Antidepressant therapy in idiopathic Parkinson's disease

The co-occurrence of depression and Parkinson's disease (PD) is common. Antidepressant treatment is necessary as depression has been shown to have a negative influence on activities of daily living, cognitive performance and quality of life in PD patients. The limited number of double-blind, placebo-controlled studies offers insufficient evidence for the efficacy and safety of selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants (TCA) in the treatment of depression in PD with the exception of a possible efficacy of nortriptyline. In the absence of evidence based trials, trial-treatment is recommended by the American Psychiatric Association (APA) and the American Academy of Neurology (AAN). Guidelines favor a first-choice treatment with SSRIs over the treatment with TCAs because of the risk of a potential negative influence on cognition and perception due to the anticholinergic properties of TCAs.