Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics
Major and minor forms of depression are significant contributors to Parkinson’s disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently,...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Parkinson's Disease |
| Online Access: | http://dx.doi.org/10.1155/2021/6621991 |
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| author | Luis Agüera-Ortiz Rocío García-Ramos Francisco J. Grandas Pérez Jorge López-Álvarez José Manuel Montes Rodríguez F. Javier Olazarán Rodríguez Javier Olivera Pueyo Carmelo Pelegrín Valero Jesús Porta-Etessam |
| author_facet | Luis Agüera-Ortiz Rocío García-Ramos Francisco J. Grandas Pérez Jorge López-Álvarez José Manuel Montes Rodríguez F. Javier Olazarán Rodríguez Javier Olivera Pueyo Carmelo Pelegrín Valero Jesús Porta-Etessam |
| author_sort | Luis Agüera-Ortiz |
| collection | DOAJ |
| description | Major and minor forms of depression are significant contributors to Parkinson’s disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson’s disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson’s disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson’s comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design. |
| format | Article |
| id | doaj-art-d76417cc37f14c3bb27f68d14062e564 |
| institution | Kabale University |
| issn | 2090-8083 2042-0080 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Parkinson's Disease |
| spelling | doaj-art-d76417cc37f14c3bb27f68d14062e5642025-02-03T01:25:26ZengWileyParkinson's Disease2090-80832042-00802021-01-01202110.1155/2021/66219916621991Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and GeriatricsLuis Agüera-Ortiz0Rocío García-Ramos1Francisco J. Grandas Pérez2Jorge López-Álvarez3José Manuel Montes Rodríguez4F. Javier Olazarán Rodríguez5Javier Olivera Pueyo6Carmelo Pelegrín Valero7Jesús Porta-Etessam8Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, SpainMovement Disorders Unit, Servicio de Neurología, Hospital Clínico San Carlos, Complutense University, Madrid, SpainMovement Disorders Unit, Hospital General Universitario Gregorio Marañón, Madrid, SpainServicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, SpainService of Psychiatry, University Hospital Ramón y Cajal. CIBERSAM, IRYCIS. University of Alcalá, Madrid, SpainService of Neurology, HGU Gregorio Marañón, Madrid, SpainService of Psychiatry, Hospital Universitario “San Jorge”, Huesca, SpainNeurological Rehabilitation Unit, Clínica Ubarmin, Pamplona, Navarra, SpainService of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, SpainMajor and minor forms of depression are significant contributors to Parkinson’s disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson’s disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson’s disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson’s comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.http://dx.doi.org/10.1155/2021/6621991 |
| spellingShingle | Luis Agüera-Ortiz Rocío García-Ramos Francisco J. Grandas Pérez Jorge López-Álvarez José Manuel Montes Rodríguez F. Javier Olazarán Rodríguez Javier Olivera Pueyo Carmelo Pelegrín Valero Jesús Porta-Etessam Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics Parkinson's Disease |
| title | Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics |
| title_full | Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics |
| title_fullStr | Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics |
| title_full_unstemmed | Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics |
| title_short | Focus on Depression in Parkinson’s Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics |
| title_sort | focus on depression in parkinson s disease a delphi consensus of experts in psychiatry neurology and geriatrics |
| url | http://dx.doi.org/10.1155/2021/6621991 |
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