Diagnosis of Depression in Parkinson's Disease
Bernard Ravina, MD, Emmeline Edwards, Ph.D., & Paul Sheehy, Ph.D. NINDS
December 4-5, 2003
Hotel Sofitel, Washington DC
A conference to address diagnostic issues related to depression in PD was held on December 4 and 5, 2003 in Washington DC. The conference, was sponsored by the National Institute of Neurological Diseases and Stroke (NINDS) with participation from the National Institute of Mental Health (NIMH), and was organized and moderated by Dr. Bernard Ravina of NINDS. One of the goals of the conference was to determine whether or not current diagnostic criteria for depression, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth addition (DSM-IV), are adequate to effectively diagnose depression in PD. Another goal was to determine if currently available depression rating scales are adequate for use in PD. A fundamental question that was debated is whether or not depression in PD is different than depression in non-PD patients. The conference did not yield definitive answers, but resolved some issues and framed the approach necessary to advance our knowledge of depression in PD and, ultimately, to alleviate suffering in affected patients and their loved ones. The participants in the meeting included psychiatrists, psychologists, neurologists and a statistician, who all brought vast and diverse experience to the table. There were formal presentations and lively discussions. The presentations included overviews of the clinical characteristics, causes and classification/measurement of depression in PD. Several participants reviewed research studies in which currently available diagnostic criteria and depression rating scales were used in PD populations.
An Overview of Depression in PD
Studies indicate that almost half of all PD patients will experience depression at some point in their illness. Depression is different from normal sadness that everyone experiences on occasion. Depression is an illness characterized by sad mood and/or diminished ability to enjoy things accompanied by other symptoms such as changes in appetite, problems sleeping or excessive sleepiness, decreased energy level, slowed movements and poor concentration. At times, patients can have recurrent thoughts of death or that life is not worth living. Depression is generally diagnosed when these symptoms have been present every day for at least two weeks. It has been shown that depression in PD is a leading factor contributing to reduced quality of life (more so than the motor features). Most research suggests that depression in PD is caused by biological changes related to the underlying brain disease, rather than solely a reaction to disability.
The Difficulties Associated with Diagnosing Depression in PD
It can sometimes be difficult to make a diagnosis of depression in the setting of PD. This is, in part, because many symptoms of depression (e.g. slowed movements, sleep disturbances) may also be seen in non-depressed PD patients. It is also not clear how closely depression in PD resembles depression seen in non-PD patients. Furthermore, there are some aspects of PD that must be kept in mind when attempting to evaluate depression in PD. For example, many patients with PD who have fluctuations in their motor function also have fluctuations in their mood. These individuals may look and act very differently depending on their motor and mood state.
The reasons for ensuring diagnostic accuracy include the following:
Last updated March 23, 2011