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.