Psychotherapy for the Treatment of Anxiety and Depression in Patients with Parkinson Disease: A Meta-Analysis of Randomized Controlled Trials

Objective: Anxiety and depression are major psychiatric nonmotor symptoms (NMSs) of Parkinson disease (PD). Although several studies have investigated the effects of psychotherapeutic interventions, particularly cognitive-behavioral therapy (CBT), for alleviating anxiety and depression in patients with PD, the findings have been inconclusive because of the small sample size and the lack of a unified protocol for such treatments. Thus, the present meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effect of psychotherapy on PD-related anxiety and depression. Design: Systematic review and meta-analysis. Setting and Participants: Relevant RCTs were extracted from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases. This study was registered in PROSPERO under the number CRD 42020165052. Measures: The primary and secondary outcomes were changes in the anxiety score and depressive symptoms, respectively. Results: Fourteen RCTs including 507 patients with PD were analyzed. The interventions were classified as CBT and non-CBT. CBT significantly reduced anxiety at the end of the study (standardized mean difference = -0.85, 95% confidence interval = -1.12 to -0.58, P < .001, I-2 = 0%), whereas non-CBT did not. Greater heterogeneity in the effects of non-CBT treatment was observed. CBT was significantly beneficial for depression (standardized mean difference = -0.83, 95% confidence interval = -1.26 to -0.40, P < .001, I-2 = 55%). Despite the greater heterogeneity in the effects, non-CBT interventions were also effective in alleviating depressive symptoms. Conclusion and Implications: CBT is effective for the management of anxiety and depression in patients with PD. Routine treatment for patients with this condition is strongly recommended. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Automated summary

Psychotherapeutic interventions, especially cognitive-behavioral therapy, are effective in managing anxiety and depression in patients with Parkinson's disease, significantly reducing symptoms. CBT has a significant alleviating effect on anxiety and depression, while non-CBT interventions are also effective in reducing depressive symptoms.