The effects of antidepressants on the health outcomes of Parkinson's disease patients: A meta-analysis.

A meta-analysis of 44 placebo-controlled trials was conducted to examine three issues pertaining to the safety and efficacy of antidepressants in Parkinson's disease (PD). The first examined the magnitude and significance of the effects of antidepressants on depression. The second assessed whether or not antidepressants can provide salutary benefits to PD patients. Finally, the third issue was concerned with the side effect profile of antidepressants. To examine these three issues, a meta-analysis was conducted using Cohen's d as the effect size. The results show that TCAs produced a moderate antidepressant effect (d = .55, p = .01). TCAs also provided salutary benefits on motor outcomes (d = .30, p = .07), headache pain (d = 1.79, p = .00), and global psychological function (d = .81, p = .00). Although a significant effect size result was observed on adverse events (d = -.27, p = .02), they were deemed tolerable because PD patients subjectively evaluated their TCA medication positively (d = 1.02, p = .01). SSRIs produced a robust antidepressant effect on moderately depressed PD patients (d = .44, p < .05). A modestly positive and significant effect size result was observed with SSRIs on motor function (d = .34, p < .05), and there were no significant side effects (d = -.002, p = .50). These results provide evidence that SSRIs can be used to treat depression without the fear of worsening PD. Finally, selegeline did not improve depression when given at a dose where it was influencing dopamine metabolism (i.e., 10 mg daily). However, the MAO-B inhibitor did improve motor function (d = .36, p < .00), global psychological functioning (d = .21, p < .00), and health-related quality of life (d = .23, p < .00). Few effects were observed with selegeline (d = -.07, ns), especially with mortality (d = -.06, p = .10) and depression (d = .15, p = .06). All things considered, the decision to choose between antidepressant classes should be carefully considered and monitored on an individual basis, weighing (and/or ranking) the benefits of improving depressive symptomatology together with the risk of creating and tolerating side effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved)