Department of Neurological Sciences, University of Naples Federico II, Naples, Italy.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 4:S81-4. doi: 10.1016/S1353-8020(09)70841-7.
Depression is one of the most common non-motor symptoms in Parkinson's disease (PD). It is associated with a more rapid progression of physical symptoms, greater decline in cognitive skills, and a poorer quality of life. Despite the high prevalence of depression and antidepressant use in PD, validated guidelines for the treatment of PD-associated depression (dPD) are lacking. Several methodological limitations have been recognized in the available studies examining the treatment of dPD. Some studies support a relevant role of the catecholaminergic systems in the pathogenesis of dPD. In open-label studies, the dopamine receptor agonists pramipexole and pergolide have shown antidepressant effects in PD patients. A placebo-controlled study of pramipexole in dPD is ongoing. The combined results of data from animal models and evidence in human studies support the strategy of dopaminergic stimulation as a treatment of depression. Treatment strategies for depressive symptoms in PD should include optimization of dopaminergic treatment prior to the addition of classic antidepressant drugs, thus reducing the risk of side-effects associated with multi-drug therapies.
抑郁症是帕金森病（PD）中最常见的非运动症状之一。它与身体症状的更快进展、认知能力的更大下降以及生活质量的降低有关。尽管 PD 中抑郁症和抗抑郁药的使用很普遍，但缺乏针对 PD 相关抑郁症（dPD）的治疗的验证指南。在检查 dPD 治疗的现有研究中，已经认识到了一些方法学上的局限性。一些研究支持儿茶酚胺能系统在 dPD 发病机制中的重要作用。在开放标签研究中，多巴胺受体激动剂普拉克索和培高利特在 PD 患者中显示出抗抑郁作用。一项针对 dPD 的普拉克索安慰剂对照研究正在进行中。来自动物模型的数据和人类研究证据的综合结果支持多巴胺能刺激作为治疗抑郁症的策略。PD 中抑郁症状的治疗策略应包括在添加经典抗抑郁药之前优化多巴胺能治疗，从而降低与多药物治疗相关的副作用风险。
