Objective: We aimed to investigate whether depression is associated with a higher risk of developing impulse control disorders (ICD) in Parkinson´s disease (PD) patients and in non-PD patients with pathological gambling (PG).

Background: ICD and related behaviors represent a devastating psychiatric condition in patients with PD receiving dopaminergic replacement therapy, particularly dopamine agonists (DA). Depression is also common in PD and usually precedes the onset of the first motor symptoms, representing part of the prodromal syndrome. Whether depression is associated with a higher risk of ICD is a matter of debate.

Method: This cross-sectional study included 30 patients with PD and ICD (PD+ICD), 30 patients with PD without ICD (PD-nonICD) and 30 patients with PG without PD (ICD-nonPD). All PD patients were previously exposed to DA. Demographic and clinical data were obtained by clinical records and formal interview. All 90 participants underwent a comprehensive neuropsychological evaluation including cognitive assessment, motor  and non-motor status, and measures of impulsiveness, apathy, ICD, depression, mania and anxiety.

Results: The mean age was 59,5. Hypersexuality and PG were the predominant ICD in PD+ICD group. DA dose and subtype did not significantly differed between PD+ICD and PD-nonICD patients. Past medical history of depression was higher in PD+ICD compared with PD-nonICD (36,7% vs. 10,0%; p=0,03) and in ICD-nonPD compared with PD-nonICD (53,3% vs. 10,0%; p=0,006). In a multivariate regression analysis accounting for age and DA levodopa equivalent dose, the association between depression and ICD in PD patients remained significant (OR=2,06; 95% CI=1,07-19,04). Apathy, anxiety and impulsivity were also significantly higher in PD+ICD and ICD-nonPD groups compared with PD-nonICD.

Conclusion: In this study depression was found to be higher in both ICD groups (PD+ICD and ICD-nonPD) than in PD-nonICD patients. There was a particularly high prevalence of depression in ICD-nonPD. This association could be explained by common pathophysiological features shared between depression and ICD, including dysfunction of the dopaminergic mesocorticolimbic pathway and serotoninergic circuitry. There is current evidence of some DA having a potential antidepressant effect in PD, which in the other hand could trigger ICD in depressed PD patients. Thus, DA should be used with caution in patients with PD and depression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-role-of-depression-in-the-development-of-impulse-control-disorders-in-parkinsons-disease/