Current approaches to management of depression in Parkinson's Disease

Depression is a common problem in patients affected by Parkinson's Disease (PD). In many cases, treatment with antidepressants is necessary, and the choice of the most suitable drug is often controversial, as many factors need to be considered that may complicate the development of the disease, including potential side effects of antidepressant therapy. Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic Antidepressants (TCAs) are the two major categories of antidepressants used. Tricyclics have been shown to be effective in most cases, but some side effects (orthostatic hypotension, sedation, cognitive and anticholinergic effects) may present problems. In contrast, SSRI appear to be better tolerated, but some reports indicate a potential worsening of the parkinsonism. Other recently introduced medications need further investigation. The main therapeutic strategies, as reported in the international literature according to efficacy and tolerability, interactions with antiparkinsonian or concomitant drugs and possible effects on worsening of PD, are presented.