Medikamentöse Therapie depressiver Störungen beim Morbus Parkinson

Zusammenfassung

Depressive Störungen bei Morbus Parkinson werden zu selten diagnostiziert und therapiert, obwohl sie bei 40 % aller Patienten auftreten. An ihrer Pathogenese sind organische und psychologische Faktoren beteiligt. Sie beeinträchtigen als einer von drei wichtigen Faktoren die Lebensqualität. Die Diagnostik kann mit Hilfe von Fremd- und Selbstbeurteilungsskalen vereinfacht werden. Eine Optimierung der dopamimetischen Medikation reicht bei den meisten Patienten nicht aus, sodass die Gabe eines Antidepressivums erforderlich wird. Die derzeitige Studienlage zur Wirksamkeit und Verträglichkeit der Antidepressivatherapie bei Morbus Parkinson erlaubt keine evidenzbasierten Therapieempfehlungen. Obwohl die neueren Antidepressiva wie die selektiven Serotoninwiederaufnahmehemmer im Vergleich zu den älteren Antidepressiva wie den trizyklischen Antidepressiva keine bessere Wirksamkeit zeigen, werden sie aufgrund ihres günstigeren Nebenwirkungsprofils bei älteren Patienten, einfacherer Aufdosierung und ihres geringeren Interaktionspotenzials häufiger verordnet. Die vorgestellten Therapieempfehlungen leiten sich aus pharmakologischen Überlegungen, klinischer Erfahrung, der zu behandelnden Zielsymptomatik und Art und Intensität von Nebenwirkungen ab.

Abstract

Although affecting 40 % of all patients suffering from Parkinson's disease, depression is often neither diagnosed nor treated. Biological and psychological factors contribute to the pathogenesis of depression. As one of three important factors, depressive disorders influence quality of life. The difficulties of diagnosing depression could be overcome by the use of rating instruments like the Beck Depression Inventory or the Montgomery Asberg Depression Scale. Improving the dopaminergic medication is in most of the cases not sufficient enough, so there is need for the use of an antidepressant. Data on the efficacy and the safety of antidepressive treatment in Parkinson's disease are currently too limited to give evidence-based recommendations. Although newer antidepressants like the selective serotonin reuptake inhibitors and older ones like the tricyclic antidepressants are equally effective, the newer ones are recommended more often because of their more favorable adverse effects in older patients, easier dosing and less interactions. The following recommendations depend on pharmacological considerations, clinical experience, the intended-to-treat symptoms and the kind and intensity of adverse effects.

Literatur

• 1 Poewe W, Luginger E. Depression in parkinson's disease: Impediments to recognition and treatment options.  Neurology. 1999;  52 S2-6
• 2 Shiba M, Bower J H, Maraganore D M. et al . Anxiety disorders and depressive disorders preceding parkinson's disease: A case-control study.  Mov Disord. 2000;  15 669-677
• 3 Santamaria J, Tolosa E, Valles A. Parkinson's disease with depression: A possible subgroup of idiopathic parkinsonism.  Neurology. 1986;  36 1130-1133
• 4 Starkstein S E, Mayberg H S, Leiguarda R. et al . A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with parkinson's disease.  J Neurol Neurosurg Psychiatry. 1992;  55 377-382
• 5 Mayberg H S, Solomon D H. Depression in parkinson's disease: A biochemical and organic viewpoint.  Adv Neurol. 1995;  65 49-60
• 6 Becker T, Becker G, Seufert J. et al . Parkinson's disease and depression: Evidence for an alteration of the basal limbic system detected by transcranial sonography.  J Neurol Neurosurg Psychiatry. 1997;  63 590-596
• 7 Mayeux R, Stern Y, Cote L, Williams J B. Altered serotonin metabolism in depressed patients with parkinson's disease.  Neurology. 1984;  34 642-646
• 8 Mayberg H S, Starkstein S E, Sadzot B. et al . Selective hypometabolism in the inferior frontal lobe in depressed patients with parkinson's disease.  Ann Neurol. 1990;  28 57-64
• 9 Menza M A, Palermo B, DiPaola R. et al . Depression and anxiety in parkinson's disease: Possible effect of genetic variation in the serotonin transporter.  J Geriatr Psychiatry Neurol. 1999;  12 49-52
• 10 Mossner R, Henneberg A, Schmitt A. et al . Allelic variation of serotonin transporter expression is associated with depression in parkinson's disease.  Mol Psychiatry. 2001;  6 350-352
• 11 Stern Y, Marder K, Tang M X, Mayeux R. Antecedent clinical features associated with dementia in parkinson's disease.  Neurology. 1993;  43 1690-1692
• 12 Brown R G, MacCarthy B, Gotham A M. et al . Depression and disability in parkinson's disease: A follow-up of 132 cases.  Psychol Med. 1988;  18 49-55
• 13 APA .Diagnostic and statistical manual of mental disorders. 1994
• 14 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
• 15 Montgomery S A, Asberg M. A new depression scale designed to be sensitive to change.  Br J Psychiatry. 1979;  134 382-389
• 16 Leentjens A F, Verhey F R, Lousberg R. et al . The validity of the hamilton and montgomery-asberg depression rating scales as screening and diagnostic tools for depression in parkinson's disease.  Int J Geriatr Psychiatry. 2000;  15 644-649
• 17 Beck A TWC, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.  Arch Gen Psychiatry. 1961;  4 561-571
• 18 Zung W. A self-rating depression scale.  Arch Gen Psychiatry. 1965;  12 63-70
• 19 Bech P WL. Applicability and validity of the major depression inventory in patients with parkinson's disease.  Nord J Psychiatry. 1998;  52 305-309
• 20 Leentjens A F, Verhey F R, Luijckx G J, Troost J. The validity of the beck depression inventory as a screening and diagnostic instrument for depression in patients with parkinson's disease.  Mov Disord. 2000;  15 1221-1224
• 21 Bauer M, Whybrow P C, Angst J. et al . World federation of societies of biological psychiatry (wfsbp) guidelines for biological treatment of unipolar depressive disorders, part 1: Acute and continuation treatment of major depressive disorder.  World J Biol Psychiatry. 2002;  3 5-43
• 22 Nierenberg A A, DeCecco L M. Definitions of antidepressant treatment response, remission, nonresponse, partial response, and other relevant outcomes: A focus on treatment-resistant depression.  J Clin Psychiatry. 2001;  62, Suppl 16 5-9
• 23 Kirchheiner J, Bertilsson L, Bruus H. et al . Individualized medicine - implementation of pharmacogenetic diagnostics in antidepressant drug treatment of major depressive disorders.  Pharmacopsychiatry. 2003;  36, Suppl 3 S235-243
• 24 Menza M A, Sage J, Marshall E. et al . Mood changes and „on-off” phenomena in parkinson's disease.  Mov Disord. 1990;  5 148-151
• 25 Allain H, Schuck S, Mauduit N. Depression in parkinson's disease.  Bmj. 2000;  320 1287-1288
• 26 Shaw K MLA, Stern G M. The impact of treatment with levodopa on parkinson's disease.  Q J Med. 1980;  49 283-293
• 27 Rogers D C, Costall B, Domeney A M. et al . Anxiolytic profile of ropinirole in the rat, mouse and common marmoset.  Psychopharmacology (Berl). 2000;  151 91-97
• 28 Perugi G, Toni C, Ruffolo G. et al . Adjunctive dopamine agonists in treatment-resistant bipolar ii depression: An open case series.  Pharmacopsychiatry. 2001;  34 137-141
• 29 Ostow M. Pramipexole for depression.  Am J Psychiatry. 2002;  159 320-321
• 30 Corrigan M H, Denahan A Q, Wright C E. et al . Comparison of pramipexole, fluoxetine, and placebo in patients with major depression.  Depress Anxiety. 2000;  11 58-65
• 31 Lattanzi L, Dell'Osso L, Cassano P. et al . Pramipexole in treatment-resistant depression: A 16-week naturalistic study.  Bipolar Disord. 2002;  4 307-314
• 32 Rektorova I, Rektor I, Bares M. et al . Pramipexole and pergolide in the treatment of depression in parkinson's disease: A national multicentre prospective randomized study.  Eur J Neurol. 2003;  10 399-406
• 33 Andersen J, Aabro E, Gulmann N. et al . Anti-depressive treatment in parkinson's disease. A controlled trial of the effect of nortriptyline in patients with parkinson's disease treated with l-dopa.  Acta Neurol Scand. 1980;  62 210-219
• 34 Wermuth L, Sorensen P S, Timm B. et al . Depression in idiopathic parkinson's disease treated with citalopram - a placebo-controlled trial.  Nordic Journal of Psychiatry. 1998;  52 163-169
• 35 Rabey J, Orlov E, Korczyn A D. Comparison of fluvoxamine versus amitriptyline for treatment of depression in parkinson's disease.  Neurology. 1996;  46 A374
• 36 Shabnam G N, Chung T H, Deane K HO. et al .Therapies for depression in parkinson's disease. Cochrane Database Syst Rev 2003, CD003465
• 37 Emre M. What causes mental dysfunction in parkinson's disease?.  Mov Disord. 2003;  18, Suppl 6 S63-71
• 38 Bedard M A, Pillon B, Dubois B. et al . Acute and long-term administration of anticholinergics in parkinson's disease: Specific effects on the subcortico-frontal syndrome.  Brain Cogn. 1999;  40 289-313
• 39 Bosboom J L, Stoffers D, Wolters E. The role of acetylcholine and dopamine in dementia and psychosis in parkinson's disease.  J Neural Transm Suppl. 2003;  65 185-195
• 40 Emre M. Dementia in parkinson's disease: Cause and treatment.  Curr Opin Neurol. 2004;  17 399-404
• 41 Sternic N, Kacar A, Filipovic S, Svetel M. The therapeutic effect of moclobemide, a reversible selective monoamine oxidase a inhibitor, in parkinson's disease.  Clin Neuropharmacol. 1998;  21 93-96
• 42 Stassen H H, Angst J, Szegedi A. How to assess the onset of antidepressant effect. Empirical data on 2788 patients.  Pharmacopsychiatry. 2003;  36 265
• 43 Thase M E, Rush A J. When at first you don't succeed: Sequential strategies for antidepressant nonresponders.  J Clin Psychiatry. 1997;  58, suppl 13 23-29
• 44 Strang R R. Imipramine in treatment of parkinsonism: A double-blind placebo study.  Br Med J. 1965;  5452 33-34
• 45 Laitinen L. Desipramine in treatment of parkinson's disease. A placebo-controlled study.  Acta Neurol Scand. 1969;  45 109-113
• 46 Steur E N. Increase of parkinson disability after fluoxetine medication.  Neurology. 1993;  2 211-213
• 47 Jimenez-Jimenez F J, Tejeiro J, Martinez-Junquera G. et al . Parkinsonism exacerbated by paroxetine.  Neurology. 1994;  44 2406
• 48 Simons A. Fluoxetine in parkinson's disease.  Movement Disorders. 1996;  11 581-582
• 49 Linazasoro G. Worsening of parkinson's disease by citalopram.  Parkinson Rel Disord. 2000;  6 111-113
• 50 Ceravolo R, Nuti A, Piccinni A. et al . Paroxetine in parkinson's disease: Effects on motor and depressive symptoms.  Neurology. 2000;  55 1216-1218
• 51 Tesei S, Antonini A, Canesi M. et al . Tolerability of paroxetine in parkinson's disease: A prospective study.  Mov Disord. 2000;  15 986-989
• 52 Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias.  Neurology. 1999;  53 1154
• 53 Montastruc J L, Fabre N, Blin O. et al . Does fluoxetine aggravate parkinson's disease? A pilot prospective study.  Mov Disord. 1995;  10 355-357
• 54 McCance-Katz E F, Marek K L, Price L H. Serotonergic dysfunction in depression associated with parkinson's disease.  Neurology. 1992;  42 1813-1814
• 55 Shulman L MSC, Liefert R. Therapeutic effects of sertraline in patients with parkinson's disease.  Mov Disord. 1996;  1 12
• 56 Hauser RA ZT. Sertraline for the treatment of depression in parkinson's disease.  Mov Disord. 1997;  12 756-759
• 57 Lemke M R. Reboxetine treatment of depression in parkinson's disease.  J Clin Psychiatry. 2000;  61 872