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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ [log in to unmask] =20