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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index




Minerva Psichiatrica 2009 March;50(1):45-53


language: English

Behind the masked face: depression and Parkinson’s disease

Bahroo L. B. 1, Appleby B. S. 2

1 Department of Neurology Georgetown University Hospital Washington DC, USA 2 Division of Geriatric Psychiatry and Neuropsychiatry Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore, MD, USA


Depression is the most common neuropsychiatric manifestation of Parkinson’s disease. The diagnosis of depression is challenging as symptoms can be masked by the presentation of Parkinson’s disease. Lack of clinician awareness, screening, inaccurate reporting by patient and caregivers, and concerns over stigma of the disease add to the challenge. Depression in Parkinson’s disease presents predominately with symptoms of anhedonia, apathy, and irritability compared to primary depressive symptoms. The symptoms of depression in Parkinson’s disease can range from major depression to subsyndromal depression occurring during motor fluctuations. Several etiological mechanisms are proposed including neurotransmitter imbalance, neuronal degeneration, genetic predisposition, and reactive depression. The mechanism of depression in Parkinson disease may be multifactorial with several contributing etiologies. Recently, deep brain stimulation patients have focused attention on depression in Parkinson’s disease, specifically the importance of diagnosis prior to surgical intervention and follow-up. Multi-disciplinary management of depression is recommended including psychotherapy, pharmacotherapy, and electroconvulsive therapy for refractory patients. Psychotherapy may have a role at the time of initial diagnosis and at times of advancing disability. Selective serotonin reuptake inhibitors are safe and tolerable. Tricyclic antidepressants are effective but less tolerable in an elderly population. Dopamine agonists may be effective in improving depression, apathy and motor symptoms. Studies are needed to expand our knowledge about the prevalence, manifestation, screening, and treatment of depression in Parkinson’s disease. Untreated depression can be extremely debilitating and significantly deteriorate patient and caregiver quality of life.

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