A hot topic in the Parkinson’s community is whether it is safe to take antidepressants when you have depression and Parkinson’s disease (PD). And if so, what is the best antidepressant to take. There is no single answer.
Depression is a mood disorder that affects more than half of those with Parkinson’s.1,2 Its symptoms can affect the way you feel and think, and cause changes to your regular patterns of sleeping and eating, as well as your ability to go to work and interact with friends and family. There are different types of depressive disorders and the symptoms can vary.2
Depression can be diagnosed by a physician and can generally be effectively treated with talk therapy and medications. The treatment approach is very individual based on the symptoms you are experiencing, other medications you take, and your personal medical history along with Parkinson’s stage. No one drug is effective for everyone, and it may take trying several before finding the one or combination that works best for you. It is important to carefully follow the prescribed instructions when taking antidepressants and report any side effects to your physician.
Signs of depression
Neurotransmitters are brain chemicals associated with depression. They include serotonin, norepinephrine, and dopamine – the loss of which is closely associated with causing the motor disturbances in Parkinson’s.1,2 Parkinson’s depression can affect you and your family or caregivers.3 If not properly managed it can lead to decreased mobility, disease progression, an onset of cognitive impairment, treatment, and a poorer quality of life.
Classes of antidepressants1,4,5
Selective serotonin reuptake inhibitors (SSRIs) – Often the first medications tried because they have fewer side effects than other drugs, it works by blocking the reabsorption of serotonin back into the cell, thereby raising the levels in the brain that control your mood. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) – A newer class of antidepressant, these block the reabsorption of both serotonin and norepinephrine thereby increasing the brain levels of the neurotransmitters that affect mood and respond to stress. Examples of SNRIs include Duloxetine (Cymbalta) and Venlafaxine (Efexor).
Tricyclic antidepressants – One of the original classes of anti-depressant drugs, first used in the 1950s, these are very effective but have significant side effects. Side effects include blurred vision, constipation, dry mouth, and others. They are generally prescribed only after other medications have not been effective. Examples of tricyclic antidepressants include Amitriptyline and Doxepin.
Monoamine oxidase inhibitors (MAOIs) – Severe side effects are associated with MAOIs and taking them requires a strict diet because of very severe consequences from food interactions. So they are generally prescribed only after other classes of antidepressants have failed to effectively treat depression. Examples include Parnate and Nardil.
Atypical antidepressants – Atypical antidepressants don’t fit neatly into any other class. They alter brain chemistry by impacting neurotransmitter levels that work in different ways. Examples include Wellbutrin and Remeron.
How to take antidepressants
Your doctor will prescribe an antidepressant that he or she thinks is a good medication to treat your symptoms. It can take time, usually two to four weeks, for an antidepressant to become effective, so be sure to follow instructions carefully. The different classes of antidepressants work differently and have varied side effects, so it may take several tries to find the right medication and dosage to manage your symptoms.6 Do not stop taking the medication without speaking to your medical team. In some cases, antidepressants lose their effectiveness over time so be sure to discuss with your doctor if you begin to experience symptoms that have been previously managed by your medication.
Some people have concerns about the interaction of antidepressants on their Parkinson’s medications, especially the proper absorption of Levodopa. In the past, they were thought to have the potential to make motor symptoms worse. It has been demonstrated that the medications have been well tolerated.7 Research is being directed to help physicians determine the optimal approach to treatment, to have tools to predict who will respond to antidepressants, and which kind.
Seeking treatment may be a hurdle for some, but effective treatment is obtainable for most. In fact, some studies suggest that antidepressants may have neuroprotective benefits. Newer classes of antidepressants, which have fewer side effects, are generally considered preferable for people with Parkinson’s. SNRIs appear to be the safest medication for people with PD and depression, resulting in the fewest side effects, yet not always managing all PD symptoms.5,7 SSRIs are effective for treating PD depression and have also been demonstrated to have positive effects on motor ability and activities of daily living, yet those can have significant side effects.8
Poor adherence to the antidepressant regimen can be a symptom of depression and Parkinson’s. When someone feels blue, is in pain, or is feeling depressed, they may be less likely to make the effort to follow their medication regimen. This is the time, however, when it is most important to be vigilant about your routine.9 Low compliance is related to increased mortality rates in people with PD. Remember, the most important step in medication treatment is to take medications as prescribed. Do not adjust your dosages or stop taking medications without first consulting your physician.
Depression. Parkinson’s Foundation. Available at: https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Depression. Accessed 11.8.18
Depression: Overview and Its Role in Parkinson's Disease. The Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9379-depression-overview-and-its-role-in-parkinsons-disease. Accessed 11.8.18
The anti-depressing research of antidepressants. Available at: https://scienceofparkinsons.com/tag/ssris/. Accessed 11.8.18
Antidepressants: Selecting one that's right for you. The Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273. Accessed 11.8.18
Richard IH, Mcdermott MP, Kurlan R, et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease. Neurology. 2012;78(16):1229-36. Accessed 11.7.18
Depression. National Institute of Mental Health. Available at: https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed 11.7.18
Commonly Used Drugs Improve Depression in People with PD. Available at: https://www.michaeljfox.org/foundation/publication-detail.html?id=105. Accessed 11.7.18
Zhuo C, Xue R, Luo L, et al. Efficacy of antidepressive medication for depression in Parkinson disease: a network meta-analysis. Medicine (Baltimore).2017;96(22):e6698. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459691/. Accessed 11.6.18
Mumal, I. Doctors Should Ensure that PD Patients Adhere to Antidepressants, Study Suggests. Available at: https://parkinsonsnewstoday.com/2017/09/25/parkinson-disease-patients-with-low-antidepressants-adherence-have-increased-mortality-risk-study-finds/. Accessed 11.7.18