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To: Alan Bonander (post of 19 Feb 95) Re: Depression in P.D. From: Joel Young Thank you for your extending your welcome. You asked me several questions about Parkinson Disease and antidepressants and I will offer you my opinion. I certainly don't feel that I'm the final word on these issues and would certainly welcome other physicians (and others) to expand. There probably is a biochemical connection between Parkinson Disease and major depression. I don't think we know enough to limit the explanation to insufficient serotonin levels. My huch is that while this plays a role - the relationship between these clinical entitities is multifactorial. Although I feel time will reveal more about the neurotransmitter story, its important to remember that Major depression is a very common disorder affecting 10% of American men and 20% of women. Clearly it is well represented in the PD population, and PD itself is more than likely a risk factor for depression. You asked me to comment about the various Serotonin reuptake inhibitors (SSRIs) Prozac is best known, but Zoloft, Paxil, and even newer different agents ie Effexor, are excellent agents. In clinical practice, each is unique and those of us who prescribe these medications frequently have our favorites, but in general good studies indicate equivalent responses in depressed populations. Some people respond preferentially to one antidepressant over the other. The key is to obtain a high enough dose (although in my experience, depressed patients with P.D. generally respond to low dosages) In other words 20 mgs of Prozac or Paxil may be insufficient. You may need 30-60 mg/day. Zoloft frequently requires 150-200 mg/day. The side effect profiles are generally similar between the above mentioned SSRIs. If one causes unpleasant fatigue or sexual dysfunction, tell your doctor, and try another one. These are exciting times in central nervous system pharmacology. The medications will only get better. At least 5-6 of the "top ten" medications I prescribe most frequently were not around a few short years ago, and the pace of change is increasing. I agree with you that there needs to be more understanding regarding affective disorders and P.D. Clearly Sinemet has many confounding properties which can affect a person's psychiatric presentation. Anti-psychotic medications with P.D are a particular problem, best left for another day. Hope you find this helpful. Joel Young, MD