Menza Matthew, Dobkin Roseanne DeFronzo, Marin Humberto, Mark Margery H, Gara Michael, Buyske Steven, Bienfait Karina, Dicke Allison
Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.
Mov Disord. 2009 Jul 15;24(9):1325-32. doi: 10.1002/mds.22586.
Parkinson's disease (PD) is a common neurodegenerative disease affecting up to one million individuals in the United States. Depression is found in 40 to 50% of these patients and is associated with a variety of poor outcomes for both patients and their families. Despite this, there are few evidence-based data to guide clinical care. This was an NIH-funded, randomized, controlled trial of paroxetine, nortriptyline, and placebo. It included an 8 week acute phase and a 16 week blind extension phase. This report details the impact of depression treatment on quality of life (QoL) and disability in the acute and extension phase of this study. Secondary outcomes included relapse, tolerability, safety, and the impact of depression treatment on PD physical functioning. Patients who had improvement in depression, compared with those who did not, had significant gains in measures of QoL and disability (PDQ-8, P = 0.0001; SF-36, P = 0.0001) at 8 weeks and maintained their gains in the extension phase. Patients who were on active drug were significantly less likely to relapse in the extension phase than those on placebo (P = 0.041). Though relatively modest in size, this trial provides the first controlled data on the impact of treatment of depression on QoL and disability in PD. It suggests that successfully treating depression in PD leads to important, sustained improvements in these outcomes and that patients who improve on antidepressants are less likely to relapse than are patients who initially improve on placebo.
帕金森病（PD）是一种常见的神经退行性疾病，在美国影响着多达100万人。在这些患者中，40%至50%存在抑郁，且抑郁与患者及其家人的各种不良后果相关。尽管如此，几乎没有循证数据可用于指导临床护理。这是一项由美国国立卫生研究院资助的关于帕罗西汀、去甲替林和安慰剂的随机对照试验。它包括一个为期8周的急性期和一个为期16周的盲法延长期。本报告详细阐述了抑郁治疗对本研究急性期和延长期生活质量（QoL）及残疾状况的影响。次要结果包括复发、耐受性、安全性以及抑郁治疗对帕金森病身体功能的影响。与未改善抑郁的患者相比，改善抑郁的患者在8周时生活质量和残疾状况测量指标（PDQ - 8，P = 0.0001；SF - 36，P = 0.0001）有显著改善，并在延长期维持了这些改善。在延长期，服用活性药物的患者比服用安慰剂的患者复发可能性显著降低（P = 0.041）。尽管规模相对较小，但该试验提供了关于抑郁治疗对帕金森病生活质量和残疾状况影响的首批对照数据。这表明成功治疗帕金森病患者的抑郁会导致这些结果得到重要且持续的改善，并且在抗抑郁药治疗中改善的患者比最初在安慰剂治疗中改善的患者复发可能性更低。
