 |
 |
thoughtt his stydy would be of interest since many PWP are taking antidepressants... ---------- Forwarded Message ---------- From : E-MOVE Jan. 2009 The tricyclic antidepressant nortriptyline is superior to the SSRI paroxetine CR for treatment of depression in Parkinson’s disease, according to a head-to-head, placebo-controlled study. Fifty-two patients with PD and depression were randomized to receive nortriptyline, paroxetine CR, or placebo for 8 weeks. Scores on the Hamilton Depression Rating Scale fell by 10.3 points for nortriptyline, 6.4 points for paroxetine CR, and 3.5 points for placebo. The results favored nortriptyline versus placebo at weeks 2 and 8, and nortriptyline versus paroxetine CR at weeks 2 and 4. Paroxetine CR was not superior to placebo at any time point. Fifty-three percent of patients receiving nortriptyline were responders (>50% improvement) compared to 11% for paroxetine CR and 24% for placebo. Anxiety and sleep also improved more for patients on nortriptyline compared to either other arm. No difference between the treatment was found for UPDRS scores. Side effects were also slightly less for nortriptyline, and no patient had a clinically significant change in the QTc interval on nortriptyline. This is the largest placebo-controlled trial for depression in PD, the authors note, and the first to compare a tricyclic to an SSRI. “While preliminary, this trial yielded results that are perhaps surprising and may have significant clinical implications,” they state. They speculate that the increased efficacy of nortriptyline may be related to its effect on two neurotransmitter systems, norepinephrine and serotonin, as opposed to the single system affected by the SSRI. “It is possible that the mechanism of the apparent superiority of nortriptyline is its effect on norepinephrine,” they suggest. In an accompanying editorial, Michael Okun and Hubert Fernandez raise the question of whether a longer treatment period with paroxetine CR might have allowed it to benefit more patients, since SSRIs are known to take longer to produce an effect than tricyclics. “This study reminds us that TCAs are not necessarily less tolerated,” they say, “and SSRIs may not be as efficacious as currently perceived by practice patterns. A larger and perhaps longer duration trial…will be important. Such trials may demonstrate that, for a subpopulation of patients with non-motor PD symptoms, a TCA may be the right choice.” A controlled trial of antidepressants in patients with Parkinson disease and depression M Menza, R Defonzo Dobkin, H Marin, MH Mark, M Gara, S Buyske, K Bienfait, A Dicke Neurology 2008; published online 17 December 2008 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn