Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte-Anne, Paris, France.
J Affect Disord. 2012 Jul;139(2):103-12. doi: 10.1016/j.jad.2011.07.002. Epub 2011 Jul 26.
Clinical lore and research have suggested for a long time that depression and PD are closely related. We examined the validity of depression associated with PD (dPD) as a specific subtype of depression according to face validity, descriptive validity, construct validity and predictive validity.
The English literature was reviewed after searching the MEDLINE database up to June 2010.
There appears to be three possible subtypes of comorbid depression: 1) patients who would have been depressed even if they had no PD (nonspecific-casual comorbid dPD), 2) patients who would have been depressed if they had had another disabling medical illness (nonspecific-reactive comorbid dPD) 3) those for which depression is directly related to the underlying pathophysiology of PD (specific comorbid dPD). These latter patients may more often present with particular clinical characteristics (descriptive validity): absence of history of depression or only within 5 years prior to onset of PD, absence of guilty thoughts and self-blame, absence of suicidal behavior, right-sided onset. However, dPD is only partly responsive to dopamine replacement and cannot be solely explained by dopamine deficiency. Other neurotransmitter systems are affected in PD and are involved in the pathophysiology of dPD. Their relative involvement however may differ from that in idiopathic depression (i.e.: lesser involvement of serotonergic systems).
Therapeutic data are limited to few controlled trials.
Further research may allow differential diagnosis between dPD subtypes (i.e.: those who do and do not result from the underlying pathophysiological process of PD) and help inform treatment choice.
长期以来，临床经验和研究表明抑郁和 PD 密切相关。我们根据表面效度、描述性效度、构念效度和预测效度来检验与 PD 相关的抑郁（dPD）作为一种特定抑郁亚型的有效性。
在 2010 年 6 月之前检索 MEDLINE 数据库后，对英文文献进行了综述。
共存在三种可能的共病性抑郁亚型：1）即使没有 PD，患者也会出现抑郁（非特异性-偶然共病性 dPD）；2）如果患者患有另一种致残性疾病，患者也会出现抑郁（非特异性-反应性共病性 dPD）；3）抑郁与 PD 的潜在病理生理学直接相关（特异性共病性 dPD）。这些患者可能更多地表现出特定的临床特征（描述性有效性）：没有抑郁史或仅在 PD 发病前 5 年内有抑郁史，没有内疚感和自责感，没有自杀行为，右侧起病。然而，dPD 仅部分对多巴胺替代治疗有反应，不能仅用多巴胺缺乏来解释。其他神经递质系统在 PD 中受到影响，并参与 dPD 的病理生理学。然而，它们的相对参与可能与特发性抑郁不同（即：血清素能系统的参与程度较低）。
治疗数据仅限于少数对照试验。
进一步的研究可能允许对 dPD 亚型进行鉴别诊断（即：那些是否源于 PD 的潜在病理生理过程），并有助于指导治疗选择。
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