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Depression in Parkinson's Disease: Real-World Prescribing Patterns and Treatment Dynamics from a Nationwide Greek
Vasilios Karageorgiou1, Petros Skapinakis2, Ioannis Michopoulos1
1Second Department of Psychiatry, University of Athens, Athens, Greece.
Background:
Depression in Parkinson's disease (PD-DD) is common, but little is known for outcomes after antidepressants are started.
Objectives:
We examine prescribing patterns and treatment trajectories for depression in Parkinson's disease (PD) in a Greek nationwide cohort (IDYKA) of 28,370 PD-DD patients and 660,504 DD patients without PD.
Methods:
Target trial emulation with propensity score weighting comparing SSRIs, non-SSRI antidepressants, atypical antipsychotics (AAPs), and benzodiazepines on discontinuation and switching/augmentation.
Results:
The PD-DD association (pooled OR 8.37, 95% CI 5.02-13.98) is age-dependent in both sexes. Clinicians favored sedative agents, particularly mirtazapine (age- and gender-adjusted OR [aOR] 1.26, 95% CI 1.22-1.30), duloxetine (1.41, 1.36-1.48), and quetiapine (1.33, 1.28-1.38). AAP were less commonly discontinued compared to SSRIs (HR 0.838 [0.771, 0.911]). Non-SSRI ADs were associated with higher switch/augmentation rates (1.155 [1.058, 1.240]).
Conclusions:
In PD depression, AAP outlast SSRIs in real-world persistence and non-SSRIs are more commonly switched or augmented.
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