Xie, C.L., Wang, X.D., Chen, J., Lin, H.Z., Chen, Y.H., Pan, J.L., & Wang, W.W. (2015). A systematic review and meta-analysis of cognitive behavioral and psychodynamic therapy for depression in Parkinson’s disease patients. Neurological Sciences, 1-11.
Parkinson’s disease (PD) is a neurodegenerative brain disorder that progresses slowly in most people. When dopamine producing cells in the brain are damaged or do not produce enough dopamine, motor symptoms of PD appear. Non-motor symptoms, including depression, apathy, and sleep disorders are also common so that in clinical settings about a 40% of patients with PD may have a depressive disorder. Depression is a top predictor of poor quality of life in patients with PD. Depression in PD is not well understood but may be due to neurobiological vulnerability and to psychological factors. Antidepressant medications are often prescribed for depression in PD but their efficacy is questionable. Xie and colleagues argue that long term use of some antidepressants may lead to worsening of some PD motor symptoms. In this meta analysis, Xie and colleagues examine the efficacy of brief psychological interventions, including cognitive behavioral therapy (CBT) and psychodynamic psychotherapy for depressive symptoms in PD. Twelve eligible studies were included in the meta analysis representing 766 patients with a mean age of 62 years (48% men). As an interesting note, 9 of the 12 studies were conducted in China and 3 were from the US or UK. Six of the studies used CBT for depression, and the remaining used psychodynamic therapy for depression in PD patients. Control conditions were often “treatment as usual”, and varied from antidepressant medication (e.g., Citalopram), nursing care, telephone calls, or no treatment for the depression. The effects of psychological interventions compared to control conditions on depressive symptoms were large, and remained large even after removing outlier studies. Outcomes for psychodynamic psychotherapy were better than for CBT, although both interventions resulted in large effects. There were also significant positive effects of brief psychotherapies on cognitive functioning, but not on quality of life. The authors were concerned that the quality of studies was variable and that many studies demonstrated a risk of bias. Further, most studies did not report outcomes at follow up periods.
Significant depressive symptoms commonly occur in patients with Parkinson’s disease (PD). As a result, overall quality of life may be reduced in patients with PD. Medications for depression may be complicated by the neurodegenerative nature of PD – that is, effects of medications on depressive symptoms may be small and their neuro-motor side effects may be intolerable for some patients. This meta analysis by Xie and colleagues of 12 studies suggests that better research on psychotherapy for depression in PD needs to be conducted with adequate follow ups. Nevertheless, the findings suggest that brief psychological interventions may represent viable and effective alternatives for patients with PD who have a depressive disorder.