Rasagiline + Antidepressants May Help with Depression in PD
the MPR take:
Approximately 35% of patients with Parkinson’s disease (PD) also have clinically significant depressive symptoms; major depression is also more prevalent in PD patients than in individuals without this disease. In a study published in JAMA Neurology, researchers aimed to determine what effect the addition of rasagiline, a monoamine oxidase B inhibitor, to antidepressant therapy would have on depression, cognition, and other nonmotor symptoms of PD. In this study, 191 PD patients already on antidepressant therapy were randomized to receive either rasagiline 1 or 2mg/day or placebo over a 36-week period. Antidepressants being taken by this group included serotonin reuptake inhibitors (76%), tricyclic antidepressants (21.4%), serotonin-norepinephrine reuptake inhibitors (0.5%), and other (8.3%). Compared with the placebo group, the rasagiline group showed significantly less worsening in depression and cognition scores as well as fatigue and daytime sleepiness; less worsening in apathy was also noted but this trend was nonsignificant. No significant differences were seen between the two groups with regards to anxiety or sleep. After controlling for improvement in motor symptoms, the effect on depression remained significant. While the labeling for rasagiline includes postmarketing information regarding nonfatal cases of serotonin syndrome in patients co-prescribed antidepressants, no serious adverse events were reported in the rasagiline group over the nine-month period. The authors conclude that combining rasagiline with antidepressant therapy may reduce worsening of nonmotor symptoms (depression, cognitive impairment) in early PD, but further research of dopamine-enhancing therapies should be explored in this patient population before it can be recommended.
Depression, cognitive impairment, and other nonmotor symptoms (NMSs) are common early in Parkinson disease (PD) and may be in part due to disease-related dopamine deficiency.