Pramipexole, Citalopram Effective Therapies for Depression in Parkinson Disease

Patients with Parkinson disease demonstrated significant reduction in depressive symptoms with citalopram and pramipexole, with pramipexole showing slightly more benefit in improving quality of life.

Citalopram and pramipexole both showed significant efficacy in reducing depressive symptoms and improving quality of life (QOL) in patients with Parkinson disease (PD), according to study findings published in Journal of Research in Medical Sciences.

Despite depression being one of the most common neuropsychiatric symptoms in PD, the researchers of the present studynote that there is little evidence to guide treatment for affected patients. Moreover, the clinical efficacy and safety of commonly prescribed antidepressant therapies, such as selective serotonin reuptake inhibitors (SSRIs), have shown conflicting results in patients with PD on whether these drugs may exacerbate parkinsonism.


“In addition to the patient suffering, [depression] is associated with cognitive decline, reduced QOL, and increased burden of caregivers,” said the study authors. “There are some lines of evidence showing that dopamine receptor agonists, especially pramipexole, might be effective in the treatment of depression in PD patients.”


They sought to compare an SSRI antidepressant, citalopram, and a dopamine agonist, pramipexole, on their effectiveness in reducing depressive symptoms in patients with PD.

An 8-week open-label parallel-group randomized trial was conducted to evaluate the 2 therapies for the management of depression in patients with PD (primary end point), as measured via the Beck Depression Inventory (BDI). Secondary outcomes were QOL and daytime sleepiness via the Parkinson’s disease summary index (PDSI), derived from the 39-item PD Questionnaire (PDQ-39) score and Epworth Sleepiness Scale (ESS), respectively.

A total of 44 patients with PD and depression (median age, 64 years; approximately 85% male) were randomly selected to receive open‑label oral citalopram tablets (n = 22) or pramipexole (n = 22). All end points were evaluated at baseline and after the 8-week trial period.

For both groups, BDI score, PDSI, and ESS significantly decreased (P < .05) throughout the study period. No statistical difference was observed for BDI or ESS between the 2 groups (P > .05); however, the PDSI score showed significant improvement in the pramipexole group compared with the citalopram group (r = 0.319; P < .0001).

“We found that pramipexole made more impact on the QOL than citalopram. It might be due to the pramipexole effects on motor symptoms that affect the PDSI as an overall single index derived from the PDQ-39,” said the study authors.

No serious adverse effects or treatment discontinuation due to the adverse effects was reported. As the study group was of small sample size and predominantly male, the researchers said findings may require additional analysis.

“Further studies with a placebo arm are required to confirm the efficacy of pramipexole compared with other antidepressants on depression and QOL (especially on motor symptoms and daily activities) in patients with PD,” they added.

Reference

Ziaei E, Ardestani PE, Chitsaz A. Comparison of pramipexole and citalopram in the treatment of depression in Parkinson’s disease: a randomized parallel‑group trial. J Res Med Sci. 2022 Jul 29;27:55. doi:10.4103/jrms.jrms_790_21