Moonen A J H, Wijers A, Leentjens A F G, Christine C W, Factor S A, Juncos J, Lyness J M, Marsh L, Panisset M, Pfeiffer R, Rottenberg D, Serrano Ramos C, Shulman L, Singer C, Slevin J, McDonald W, Auinger P, Richard I H
Department of Psychiatry, Maastricht University, Maastricht, The Netherlands.
Department of Psychiatry, Maastricht University, Maastricht, The Netherlands.
Parkinsonism Relat Disord. 2014 Jun;20(6):644-6. doi: 10.1016/j.parkreldis.2014.02.025. Epub 2014 Mar 18.
Antidepressants have appeared to be more effective than placebo treatment in treating depressive syndromes in patients with Parkinson's disease (PD).
To identify factors that predict improvement in depressive symptoms during antidepressant treatment in depressed PD patients.
A secondary analysis was performed on the dataset of the Randomized Placebo-controlled Study of Antidepressants in PD (SAD-PD), in which 76 patients received active treatment with either paroxetine or venlafaxine extended release (XR), and 39 patients received placebo treatment. Backward stepwise regression analyses were conducted with change in 24-item Hamilton Depression Rating Scale (HAMD-24) score between assessments at baseline and week 12 as the main outcome measure, and sex, age, baseline HAMD-24 score, Unified Parkinson's Disease Rating Scale section III (UPDRS-III) score, Mini-Mental State Examination (MMSE), and the Clinical Anxiety Scale (CAS) as independent variables.
In both the active treatment and placebo groups, higher baseline HAMD-24 score and lower UPDRS-III score were associated with greater reduction in HAMD-24 score. Higher anxiety scores predicted less response in the active treatment group. Higher MMSE scores predicted greater response only in the placebo-treated group. Sex and age were no predictors of response.
Higher pre-treatment depression scores and lower pre-treatment anxiety scores are the two most important predictors for improvement during antidepressant treatment in depressed PD patients, which is in line with those found in treatment studies of depressed non-PD patients. Furthermore, our results indicate the requirement for different or more intensive treatment for depressed PD patients with more severe anxiety symptoms.
在治疗帕金森病（PD）患者的抑郁综合征方面，抗抑郁药似乎比安慰剂治疗更有效。
确定预测抑郁的帕金森病患者抗抑郁治疗期间抑郁症状改善的因素。
对帕金森病抗抑郁药随机安慰剂对照研究（SAD-PD）的数据集进行二次分析，其中76例患者接受帕罗西汀或文拉法辛缓释剂（XR）的积极治疗，39例患者接受安慰剂治疗。以基线和第12周评估之间24项汉密尔顿抑郁量表（HAMD-24）评分的变化作为主要结局指标，以性别、年龄、基线HAMD-24评分、统一帕金森病评定量表第三部分（UPDRS-III）评分、简易精神状态检查表（MMSE）和临床焦虑量表（CAS）作为自变量进行向后逐步回归分析。
在积极治疗组和安慰剂组中，较高的基线HAMD-24评分和较低的UPDRS-III评分与HAMD-24评分的更大降低相关。较高的焦虑评分预示积极治疗组的反应较小。较高的MMSE评分仅在安慰剂治疗组中预示更大的反应。性别和年龄不是反应的预测因素。
较高的治疗前抑郁评分和较低的治疗前焦虑评分是抑郁的帕金森病患者抗抑郁治疗期间改善的两个最重要预测因素，这与非帕金森病抑郁患者的治疗研究结果一致。此外，我们的结果表明，对于焦虑症状更严重的抑郁帕金森病患者，需要不同的或更强化的治疗。
