do not appear to delay disease progression in terms of improved survival but may reduce later motor fluctuations. At present, we do not feel these drugs can be recommended for routine use in the treatment of early Parkinson's disease.
OBJECTIVE: To quantify more reliably the benefits and risks of monoamine oxidase type B inhibitors (MAOBIs) in early Parkinson's disease. Data sources: Searches of the Cochrane Library, Medline, Embase, PubMed, and Web of Science for years 1966-2003, plus major journals in the field, abstract books, and proceedings of meetings, for randomized trials comparing MAOBIs with placebo or levodopa. Data extraction: Available data on mortality, motor complications, side effects, treatment compliance, and clinician rated disability (for example, unified Parkinson's disease rating scale) were extracted from 17 trials and combined using standard meta-analytic methods. RESULTS: No significant difference in mortality existed between patients on MAOBIs and control patients (odds ratio 1.13,95% confidence interval 0.94 to 1.34; P=0.2). Patients randomised to MAOBIs had significantly better total scores, motor scores, and activities of daily living scores on the unified Parkinson's disease rating scale at three months compared with patients taking placebo; they were also less likely to need additional levodopa (0.57,0.48 to 0.67; P<0.00001) or to develop motor fluctuations (0.75,0.59 to 0.95; P=0.02). No difference existed between the two groups in the incidence of side effects or withdrawal of patients. CONCLUSIONS: MAOBIs reduce disability, the need for levodopa, and the incidence of motor fluctuations, without substantial side effects or increased mortality. However, because few trials have compared MAOBIs with other antiparkinsonian drugs, uncertainty remains about the relative benefits and risks of MAOBIs. Further large, long term comparative trials that include patient rated quality of life measures are needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
