Coping With Depression in Parkinson's Disease

Depression is the most common emotional problem found in persons with Parkinson's disease (PD). It causes immense personal suffering and is associated with increased disability and burden to caregivers. Despite the adverse consequences of depression in PD, there are virtually no studies to guide clinical treatment. Several studies are currently examining the effectiveness of antidepressant medication for depression in PD. However, there have been no studies to examine the effectiveness of non-medication approaches, such as cognitive-behavioral therapy, despite the success of these techniques in other populations. Cognitive-behavioral therapy teaches people with PD to become more aware of their thoughts and feelings and to change thinking patterns and behaviors that may be related to symptoms of depression.

The purpose of this study is to determine if cognitive-behavioral therapy--with a caregiver-focused social support intervention--is effective in treating depression in persons with PD. This study will enroll 80 people with PD and their caregivers. Forty participants with PD will be randomly chosen to receive the study treatment in addition to standard medical care. The other 40 will only receive standard medical care and will have the option to receive the study treatment after completing all study assessments (4 months after the initial evaluation).

The study treatment will consist of 10 weekly individual cognitive-behavioral treatment sessions, lasting 1 hour each and modified to meet the unique needs of each individual with PD. Caregivers will attend 4 separate educational sessions-lasting 30 minutes each--designed to provide them with the tools needed to reinforce and supplement the material presented in the cognitive-behavioral sessions. Duration of the study for participants is 15 weeks.

This is the first study to evaluate the impact of a cognitive-behavioral treatment for PD depression in a randomized controlled trial. Information gained from this study may be beneficial in treating depression in persons with PD.

Persons with PD Inclusion Criteria:

• Confirmed diagnosis of PD with no significant motor fluctuations or dementia.
• Major Depression, Dysthymia, or Depression NOS (Clinically significant depression not otherwise specified).
• 35-85 years old.
• Willingness to ask a family member or friend, with whom the patient has regular contact, to be involved in treatment.
• Patients will be allowed to remain on antidepressant medications that have been stabilized (e.g., no dose changes) for at least 6 weeks prior to screening provided that they do not have plans to change these medications while in the study.
• Patients will be allowed to remain on sedative-hypnotics or anxiolytics that have been stabilized for at least 4 weeks prior to screening. Patients who are taking these medications at screening and qualify for participation will be asked to remain on a stable course of these medications throughout the trial.
• Taking a stable dose of dopaminergic replacement therapy for at least one month

Persons with PD Exclusion Criteria:

• DSM-IV criteria for a psychotic disorder, bipolar disorder, organic brain syndrome, or psychoactive substance dependence or abuse (Nicotine or caffeine dependence is allowed). Other psychiatric co-morbidity is not exclusionary as long as the depressive disorder is primary.
• Active suicidal ideation.
• An unstable major medical condition that would interfere with the study.
• Plans to engage in additional psychotherapy during the study (PD support group is ok).
• A diagnosis of dementia, defined as above.
• Significant motor fluctuations, defined as above; mild end of dose wearing off is allowed.
• Patients unwilling or unable to maintain a stable dose of dopaminergic replacement therapy during the trial.
• Use of mood-stabilizers or antipsychotic medication.

Caregiver Inclusion Criteria:

• Ages 25 to 85
• Daily contact with a friend, family member, or spouse with depression and PD *MMSE > 26 [Mini Mental Status Exam score of greater than 26 (i.e., no signs of significant memory impairment)].

Caregiver Exclusion Criteria:

• Active suicidal ideation
• An unstable major medical or psychiatric condition
• Evidence upon clinical interview of substance abuse/dependence