hi again

my recent discussions with some of you=20
on clinical depression [cd] and parkinson's disease [pd]=20
made me want to dig a little deeper

so i found the following abstracts at the free medline site
PubMed  <http://www.ncbi.nlm.nih.gov/PubMed>
[thank you, mare cans!]

janet

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1996/11
Depression in Parkinson's disease.

Depression occurs in 40% to 50% of Parkinson's disease (PD) patients. From
research over the last decade, this co-occurrence appears to be more than
an emotional reaction to disability. Replacement of the neurotransmitter,
dopamine, benefits the PD motor functions, and the neurotransmitter,
serotonin, in antidepressants, reduces depressive symptoms. However,
identification of the physiological linkage between PD and depression
continues to evade research efforts.

J Psychol 1996 Nov;130(6):659-667
Murray JB
St. John's University, Jamaica, NY, USA.
PMID: 8914304, MUID: 97071379
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1996/11
Depression and Parkinson's disease:
neurobiologic foundations and therapeutic management.

The prevalence of depression in Parkinson's disease (PD) is estimated to be
around 40% and generally takes the form of dysthymia. Although
psychological factors probably contribute to depression, data point to a
relation to structural and biochemical changes linked to PD. Thus, the
onset of motor impairment is often preceded by a depressive episode,
although there is no consistency between the seriousness of motor
disability and depression. Furthermore, depression aggravates the memory
and language impairments of PD and is thought to be a risk factor for
developing dementia. Regional cerebral blood flow abnormalities in the
medial frontal and cingulate cortices and low 5-HIIA concentrations in
cerebro-spinal fluid suggest that degeneration of the mesocorticolimbic
dopaminergic system as well as dorsal raphe changes may be implicated.
Assessment of depression in PD is difficult, as none of the currently
available scales were specifically designed for patients with this disease.
Furthermore, there is a lack of well-controlled studies showing that
current antidepressants are effective in PD patients or are safe for use
when the motor, cognitive and autonomic impairments of PD are present.

Neurologia 1996 Nov;11(9):332-340
Gimenez-Roldan S, Dobato JL, Mateo D, Gonzalez Alvarez M, Novillo
Infantes MJ, Gimenez-Zuccarelli M
Hospital General Universitario Gregorio Maranon, Madrid.
PMID: 9004744, MUID: 97139366
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1996/10
Prolactin and cortisol responses to fenfluramine
in Parkinson's disease.

Dysfunction of the central serotonergic system has been associated with
depression in Parkinson's disease. To evaluate central serotonergic
function in Parkinson's disease in relation to depression, we examined
prolactin and cortisol responses to a single-dose challenge with
fenfluramine (60 mg orally), a serotonin releasing/uptake-inhibiting agent,
in the course of 5 hours in 11 patients with Parkinson's disease associated
with major depression (SADS-RDC), 22 nondepressed parkinsonians, and 20
age- and gender-matched healthy controls. No difference in cortisol
responses were observed between the groups; however, prolactin responses to
fenfluramine were significantly impaired in patients with Parkinson's
disease compared to controls, and the response was significantly more
blunted in parkinsonian patients with major depression in comparison with
the nondepressed ones. These findings indicate that there is a diminished
serotonergic responsivity in depression associated with Parkinson's disease.

Biol Psychiatry 1996 Oct 15;40(8):769-775
Kostic VS, Lecic D, Doder M, Marinkovic J, Filipovic S
Institute for Neurology CCS, Belgrade, Yugoslavia.
PMID: 8894070, MUID: 97049340
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1996
Depression and disability in Parkinson's disease.

The relationship between depression and disability in idiopathic
Parkinson's disease (PD) was examined in 31 outpatients. Thirteen percent
had current major depression (MD), 10% dysthymia, and 32% a lifetime
history of MD. Depression was significantly related to both illness
severity and functional impairment. Male patients with early-onset PD
(before age 55) had more mood and anxiety disorders than late-onset male
patients. Patients with right-sided PD had significantly more depressive
symptoms than those with left-sided PD. On multiple regression analyses,
depression predicted impaired social, role, and physical functioning for
men (but not for women), independent of the impact of illness severity. The
results suggest that treatment of depression may improve function; however,
findings of gender differences will require replication.

J Neuropsychiatry Clin Neurosci 1996;8(1):20-25
Cole SA, Woodard JL, Juncos JL, Kogos JL, Youngstrom EA, Watts RL
Emory University School of Medicine, Atlanta, Ga USA.
PMID: 8845697, MUID: 96403150
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1995/05
Sleep in Parkinson's disease. The role of depression and anxiety.

Sleep disorders are frequent and well documented in patients with
Parkinson's disease (PD). The effect of depression and anxiety on sleep in
PD patients has not been carefully studied however, despite the fact that
both depression and anxiety are common in PD and well known to affect sleep
in patients without PD. In this questionnaire study, sleep, anxiety, and
depression were evaluated in 99 patients with PD and 47 control subjects.
PD patients had significantly higher scores on a variety of sleep variables
as well as on measures of anxiety and depression. While anxiety and
depression were correlated with some sleep measures, neither contributed
significantly to overall variance in sleep quality. The effect on sleep
variables was dominated by on-off symptom phenomena, levodopa dose, and age.

Psychosomatics 1995 May;36(3):262-266
Menza MA, Rosen RC
UMDNJ-Robert Wood Johnson Medical School, New Brunswick NJ USA
PMID: 7638313, MUID: 95365491
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1994/03
Depression in Parkinson disease. A literature review.

Depressive disorders occur in Parkinson's disease in about 40%. They often
manifest -- not seldom preceding diagnosis of Parkinson's syndrome -- like
monopolar depression. Their cause has not yet been explained in a
satisfactory way. Neurotransmitter disturbances are discussed as well as
psychogenic factors. There seems to be a subtype of Parkinson's disease
with more frequent depression, which is characterized by increased rigidity
and bradykinesia, lower age at onset and family history of Parkinson's
disease. Especially antidepressants, but also sleep deprivation and
electroconvulsive therapy are efficient. The review is illustrated by a
case report.

Fortschr Neurol Psychiatr 1994 Mar;62(3):94-101
Haltenhof H, Schroter C
Philipps-Universitat Marburg Germany
PMID: 8181790, MUID: 94237523
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1994
Parkinson's disease and depression:
the relationship to disability and personality.

In a study of 104 patients with Parkinson's disease (PD) and 61 control
subjects with equal disability scores, PD patients had higher depression
scores (P < 0.001) than control subjects. Functional disability was
correlated with depression in PD and, in a regression analysis, explained
9% of the variance in depression (P < 0.001). Depression was not correlated
with novelty seeking, a personality trait related to dopaminergic pleasure
and reward systems. Harm avoidance, a trait related to central serotonergic
systems, was, however, correlated with depression (P < 0.001) and explained
31% of the variance in depression scores. Results support the hypotheses
that both physiologic and psychologic factors contribute to depression seen
in these patients and that serotonergic function plays a more critical role
than dopaminergic function.

J Neuropsychiatry Clin Neurosci 1994;6(2):165-169
Menza MA, Mark MH
UMDNJ-Robert Wood Johnson University, New Brunswick NJ USA
PMID: 8044039, MUID: 94319178
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1992/04
Depression and Parkinson's disease: a review.

OBJECTIVE: The purpose of this review is to provide an update of the
research regarding depression in Parkinson's disease and to synthesize the
information into a neurobiological model relating the structural and
biochemical changes in this disorder to the behavioral manifestations.=20
METHOD: The author used a computer-based search of the literature,
augmented by extensive bibliography-guided article reviews, to find
information on depression and Parkinson's disease.=20
FINDINGS: Depression occurs in approximately 40% of patients with
Parkinson's disease; depression in Parkinson's disease is distinguished
from other depressive disorders by greater anxiety and less self-punitive
ideation. Lower CSF levels of 5-hydroxyindoleacetic acid, a past history of
depression, and greater functional disability are associated with a greater
risk of depression in Parkinson's disease. Female gender, early age at
onset of Parkinson's disease, and greater left brain involvement may also
be risk factors. Approximately half of depressed patients with Parkinson's
disease meet criteria for major depressive episodes; half have dysthymia.
Depression is more common in Parkinson's disease with prominent
bradykinesia and gait instability than in tremor-dominant syndromes.
Depressed patients with Parkinson's disease have greater frontal lobe
dysfunction and greater involvement of dopaminergic and noradrenergic
systems than nondepressed patients with the disease. Mood changes in
Parkinson's disease respond to treatment with conventional tricyclic
antidepressants or ECT.=20
CONCLUSIONS: Neurobiological investigations suggest that depression in
Parkinson's disease may be mediated by dysfunction in
mesocortical/prefrontal reward, motivational, and stress-response systems.
Neuropsychological, metabolic, clinical, pharmacological, and anatomical
studies support the involvement of frontal dopaminergic projections in
patients with Parkinson's disease and depression.

Am J Psychiatry 1992 Apr;149(4):443-454
Cummings JL
University of California, School of Medicine, Los Angeles CA USA
PMID: 1372794, MUID: 92206517
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1992
Preliminary examination of the comorbidity of anxiety and depression
in Parkinson's disease.

Significant anxiety in combination with depression may represent a specific
depressive subtype in Parkinson's disease (PD). To ascertain the prevalence
of this symptom complex, we administered a self-report survey and
standardized psychological tests that measure anxiety and depression to 164
PD patients and 150 age-matched healthy spouse control subjects. The
reporting of depression in combination with panic/anxiety best
differentiated the two populations (38% vs. 8%). Depression and anxiety
were highly correlated in relationship to clinical features of PD. Our
findings suggest that clinically significant levels of depression and
anxiety may frequently coexist in PD. The specific neuropathology of PD may
predispose to this pattern of behavioral disturbance.

J Neuropsychiatry Clin Neurosci 1992;4(3):257-264
Henderson R, Kurlan R, Kersun JM, Como P
University of Rochester NIMH Clinical Research Center NY USA
PMID: 1498578, MUID: 92361183
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1992
Reliability, validity, and clinical correlates of apathy in
Parkinson's disease.

The authors examined a consecutive series of 50 patients for the presence
of apathy, depression, anxiety, and neuropsychological deficits using a
neuropsychological battery that included a recently designed apathy scale.
This scale was found to be reliable and valid in the diagnosis of apathy in
patients with PD. Of patients in the study, 12% showed apathy as their
primary psychiatric problem, and 30% were both apathetic and depressed.
Patients with apathy (with or without depression), showed significantly
more deficits in both tasks of verbal memory and time-dependent tasks.
Results suggest that apathy is a frequent finding in PD, is significantly
associated with specific cognitive impairments, and may have a different
mechanism than depression.

J Neuropsychiatry Clin Neurosci 1992;4(2):134-139
Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R,
Robinson RG
Johns Hopkins University School of Medicine, Baltimore, MD USA
PMID: 1627973, MUID: 92330493
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991/06
An analysis of the prevalence and etiology
of depression in Parkinson's disease.

Depression in patients with Parkinson's disease (PD) is a significant
clinical problem for which the etiological basis remains unclear. Several
authors have asserted it to be a reactive state to progressive, disabling
symptoms, whereas others have suggested a neurochemical basis. Recent
evidence suggests serotonin deficiencies as a plausible explanation.

J Neurosci Nurs 1991 Jun;23(3):165-169
Habermann-Little B
University of California, San Francisco CA USA
PMID: 1831481, MUID: 91341293
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991/06
Depression in Parkinson's disease.

Approximately 50% of patients with Parkinson's disease experience clinical
depression. Neurotransmitter deficits in depression and Parkinson's disease
suggest a common lesion may be responsible for this high incidence. In
addition to similar psychological profiles, the clinical features of
Parkinson's disease and depression likewise overlap making the distinction
difficult. Differentiating these two diseases is very important, as each is
treatable. The neuroscience nurse is in a unique position to evaluate the
patient with Parkinson's disease for signs and symptoms of depression.

J Neurosci Nurs 1991 Jun;23(3):158-164
Bunting LK, Fitzsimmons B
Johns Hopkins Hospital, Baltimore, MD USA
PMID: 1831480, MUID: 91341292
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991/03
Depression antedating the onset of Parkinson's disease.

Neurological and depressive symptoms in a subtype of Parkinson's disease
(PD), in which a depressive state precedes the clinical manifestation of
neurological symptoms, were examined on the basis of clinical observations
for 3 years or more. PD, in which depression preceded, was different from
PD with preceding neurological symptoms, in the severity of not only
neurological but also depressive symptoms. These results suggest that PD in
which depression precedes neurological symptoms is a specific subtype of
PD. It was speculated that the differences in clinical symptoms might be
due to a biological background, in particular the dopaminergic system.

Jpn J Psychiatry Neurol 1991 Mar;45(1):7-11
Fukunishi I, Hosokawa K, Ozaki S
Psychiatric Research Institute of Tokyo, Japan.=7F
PMID: 1753493, MUID: 92092399
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991
Sleep disorders, pain, and depression in Parkinson's disease.

A consecutive series of patients with Parkinson's disease (PD) were
examined for the presence of sleep disturbances, pain, and depression. We
found that patients with PD and major depression had significantly more
sleep disturbances and severe pain than non-depressed patients with PD.
Moreover, depression scores accounted for most of the variance in a
stepwise regression analysis of the effect of numerous clinical variables
on either sleep disorders or pain severity. These findings suggest that
depression is the most important factor associated with the common problems
of sleep disorder and pain among patients with PD.

Eur Neurol 1991;31(6):352-355
Starkstein SE, Preziosi TJ, Robinson RG
University of Buenos Aires, Argentina.
PMID: 1756757, MUID: 92097600
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991
Sleep EEG in depressed and nondepressed patients
with Parkinson's disease.

Sleep patterns of two consecutive nights were analyzed in 26 drug-free
patients with Parkinson's disease (PD), who were clinically divided into
depressed (n =3D 8) and nondepressed (n =3D 18) groups. Sleep
electroencephalographic (EEG) recording showed significantly shorter rapid
eye movement (REM) latency in depressed PD patients (41.1 +/- 21.7 min)
compared to nondepressed PD patients (129.0 +/- 84.9 min, p less than
0.002). Furthermore, shortened REM latency (less than or equal to 65.0 min)
was observed with significantly more frequency in depressed PD patients (6
out of 8) compared to nondepressed PD patients (4 out of 18, p less than
0.02). The other sleep parameters studied did not differ significantly
between the two groups of patients. Because shortened REM latency is one of
the most reliably documented biological features of major depression, these
findings may be of some importance for understanding the nature of
depression in the course of PD.

J Neuropsychiatry Clin Neurosci 1991;3(2):176-179
Kostic VS, Susic V, Przedborski S, Sternic N
Neurological Clinic UCC, School of Medicine, Belgrade, Yugoslavia.
PMID: 1821232, MUID: 92330431
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1991
The etiology of depression in Parkinson's disease patients.

Depression is the major psychiatric complication of Parkinson's disease,
and it occurs in approximately one-third of all cases. Diagnosis of
depression is complicated by the overlap of depressive and parkinsonian
symptoms. Its etiology is not fully understood but involves changes in
dopamine and serotonin. Depression has significant clinical impact;
depressed patients are more disabled (less independent). The depressive
symptoms respond to treatment with antidepressants and electroconvulsive
therapy.

Psychosomatics 1991;32(4):390-395
Guze BH, Barrio JC
University of California, Los Angeles, CA USA
PMID: 1961850, MUID: 92073501
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1990/10
Specificity of affective and autonomic symptoms
of depression in Parkinson's disease.

Previous investigators have suggested that numerous symptoms used to
diagnose depression, such as sleep or appetite disturbance, are
non-specific in medically ill patients, and alternative diagnostic criteria
should be developed. In the study this hypothesis was tested in Parkinson's
disease (PD) by comparing patients with PD who reported a depressive mood
with patients having PD but without a depressive mood. Depressed patients
showed a significantly higher frequency of both autonomic and affective
symptoms of depression. Depressed patients with PD reported a significantly
higher frequency of worrying, brooding, loss of interest, hopelessness,
suicidal tendencies, social withdrawal, self-depreciation, ideas of
reference, anxiety symptoms, loss of appetite, initial and middle insomnia,
and loss of libido when compared with non-depressed patients. No
significant between-group differences, however, were observed in the
frequency of anergia, motor retardation, and early morning awakening.

J Neurol Neurosurg Psychiatry 1990 Oct;53(10):869-873
Starkstein SE, Preziosi TJ, Forrester AW, Robinson RG
Johns Hopkins University, Baltimore, Maryland, USA
PMID: 2266368, MUID: 91093704
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1990/07
Depression in the patient with Parkinson's disease.

Depression is the most commonly encountered mental change in patients with
Parkinson's disease. However, its cause is controversial and little is
known about its natural history. Some view depression as reactive to the
physical disability inherent to Parkinson's disease; however, others view
the depressive disorder as the direct result of underlying biochemical
changes caused by the disease process. Abnormalities within the serotonin
metabolic pathway have been observed in depressed patients with Parkinson's
disease and may help to explain why this form of depressive disorder is so
common and persistent. Other forms of depression share this biochemical
alteration. Attempts to alleviate depression with serotonin agonists have
proven successful. Current research efforts are exploring biological
aspects of depression in Parkinson's disease and the epidemiology of this
disorder as a model of depression in the elderly, medically ill patient.

J Clin Psychiatry 1990 Jul;51 Suppl:20-23
Mayeux R
Columbia University, New York, NY USA
PMID: 2195009, MUID: 90307626
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1990
Depressive symptoms in Parkinson's disease:
a comparison with disabled control subjects.

A high incidence of depressive symptoms has been observed in patients with
Parkinson's disease (PD). PD involves a loss of central monoamines, and a
decrease of monoamines has been implicated in depression; therefore, it is
possible that depressive symptoms in PD result from the loss of endogenous
neurotransmitters. However, it is equally possible that depressive symptoms
represent a reaction to the chronic disabling course of PD. By comparing
depressive symptoms in PD patients to those in matched patients with other
chronic disabling diseases not involving a loss of central monoamines, it
may be possible to decide between these alternatives. Thus, depressive
symptoms were assessed in 45 patients with PD and 24 disabled controls that
did not differ from the PD subjects on a measure of functional disability.
Results showed that PD subjects obtained significantly higher total scores
on the Beck Depression Inventory (BDI) than controls. PD subjects scored
significantly higher than controls on BDI items grouped to reflect
cognitive-affective and somatic depressive symptoms. The BDI scores of PD
subjects were not reliably related to age, sex, duration of PD, or clinical
ratings of PD symptom severity or functional disability. Self-rated
disability and the number of recent medical problems were the greatest
predictors of depressive symptoms. These findings supported the hypothesis
that depressive symptoms in PD may not represent solely a reaction to
disability.

J Geriatr Psychiatry Neurol 1990 Jan;3(1):3-9
Ehmann TS, Beninger RJ, Gawel MJ, Riopelle RJ
Queen's University, Kingston, Ontario, Canada.
PMID: 2140682, MUID: 90267610
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1990
Parkinson's disease, personality, and dopamine.

Clinicians have long observed an anecdotal association of Parkinson's
disease with stoic, industrious, and inflexible personality traits, both
premorbidly and after the onset of motor symptoms. In this study, using the
Tridimensional Personality Questionnaire, we found significantly less
novelty-seeking behavior (behavior thought to be dopamine-dependent) in
Parkinson's disease patients than in matched controls, but no differences
between groups in behaviors thought to be dependent on serotonin and
norepinephrine. We discuss the literature and propose a mechanism that may
explain the relationship between brain dopaminergic systems and personality
in Parkinson's disease.

J Neuropsychiatry Clin Neurosci 1990;2(3):282-287
Menza MA, Forman NE, Goldstein HS, Golbe LI
UMDNJ-Robert Wood Johnson University, New Brunswick NJ USA
PMID: 2136087, MUID: 92330401
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