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Depression is the most common non-motor symptom (NMS) of Parkinson's disease, with an incidence of about 40%
.
Depression in Parkinson's disease peaks in the early stages of Parkinson's disease, with clinical manifestations of persistent low mood, difficulty concentrating, and reduced interest in work and life
.
Long-term depression can aggravate the motor symptoms of Parkinson's disease, form a vicious circle, seriously affect the quality of life of patients, and increase the family and socioeconomic burden
.
In order to standardize the diagnosis system of depression in Parkinson's disease and improve clinical efficacy, domestic experts in the field have compiled guidelines for the diagnosis and treatment of depression in Parkinson's disease for reference
.
Diagnostic criteria There is no specific diagnostic criteria for Parkinson's disease depression
.
➤Diagnostic criteria for depression: 5 or more of the following symptoms within 2 consecutive weeks, and changes in original function, including at least 1 item of 1 or 2, excluding delusions that are obviously due to general somatic symptoms or coordination with mood or hallucinations
.
1.
Depressed mood, subjective feelings of sadness or emptiness, or tears observed by others, almost every day most of the day, children and adolescents can be irritable
.
2.
Significantly reduced interest or pleasure in all or nearly all activities (subjective experience or observation by others) for most of the day, almost every day
.
3.
Not dieting but with significant weight loss or significant weight gain (>5% weight change within 1 month), or loss of appetite or increase almost every day, children should be considered unexpected weight gain
.
4.
Insomnia or increased sleepiness almost every day
.
5.
Psychomotor agitation or retardation (subjectively felt and observed by others) of psychomotor agitation or retardation almost daily
.
6.
Feeling tired almost every day
.
7.
Feeling useless almost every day, or having inappropriate or excessive guilt (up to the level of guilt delusions, not just self-blame or guilt for being sick)
.
8.
Decreased thinking ability or ability to concentrate almost every day, or indecision (subjective experience or observation by others)
.
9.
(1) Repeated thoughts of death (not just fear of death), repeated suicidal thoughts without specific plans or suicide attempts or specific suicide plans
.
(2) Symptoms do not meet the criteria for bipolar disorder
.
(3) Symptoms can cause clinically significant distress or social, occupational, or other important functional impairment
.
(4) Symptoms are not caused by the direct physiological effects of a substance (eg, addictive drugs, prescription drugs) or a medical condition (eg, hypothyroidism)
.
(5) Symptoms that cannot be explained by bereavement reactions (bereavement reactions), symptoms persisting for >2 months, or symptoms characterized by marked dysfunction, morbid immersion in self-uselessness, suicidal ideation, psychotic symptoms, or psychomotor symptoms Hysteresis
.
Among them, item (1) is symptom criteria, items (2) and (4) are exclusion criteria, item (3) is pain or dysfunction criteria, and item (5) is severity criteria
.
Meets at least 5 of 9 items (must include 1 or 2) of item (1) and is diagnosed as major depression according to items (2) to (5) at the same time; meets 2 of 9 items of item (1) (must include 1) Or 2) and at the same time meet (2) to (5) to be diagnosed as mild depression
.
➤Assessment scale The neuropsychological test is a commonly used Parkinson's disease depression assessment scale in clinical and scientific work, including the Geriatric Depression Scale 15 (GDS-15), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI) ), Montgomery-Asberg Depression Rating Scale (MADRS), etc.
Among them, BDI and MADRS scales are suitable for the screening of depressive symptoms in Parkinson's disease; GDS-15 scale has good applicability and is relatively concise (15 scales).
question, 2 options for each question) and high sensitivity (81%) and specificity (91%), it is widely used in the screening of depressive symptoms in Parkinson's disease, with a score of 0-4 being normal, and a score of 5-8 being mild.
Severe depressive symptoms, 9-11 are moderate depressive symptoms, and 12-15 are severe depressive symptoms
.
Treatment principles The treatment of depression in Parkinson's disease is more complicated than that of primary depression.
Not only should the treatment be stratified according to the severity, but also comorbidities, the relationship between depression and motor symptoms, whether there is a "switch" phenomenon and other influencing factors should be paid attention to.
.
1.
Mild depression: Non-drug treatment is recommended, including psychological counseling, physical exercise, sleep guidance, participation in group or social network activities,
etc.
For patients with significant depression at the end of the dose, levodopa combined with catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors or dopamine receptor agonists can be tried
.
2.
Severe depression: The recommended drugs for the treatment of depression in Parkinson's disease are mainly pramipexole and venlafaxine
.
3.
Others: Other treatments include cognitive behavioral therapy (CBT), repetitive transcranial magnetic stimulation (rTMS),
etc.
Yimaitong compiled from: Expert consensus on the diagnosis and treatment of depression in Parkinson's disease with integrated traditional Chinese and Western medicine (2021 edition), China Journal of Modern Neurology.
2021.
21(12):1207-1215.
.
Depression in Parkinson's disease peaks in the early stages of Parkinson's disease, with clinical manifestations of persistent low mood, difficulty concentrating, and reduced interest in work and life
.
Long-term depression can aggravate the motor symptoms of Parkinson's disease, form a vicious circle, seriously affect the quality of life of patients, and increase the family and socioeconomic burden
.
In order to standardize the diagnosis system of depression in Parkinson's disease and improve clinical efficacy, domestic experts in the field have compiled guidelines for the diagnosis and treatment of depression in Parkinson's disease for reference
.
Diagnostic criteria There is no specific diagnostic criteria for Parkinson's disease depression
.
➤Diagnostic criteria for depression: 5 or more of the following symptoms within 2 consecutive weeks, and changes in original function, including at least 1 item of 1 or 2, excluding delusions that are obviously due to general somatic symptoms or coordination with mood or hallucinations
.
1.
Depressed mood, subjective feelings of sadness or emptiness, or tears observed by others, almost every day most of the day, children and adolescents can be irritable
.
2.
Significantly reduced interest or pleasure in all or nearly all activities (subjective experience or observation by others) for most of the day, almost every day
.
3.
Not dieting but with significant weight loss or significant weight gain (>5% weight change within 1 month), or loss of appetite or increase almost every day, children should be considered unexpected weight gain
.
4.
Insomnia or increased sleepiness almost every day
.
5.
Psychomotor agitation or retardation (subjectively felt and observed by others) of psychomotor agitation or retardation almost daily
.
6.
Feeling tired almost every day
.
7.
Feeling useless almost every day, or having inappropriate or excessive guilt (up to the level of guilt delusions, not just self-blame or guilt for being sick)
.
8.
Decreased thinking ability or ability to concentrate almost every day, or indecision (subjective experience or observation by others)
.
9.
(1) Repeated thoughts of death (not just fear of death), repeated suicidal thoughts without specific plans or suicide attempts or specific suicide plans
.
(2) Symptoms do not meet the criteria for bipolar disorder
.
(3) Symptoms can cause clinically significant distress or social, occupational, or other important functional impairment
.
(4) Symptoms are not caused by the direct physiological effects of a substance (eg, addictive drugs, prescription drugs) or a medical condition (eg, hypothyroidism)
.
(5) Symptoms that cannot be explained by bereavement reactions (bereavement reactions), symptoms persisting for >2 months, or symptoms characterized by marked dysfunction, morbid immersion in self-uselessness, suicidal ideation, psychotic symptoms, or psychomotor symptoms Hysteresis
.
Among them, item (1) is symptom criteria, items (2) and (4) are exclusion criteria, item (3) is pain or dysfunction criteria, and item (5) is severity criteria
.
Meets at least 5 of 9 items (must include 1 or 2) of item (1) and is diagnosed as major depression according to items (2) to (5) at the same time; meets 2 of 9 items of item (1) (must include 1) Or 2) and at the same time meet (2) to (5) to be diagnosed as mild depression
.
➤Assessment scale The neuropsychological test is a commonly used Parkinson's disease depression assessment scale in clinical and scientific work, including the Geriatric Depression Scale 15 (GDS-15), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI) ), Montgomery-Asberg Depression Rating Scale (MADRS), etc.
Among them, BDI and MADRS scales are suitable for the screening of depressive symptoms in Parkinson's disease; GDS-15 scale has good applicability and is relatively concise (15 scales).
question, 2 options for each question) and high sensitivity (81%) and specificity (91%), it is widely used in the screening of depressive symptoms in Parkinson's disease, with a score of 0-4 being normal, and a score of 5-8 being mild.
Severe depressive symptoms, 9-11 are moderate depressive symptoms, and 12-15 are severe depressive symptoms
.
Treatment principles The treatment of depression in Parkinson's disease is more complicated than that of primary depression.
Not only should the treatment be stratified according to the severity, but also comorbidities, the relationship between depression and motor symptoms, whether there is a "switch" phenomenon and other influencing factors should be paid attention to.
.
1.
Mild depression: Non-drug treatment is recommended, including psychological counseling, physical exercise, sleep guidance, participation in group or social network activities,
etc.
For patients with significant depression at the end of the dose, levodopa combined with catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors or dopamine receptor agonists can be tried
.
2.
Severe depression: The recommended drugs for the treatment of depression in Parkinson's disease are mainly pramipexole and venlafaxine
.
3.
Others: Other treatments include cognitive behavioral therapy (CBT), repetitive transcranial magnetic stimulation (rTMS),
etc.
Yimaitong compiled from: Expert consensus on the diagnosis and treatment of depression in Parkinson's disease with integrated traditional Chinese and Western medicine (2021 edition), China Journal of Modern Neurology.
2021.
21(12):1207-1215.
