α2-adrenoreceptor antagonism and serotonin reuptake inhibition in patients with Parkinson disease and depression

Our objective was to evaluate the antidepressive effect of combined treatment with a serotonin reuptake inhibitor and an alpha (2)-adrenoreceptor antagonist in patients with Parkinson disease (PD) and depression. Patients were treated with citalopram and mianserin in an 8-week, open-label trial. Outcome variables were the Melancholia Scale (MES), the Montgomery & Asberg Depression Rating Scale (MADRS), and Clinical Global Impression of change (CGI). Twelve subjects were included, and 11 (92%) completed the 8-week study. The MES score improved from 19.2 (9.0) to 6.1 (5.2) (P < 0.005). This improvement was significantly more pronounced than that found in a recent study of citalopram alone in depressed PD patients (P < 0.005). Eleven subjects (92%) had at least 50% reduction of the MADRS score, and six subjects (55%) were rated as "markedly improved" or "very much improved" (CGI) after 8 weeks. A slight worsening of parkinsonism was observed in four subjects. Side-effects were mild, and most common were dry mouth, salivation, orthostatic dizziness, and sedation. No patients withdrew due to side-effects. In conclusion, the combined treatment with a serotonin reuptake inhibitor and an alpha (2)-adrenoreceptor antagonist is useful for patients with PD and depression, and this combination seems to be more effective than citalopram alone.