A SURVEY OF ANTIDEPRESSANT DRUG-USE IN PARKINSONS-DISEASE

Selective serotonin reuptake inhibitors (SSRIs) are a newer class of a ntidepressants that may have particular efficacy in Parkinson's diseas e (PD) given the known serotonergic alterations in this disease. These agents are also thought to have a favorable side-effect profile, part icularly in the elderly. Several recent case reports, however, have ra ised concern that SSRIs may worsen parkinsonian motor function. We sur veyed 71 Parkinson Study Group (PSG) investigators using a standardize d questionnaire about their usage of antidepressants in PD. Based on e stimates provided by 49 investigators (70%) (caring for approximately 23,410 PD patients) who responded, 26% of patients with PD are on phar macotherapy for depression. These physicians use SSRIs as first line t herapy 51% of the time, tricyclic antidepressants 41% of the time and other agents 8% of the time. The most common reasons for selecting SSR Is were their better side-effect profile and perceived greater efficac y. The most common reasons for selecting tricyclic antidepressants wer e their potential to help with sleep and the physician's experience wi th this class. Forty-three percent of investigators were concerned tha t SSRIs might worsen motor function, and 37% of them have had at least one patient in whom they believe this had occurred. Our survey confir ms that for treating physicians there remain uncertainties regarding t he relative efficacy and tolerability of available antidepressant medi cations for patients with PD. A controlled clinical trial of antidepre ssant therapy in PD would be valuable for settling these concerns.