Depression in Parkinson's disease. The role of pharmacotherapy

Psychiatric symptoms seem to be an immanent part of Parkinson's disease. Patients may present with psychotic symptoms, cognitive disorders, sleep disturbances (mainly associated with the REM sleep), dementia as well as depression and anxiety. Depression and anxiety are the most common psychiatric disorders, and are observed in nearly a half of patients with Parkinson's disease. They are caused by both neurochemical and neuroanatomical abnormalities occurring in this disease. This decreases the quality of life and significantly affects patients' functioning. Moreover, these disorders are frequently not diagnosed correctly. Numerous studies have shown that the most common drugs are those from the group of selective serotonin reuptake inhibitors. However, there is no strong evidence for their high efficacy. Due to the multifactorial mechanism of action, more effective, but also related with more adverse events, are selective norepinephrine reuptake inhibitors and tricyclic antidepressants. Daily practice and various publications reveal that non-ergoline dopamine agonists, such as ropinirole and pramipexole, may constitute an alternative to antidepressants.