Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA.
J Geriatr Psychiatry Neurol. 2025 Jan;38(1):13-22. doi: 10.1177/08919887241254471. Epub 2024 May 23.
Apathy, a motivational disorder, is common in Parkinson's disease (PD) and often misdiagnosed as depression. Use of selective serotonin reuptake inhibitors (SSRIs) has been associated with increased apathy in adolescents and adults with depression. Based on observations that serotonin may downregulate dopaminergic systems, we examined the relationship between apathy and SSRI use in individuals with PD.
Medications, mood/motivation scales, and clinical data were collected from a convenience sample of 400 individuals with PD. Depression and apathy were measured using the Beck Depression Inventory-II (BDI-Il) and the Apathy Scale (AS). Antidepressant medications were grouped by mechanism type.
Of the 400 PD patients, 26% were on SSRIs. On standard mood/motivation scales, 38% of the sample exceeded clinical cut-offs for apathy and 28% for depression. Results of hierarchical regression analyses revealed that SSRIs were the only antidepressant that were significantly associated with higher apathy scores (β = .1, = .02). Less education (β = -.1, = .01) worse cognition (β = -.1, = .01), and greater depressive symptoms (β = .5, < .001) were also significant predictors of apathy.
These findings suggest that use of SSRIs, but not other antidepressants, is associated with greater apathy in PD. Given the interactive relationship between serotonin and dopamine, the current findings highlight the importance of considering apathy when determining which antidepressants to prescribe to individuals with PD. Similarly, switching a SSRI for an alternative antidepressant in individuals with PD who are apathetic may be a potential treatment for apathy that needs further study.
冷漠是一种动力障碍，在帕金森病（PD）中很常见，且常被误诊为抑郁症。选择性 5-羟色胺再摄取抑制剂（SSRIs）的使用与青少年和成人抑郁症患者的冷漠增加有关。基于观察到 5-羟色胺可能下调多巴胺能系统，我们研究了 PD 患者中冷漠与 SSRI 使用之间的关系。
从 400 名 PD 患者的便利样本中收集了药物、情绪/动机量表和临床数据。使用贝克抑郁量表第二版（BDI-II）和冷漠量表（AS）测量抑郁和冷漠。抗抑郁药物按作用机制类型分组。
在 400 名 PD 患者中，26%的患者服用 SSRIs。在标准情绪/动机量表上，38%的样本超过冷漠的临床截止值，28%的样本超过抑郁的临床截止值。层次回归分析的结果表明，SSRIs 是唯一与更高冷漠评分显著相关的抗抑郁药（β=0.1，p=0.02）。受教育程度较低（β=-0.1，p=0.01）、认知能力较差（β=-0.1，p=0.01）和抑郁症状更严重（β=0.5，p<0.001）也是冷漠的显著预测因素。
这些发现表明，SSRIs 的使用，而不是其他抗抑郁药，与 PD 中的冷漠增加有关。鉴于 5-羟色胺和多巴胺之间的相互关系，目前的研究结果强调了在确定为 PD 患者开哪种抗抑郁药时考虑冷漠的重要性。同样，对于冷漠的 PD 患者，将 SSRI 换成另一种抗抑郁药可能是治疗冷漠的一种潜在治疗方法，需要进一步研究。
