Département de Pharmacologie et Physiologie, Université de Montréal.
Neurodegenerative Disease Group, Montreal Neurological Institute.
Clin Neuropharmacol. 2020 May/Jun;43(3):61-65. doi: 10.1097/WNF.0000000000000384.
The treatment of Parkinson disease (PD) psychosis remains a challenge. Only a few treatments eliciting significant relief of psychotic symptoms have passed the test of randomized controlled trials.
Here, we conducted a review of the literature on the effect of antidepressants on PD psychosis. Because there is no randomized controlled trial that assessed the antipsychotic effects of antidepressants in PD, only case reports, case series, and open-label trials were available to review. Because of the scarce literature, statistical analysis could not be performed.
The following antidepressants alleviated hallucinations in PD: amoxapine, citalopram, clomipramine, escitalopram, mianserin, mirtazapine, and venlafaxine. The antidepressants were generally well tolerated, with the exception of amoxapine, which exacerbated parkinsonism.
Whereas the conclusions that can be drawn on the efficacy of antidepressants at reducing PD psychosis are limited because of the poor quality of the reported studies, it is encouraging to notice that there are positive anecdotal reports. Further studies are needed to confirm the potential of these drugs and also to determine if a subtype of patients or of psychotic features may be more likely to be improved by antidepressants.
帕金森病（PD）伴发精神症状的治疗仍然是一个挑战。仅有少数几种能够显著缓解精神症状的治疗方法通过了随机对照试验的检验。
我们对有关抗抑郁药治疗 PD 伴发精神症状的文献进行了综述。由于没有评估抗抑郁药在 PD 中抗精神病作用的随机对照试验，因此仅可查阅到病例报告、病例系列和开放标签试验。由于文献稀少，无法进行统计学分析。
以下抗抑郁药可缓解 PD 中的幻觉：阿莫沙平、西酞普兰、氯米帕明、艾司西酞普兰、米氮平、米那普仑和文拉法辛。这些抗抑郁药通常具有良好的耐受性，除了阿莫沙平会加重帕金森病。
由于所报告研究的质量较差，关于抗抑郁药降低 PD 精神症状疗效的结论有限，但令人鼓舞的是，有一些积极的传闻报告。需要进一步的研究来证实这些药物的潜力，以及确定是否某些类型的患者或精神症状特征更有可能通过抗抑郁药得到改善。
