Efficacy and safety of newer-generation antidepressants medications in Parkinson's disease with depression - A meta-analysis of randomized controllde trials

Abstract

Background

Depression is common as non-motor symptom in Parkinson's disease (PD). Evidence of antidepressants for PD with depression remain unclear. This meta-analysis examines the efficacy and tolerability of newer-generation antidepressants for PD with depression.

Methods

Six international electronic databases (Cochrane, PubMed, Embase, Web of Science, CINAHL, and PsycINFO) and four Chinese electronic databases (CBM, CNKI, WanFang Data, and VIP) were systematically searched up to October 31, 2023. The primary outcomes were efficacy (change in depressive symptoms) and tolerability (all-cause discontinuations). Secondary outcomes contained improvement in motor symptoms, change score of anxiety rating scales, improvement in cognitive function, and adverse events. This study was registered with PROSPERO, number CRD42020198364.

Result

A total of 11 trials with 713 participants were included. Newer-generation antidepressants significantly improved depressive symptoms (standardized mean differences (SMD) = −1.12 [−1.72; −0.52]), anxiety scores (SMD = −0.60 [−1.04; −0.17]). However, there was insufficient evidence in improving motor function in PD (SMD = −1.19 [−2.74; 0.36]) and the cognitive function (SMD = 0.57 [−0.33; 1.47]). Newer-generation antidepressants were associated with increased diminished sexual desire (RR = 2.34 [1.13; 4.86]) and insomnia (RR = 0.42 [0.22; 0.82]), but similar risk of all-cause discontinuations when compared with the control group (RR = 1.25 [0.85; 1.85]).

Conclusion

Newer-generation antidepressants appear to be beneficial and safe in treating depression in PD.