Effect of reboxetine on depression in Parkinson's disease patients

Background: Depression occurs frequently in patients with Parkinson's disease and appears to be associated with increased disability and reduced quality of life. Pharmacologic treatment with tricyclic antidepressants or serotonin reuptake inhibitors may produce adverse effects on cognition or motor functions in Parkinson's disease patients. The efficacy of reboxetine, a novel norepinephrine reuptake inhibitor, has been shown in major depressive disorder, with specific effects on motivation and negligible effects on psychomotor and cognitive function. Method: The effects of reboxetine on depression were investigated in 16 patients with idiopathic Parkinson's disease in an open, prospective study. Prior antidepressant medication was stopped because of lack of efficacy or intolerable side effects. Severity of depressive symptoms was assessed by the Hamilton Rating Scale for Depression, the Self-Rating Depression Scale, the Snaith-Hamilton Pleasure Scale, and the Social Adaptation Self-Evaluation Scale during the study period of 4 weeks. Results: A significant improvement in depression scores was observed after 4 weeks (z = -3.31, p < .008). In 1 subject, reboxetine treatment was discontinued because of psychotic symptoms. Seven patients experienced transient side effects, including restlessness, insomnia, and increased sweating. There were no significant changes in parkinsonian motor symptoms or dosage of levodopa. Conclusion: Reboxetine appears to be effective and well tolerated in Parkinson's disease patients receiving 4 weeks of treatment of moderate-to-severe depression. There are good theoretical and clinical reasons, including pharmacologic specificity of effects and low incidence of side effects, to consider reboxetine for treatment of depression in Parkinson's disease.