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Review
. 2017 Jun;96(22):e6698.
doi: 10.1097/MD.0000000000006698.

Efficacy of antidepressive medication for depression in Parkinson disease: a network meta-analysis

Chuanjun Zhuo  1 , Rong Xue, Lanlan Luo, Feng Ji, Hongjun Tian, Hongru Qu, Xiaodong Lin, Ronghuan Jiang, Ran Tao
Affiliations
Review

Efficacy of antidepressive medication for depression in Parkinson disease: a network meta-analysis

Chuanjun Zhuo et al. Medicine (Baltimore). 2017 Jun.

Abstract

Background: Parkinson disease (PD) was considered as the 2nd most prevalent neurodegenerative disorder after Alzheimer disease, while depression is a prevailing nonmotor symptom of PD. Typically used antidepression medication includes tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), serotonin and norepinephrine reuptake inhibitors (SNRI), monoamine-oxidase inhibitors (MAOI), and dopamine agonists (DA). Our study aimed at evaluating the efficacy of antidepressive medications for depression of PD.

Methods: Web of Science, PubMed, Embase, and the Cochrane library were searched for related articles. Traditional meta-analysis and network meta-analysis (NMA) were performed with outcomes including depression score, UPDRS-II, UPDRS-III, and adverse effects. Surface under the cumulative ranking curve (SUCRA) was also performed to illustrate the rank probabilities of different medications on various outcomes. The consistency of direct and indirect evidence was also assessed by node-splitting method.

Results: Results of traditional pairwise meta-analysis were performed. Concerning depression score, significant improvement was observed in AD, MAOI, SSRI, and SNRI compared with placebo. NMA was performed and more information could be obtained. DA was illustrated to be effective over placebo concerning UPDRS-III, MAOI, and SNRI. DA demonstrated a better prognosis in UPDRS-II scores compared with placebo and MAOI. However, DA and SSRI demonstrated a significant increase in adverse effects compared with placebo. The SUCRA value was calculated to evaluate the ranking probabilities of all medications on investigated outcomes, and the consistency between direct and indirect evidences was assessed by node-splitting method.

Conclusion: SSRI had a satisfying efficacy for the depression of PD patients and could improve activities of daily living and motor function of patient but the adverse effects are unneglectable. SNRI are the safest medication with high efficacy for depression as well while other outcomes are relatively poor.

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Conflict of interest statement

Declaration of interest: There were no conflicts of interest in the conduct, analysis, and publishing of this manuscript among study authors.

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
The network of included trials.
Figure 3
Figure 3
Forest plot for depression score.
Figure 4
Figure 4
SUCRA of depression score, UPDRS-II, UPDRS-III, and adverse effect. SUCRA = surface under the cumulative ranking curve, UPDRS-II = Unified Parkinson Disease Rating Scale-Activities of daily living, UPDRS-III = Unified Parkinson Disease Rating Scale-Motor.
Figure 5
Figure 5
Clustered ranking plot of the network. The plot is based on cluster analysis of surface under the cumulative ranking curves (SUCRA) values. Each plot shows SUCRA values for 2 outcomes. Each color represents a group of treatments that belong to the same cluster. Treatments lying in the upper right corner are more effective and safe than the other treatments.
Figure 6
Figure 6
Net heat plot. The size of the gray squares indicates the contribution of the direct evidence (shown in the column) to the network evidence (shown in the row). The colors are associated with the change in inconsistency between direct and network evidence. Blue colors indicate an increase of inconsistency and warm colors indicate a decrease.
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