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ARTICLES: A. G. Schuurman, M. van den Akker, K. T.J.L. Ensinck, J. F.M. Metsemakers, J. A. Knottnerus, A. F.G. Leentjens, and F. Buntinx Increased risk of Parkinson’s disease after depression: A retrospective cohort study Neurology 2002; 58: 1501-1504 [Abstract] [Full text] [PDF]

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Reply from Dr. van den Akker et al

Marjan van den Akker, A. G. Schuurman, PhD, K. T.J.L. Ensinck, MSc, J. F.M. Metsemakers, MD PhD, J. A. Knottnerus, MD PhD, A. F.G. Leentjens, MD and F. Buntinx, MD PhD   (8 July 2002)

Depression as a risk factor for Parkinson's disease?

Flemming M. Nilsson, Lars V. Kessing   (27 June 2002)

Reply from Dr. van den Akker et al 8 July 2002
Marjan van den Akker Maastricht University Hospital, Netherlands, A. G. Schuurman, PhD, K. T.J.L. Ensinck, MSc, J. F.M. Metsemakers, MD PhD, J. A. Knottnerus, MD PhD, A. F.G. Leentjens, MD and F. Buntinx, MD PhD Send Correspondence to journal: Re: Reply from Dr. van den Akker et al marjan.vandenakker{at}hag.unimaas.nl Marjan van den Akker, et al.	We thank our colleague for the comments. We were unable to cite the Nilsson study [1] as the final version of our article had already been submitted at the time of publication of this study. The advantage of a general practice or population-based study is that it precludes some of the potential biases and confounders of a hospital-based study that are described in the study by Nilsson et al. The study by Shiba et al. [2] has as a main flaw that the diagnoses of affective disorder is made by a retrospective chart review. However, it is encouraging that the main finding of an increased risk of PD after depression is replicated across different settings and methodologies. In our view, this finding should stimulate further research into the pathophysiological relationship between these two disorders. We agree with our colleague that clinicians should be aware of the increased risk of PD among patients with (history of) depression. We disagree however with the proposed clinical policy. In our opinion, it is neither justified nor feasible to screen every depressed patient for PD or other neurodegenerative disorders. The vast majority of depressed patients will not develop PD, and depression is not a prodrome that specifically increases the risk of PD; it may also predispose to a number of other diseases. If the clinical suspicion of PD arises in a depressed patient, further investigations of course are indicated. These should follow the current clinical practice. References 1. Nilsson FM, Kessing LV, Bolwig, TG. Increased risk of developing Parkinson’s Disease for patients with major affective disorder: a register study. Acta Psychiatr Scand 2001;104:380-386. 2. Shiba M, Bower JH, Maraganore DM, McDonnell SK, Peterson BJ, Ahlskog JE et al. Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study. Mov Disord 2000; 15 :669-677.
Depression as a risk factor for Parkinson's disease? 27 June 2002
Flemming M. Nilsson, MD, Research fellow Depart. of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark, Lars V. Kessing Send Correspondence to journal: Re: Depression as a risk factor for Parkinson's disease? fmn{at}dadlnet.dk Flemming M. Nilsson, et al.	We read with interest the study by Schuurman et al. [1]. The authors found a positive association between depression and the development of subsequent Parkinson’s disease (PD) in a population of patients in general practice. We are aware of two other studies that showed a similar association between depression and PD but in different populations. In the study by Shiba et al. [2], hospital records were used to demonstrate an association between preceding psychiatric disorders and PD using a case-control design. Nilsson et al conducted a case register study of hospitalized patients in Denmark [3]. After up to 17 years of observation, the risk of diagnosing PD was significantly increased for 11,741 patients with depressive disorders with a hazard ratio of 2.2 (CI 95% 1.7-2.9) compared to 81,380 patients with osteoarthritis. The duration between a diagnosis of depression and a diagnosis of PD was 5.4 years on average (std. error 0.43, and 95% CI for mean 4.5-6.2 years), in accordance with others [4]. The epidemiological association between depressive illness and PD is unclear. There are, in principle, two possibilities: 1) depressive illness and PD may be comorbid illnesses and depression followed by a free interval without affective symptoms may predict PD in some patients; or 2) depressive illness may be a part of the prodromal phase, as a precursor of the onset of PD. It is possible that depression may predict PD in some patients and be a part of the prodromal phase in others. What is the consequence? Depression could be a warning of a neurodegenerative disorder (including PD) especially in the elderly. In depressed patients with psychotic features, it is important to be aware of signs of movement disorders, since antipsychotic medicine given to these patients might provoke symptoms of possible underlying PD. We recommend examining patients with depressive symptoms and any sign of movement disorder with, for example, PET scanning of the basal ganglia. This could effectively change the setting from an antipsychotic medicine being the cause of brain damage to an early detection of PD. Early detection of PD gives the patient the advantage of earlier institution of treatment for PD [5] and a better quality of life. References: 1. Schuurman AG, Van Den AM, Ensinck KT, et al. Increased risk of Parkinson's disease after depression: A retrospective cohort study. Neurology 2002;58:1501-1504. 2. Shiba M, Bower JH, Maraganore DM, et al. Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study. Mov Disord 2000;15:669-677. 3. Nilsson FM, Kessing LV, Bolwig TG. Increased risk of developing Parkinson's disease for patients with major affective disorder: a register study. Acta Psychiatr Scand 2001;104:380-386. 4. Gonera EG, van't Hof M, Berger HJ, van Weel C, Horstink MW. Symptoms and duration of the prodromal phase in Parkinson's disease. Mov Disord 1997;12:871-876. 5. Okun MS,Watts RL. Depression associated with Parkinson's disease: Clinical features and treatment. Neurology 2002;58:S63-S70.