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J Neurol Neurosurg Psychiatry 76:i48-i52 doi:10.1136/jnnp.2004.060426

Depression in neurological disorders: Parkinson’s disease, multiple sclerosis, and stroke

  1. H Rickards
  1. Correspondence to:
 Dr Hugh Rickards
 Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2QZ, UK; hugh.rickardsbsmht.nhs.uk

    Depression is a heterogeneous group of conditions and a clinical diagnosis without external validators. Diagnosis of depression in the setting of disorders that produce psychomotor retardation and changes in vegetative function can be particularly challenging. This review aims to emphasise the importance of depressive symptoms and syndromes in the overall wellbeing of people with neurological disorders, and to equip clinicians with the practical skills to recognise and treat depression effectively.

    The evidence base for the treatment of depression in neurological disorders is inadequate. Therefore much of the advice on treatment is based on clinical consensus and experience with treatments in other settings (that is, in the treatment of idiopathic depressive syndromes). Controlled trials of treatments for depression in this setting are urgently needed.

    DEPRESSION IN PARKINSON’S DISEASE

    Diagnosis and management of depression in Parkinson’s disease (PD) is important for two main reasons: firstly, depression is common in PD (see details on prevalence below), and secondly depression causes significant morbidity in terms of quality of life, disability (measured by activities of daily living), and carer stress. This effect is independent from the effect of motor disability.

    Epidemiology

    Estimates of the prevalence of depression in Parkinson’s disease vary considerably, mostly because of differences in sampling methods and case ascertainment. Studies based on community samples appear to produce lower prevalence figures. Looking at the studies as a whole, the prevalence of depression in PD is probably between 20–45%, with the lower figures relating to community based studies. There does not appear to be a higher prevalence with either sex.

    The relation between depression and the temporal course of the motor symptoms of PD has been studied in different ways. Two well conducted studies have addressed the idea that psychiatric symptoms (particularly depression and anxiety) may precede motor symptoms of PD by a number of years (as often they …

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