This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator. Depression is common in patients with Parkinson's disease (PD) and is a major factor negatively impacting quality of life. To date there have been no well-designed clinical trials of antidepressant pharmacotherapy for depression in PD. Selective serotonin reuptake inhibitor (SSRI) and, more recently, combined serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants are used as first-line treatment for depression. However, their efficacy and tolerability in PD have not been established and there are several important reasons why results from studies in primary psychiatric populations cannot simply be extrapolated to patients with PD. In PD, the underlying pathophysiology and somewhat atypical depressive features may result in a different antidepressant response. Furthermore, PD patients are particularly vulnerable to antidepressant-induced extrapyramidal side effects and a host of factors (including concomitant antiparkinsonian medications) that may affect the general tolerability of these agents. The proposed clinical trial has been designed to evaluate the efficacy and tolerability of paroxetine (an SSRI) and venlafaxine extended release (an SNRI) in PD patients with depression. Information regarding the effects of these medications on motor function, quality of life and cognition will also be obtained. Two hundred twenty-eight subjects will be enrolled among 16 centers and each subject will participate in the trial for 12 weeks. The trial will clarify many important questions regarding the treatment of depression in patients with PD.
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