Objective: To assess the prevalence of antidepressant and benzodiazepine (BDZ) treatment in Parkinson’s disease (PD), to analyze treatment with respect to altered mood indication, and to identify clinical predictors associated with treatment prescription.

Background: Depressive and anxiety disorders are very common but undetected and untreated non-motor manifestations in PD [1]. Moreover, psychotropic drug prescription lacks of evidence and specific indications [2]. To date, systematic, in-depth knowledge about the use of antidepressant and BDZ in PD is still missing.

Method: A retrospective, cross-sectional longitudinal study assessed 253 idiopathic PD patients (age 65.7  9.7; 61.3% Male) with an extensive neurologic and neuropsychological battery. We gathered pharmacological treatment information. Repeated measure logistic regression was used to identify predictors of being on BDZ, antidepressant, or both. Predictors included demographics, medical history, motor and non-motor symptoms (UPDRS, NMSS, PD-CFRS, QUIP-RS, STAI-Y1 & Y2, BDI), quality of life (PDQ-8), and global cognitive scales (MMSE, MoCA).

Results: 22.3% of patients were receiving antidepressant and/or BDZ at first visit, 24.5% was reporting depressive symptoms and 33.6% anxiety. The 70.1% was under BDZ, 3.9% NaSSA, 3.9% SARI, 7.8% SNRI, 11.7% SSRI, 2.6% TCA. No relationship was found between clinical scales cut-off for state anxiety and depression and treatment allocation (Χ²= 0.22, df= 1, p= .64). Age (OR=1.19 [1.10, 1.30]), age of onset (OR=0.91 [0.85, 0.97]), PDQ-8 (OR=0.92 [0.84, 1.00]), and, with lesser extent, QUIP-RS total score (OR=1.09 [0.98, 1.21]) significantly predicted antidepressant prescription. BDZ use was ultimately predicted by dopamine agonist and levodopa medication prescription (OR=3.44 [1.26, 9.68]), (OR=10.0 [3.17, 37.3]), amantadine (OR=5.94 [1.95, 19.8]), DBS (OR=0.12 [0.01, 0.75]), age (OR=1.10 [1.02, 1.19]), age of onset (OR=0.92 [0.87, 0.99]), MoCA (OR=1.09 [1.01, 1.18]), trait-anxiety  (OR=1.07 [1.03, 1.12]), and PDQ-8 (OR=0.88 [0.82, 0.95]).

Conclusion: These results suggest that psychotropic drug prescription in PD is driven by a complex group of factors, including disease progression and severity (i.e., motor fluctuations) but not associated with mood and anxiety severity. Notably in terms of psychiatric and functioning outcome, patients treated with antidepressants report better quality of life, and reduced depression levels.

References: [1] D. Weintraub et al., “Antidepressant studies in Parkinson’s disease: A review and meta-analysis,” Mov. Disord., vol. 20, no. 9, pp. 1161–1169, Sep. 2005, doi: 10.1002/mds.20555. [2] B. S. Connolly and A. E. Lang, “Pharmacological treatment of Parkinson disease: A review,” JAMA – Journal of the American Medical Association, vol. 311, no. 16. American Medical Association, pp. 1670–1683, Apr. 23, 2014, doi: 10.1001/jama.2014.3654. This work was supported by the PD_Pal project, funded within the EU programme Horizon 2020 (GA n. 825785).

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