SSRIs do not worsen Parkinson's disease: Evidence from an open-label, prospective study

Selective serotonin reuptake inhibitors (SSRIs) have been reported to be us eful in the treatment of depression in patients with Parkinson's disease (P D). However, a few reports have suggested that SSRIs may worsen parkinsonia n motor symptomatology and extrapyramidal side effects have been reported i n depressed patients treated with SSRIs. So far, no prospective trial compa ring the effects of different SSRIs in depressed patients with PD has been performed. The aim of the present study was to assess the effects of four S SRIs (citalopram, fluoxetine, fluvoxamine, and sertraline) on motor perform ance and their efficacy on depression in a group of patients with PD. Sixty -two consecutive nondemented, nonfluctuating, depressed patients with PD we re included in four treatment groups (15 patiens received citalopram, 16 fl uoxetine, 16 fluvoxamine, and 15 sertraline). The evaluation of extrapyrami dal and depressive symptomatology was performed with use of the Unified Par kinson's Disease Rating Scale (UPDRS), Beck Depression Inventory, and Hamil ton Depression Rating Scale at baseline and after 1, 3, and 6 months. Fifty -two patients completed the study. UPDRS scores were not significantly modi fied by the add-on therapy with each of the SSRIs Studied. A significant im provement in depressive symptoms from baseline to the end of the trial was obtained with all SSRIs (Beck and Hamilton scores improving; p < 0.05 accor ding to an analysis of variance). Our findings suggest that SSRIs do not si gnificantly worsen extrapyramidal symptomatology and may ameliorate depress ion in patients with PD.