Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review

Author: Efthalia Angelopoulou1,2, Evangelia Stanitsa1, Claire Chrysanthi Karpodini3, Anastasia Bougea1, Dionysia Kontaxopoulou1, Stella Fragkiadaki1, Christos Koros1, Vasiliki Epameinondas Georgakopoulou4, George Fotakopoulos5, Yiannis Koutedakis6, Christina Piperi2, Sokratis G Papageorgiou1
Affiliation: <sup>1</sup> 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece. <sup>2</sup> Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece. <sup>3</sup> Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK. <sup>4</sup> Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, 11527 Athens, Greece. <sup>5</sup> Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece. <sup>6</sup> Functional Architecture of Mammals in Their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 38221 Volos, Greece.
Conference/Journal: Medicina (Kaunas)
Date published: 2023 Aug 12
Other: Volume ID: 59 , Issue ID: 8 , Pages: 1454 , Special Notes: doi: 10.3390/medicina59081454. , Word Count: 256

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.

Keywords: CBT; MAO-B inhibitors; Parkinson’s disease; SNRIs; SSRIs; TCAs; complementary; depression; non-pharmacological; physical exercise.

PMID: 37629744 PMCID: PMC10456434 DOI: 10.3390/medicina59081454