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I just got my drivers license renewed for 5 years yesterday. Since the subject has been raised by the vigilant and prolific Murray Charters, I am reposting a piece that I wrote originally a couple of months ago. Although my driving skills are reduced when my meds are not working, I do not fear sleep attacks. I haven taken mirapex for several years and I used to get sleep attacks, but since I started taking ritalin (20mg cr 1xday), I do not get sleep attacks. I wanted to share this information because I think ritalin is a not often used as a treatment for PD, but it is cheaper and may be more effective than other treatments for concentration and depression-like symptoms. Have others had similar experience? My impression is that most PD patients who are treated for depression are given SSRI inhibitors (e.g. zoloft, prozac), which may not help the depression very much and may have side effects, and are quite expensive (cost is an important consideration in the real world with variable insurance coverage, but is not generally addressed in research studies). My attendance at the joint NINDS, NIA, NIMH advisory group meeting on depression and PD confirmed that little is known about the effectiveness (or even harm) of SSRI inhibitors for PD. What are others experience with these meds? Perry Cohen Washington DC The information below was written in support of a grant application to the Army Neurotoxin Research Program by a psychologist at the National Rehab. Hospital in Washington which is part of the Medstar Health System. He has been doing studies of the use of stimulants for recovery from brain injury. ============== September, 2000 The study entitled "Pilot study of efficacy and safety of stimulants to treat depression, cognitive dysfunction, and somnolence in Parkinson's disorder" addresses issues central to the quality of life and well-being of persons with Parkinson's disease. Depression and related mood disorders are common (40% or more) and woefully under studied symptoms of PD. My recent attendance at the World Movement Disorder Society (MDS) Congress underlined the paucity of research in these areas. Preliminary findings of the MDS "Evidence Based Review" of PD treatments found 22 clinical studies of depression in PD, no class I or II studies and only 2 class III studies (classes are based on strength of evidence – large, long term, double blind, randomized, controlled trails are highest, class I). Dopamine agonists by contrast had 236 studies with 57 class I studies. Given the importance of non-depressed mood and optimal cognition to quality of life and functional capacity, particularly in younger Parkinson's patients with many years of productive capacity, it is essential that we address this issue. In my own experience depression was a presenting symptom of PD. I was treated with zoloft but did not like its side effects and expense (cost of medications is important for patients with limited insurance coverage for drugs and other drug costs exceeding $10 /day). I was referred to Neuro-psychiatrist who said I was not really depressed, because I was not unhappy. He indicated that I suffered from PD induced bradyferenia and prescribed ritalin. Over 2.5 years the ritalin has been more effective than zoloft to help my concentration with less cost, no problematic side effects, and a bonus, no more "sleep attacks" (from Mirapex- a dopamine agonist). In my early 50's I have been able to continue working and have been more effective than I had been for many years. I have encountered several other patients who take ritalin, but PD experts have told me that this is a "novel" treatment. Given glaring absence of research on the efficacy and safety of such stimulants for PD, this research needs to be done. The proposed study will not likely be accomplished using alternate funding pathways. The PD Foundations tend to fund basic science over "clinical" research, and given that the drugs to be studied are off patent, there is no incentive for pharmaceutical company patronage of studies. If other patients prove to have my very good experience, the published results will be important to disseminate the knowledge (with no marketing budget) of a more effective treatment to prescribing physicians and thus to patients. Perry D. Cohen, PhD