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Friday, August 20, 2010

PD, Depression, and Pharmacology

Prevalence estimates of Depression in PD is highly variable; studies indicate these rates vary from 7-76%.  But most providers would probably place the actual prevalence towards the latter end of that range; probably anywhere from 50-70%.

We actively screen for indicators of depression in our clinic using the Center for Epidemiological Studies-Depression (CES-D) scale.  If they haven't already done so our providers then have the conversation with our patients about the issue of Depression and PD.  First-line treatments are usually pharmacological; the SSRIs, SNRIs, and occasionally the Tricyclic antidepressants.  Depending on the circumstances they will then refer the patient to see me.  We also refer patients for counseling, particularly if they are not getting much symptomatic benefit from pharmacology.

A 2010 study in the Journal of American Medicine seems to call into question the effects of pharmacology on mild to moderate depression.  This is very interesting considering the wide-spread use of pharmacology in the treatment of depression.

Another interesting factor in the treatment of depression are the recent findings that pharmaceutical companies were selective in their publishing of articles demonstrating the effects of drugs to treat depression.

Depression has been found to have the greatest influence on quality of life in PWP, making the role of the SW in working with PD that much more important.


1 comment:

  1. The treatment of depression is definitely an evolving concept after the JAMA article was published. I think the thing to keep in mind is that it was not that people weren't getting better on antidepressants, it's that they were not consistently getting better than people on placebo. It has long been observed that placebo response in depression is huge (sometimes 50-60%). This is likely thought to be related to psychological factors anticipating that the treatment will work, as well as factors relating to someone checking up on your mental health regularly. I would not stop prescribing antidepressants as they do work well for most people. I do think a combination approach with both medication and psychotherapy does work well. It has also been shown that in PD apathy is very common, and is typically resistant to treatment with antidepressants. In this case, I think the social worker or therapist has a very large role in potentially helping with the symptoms.