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Abstract：
BACKGROUND: Although antidepressants are widely used in Parkinson\'s disease (PD), few well-designed studies to support their efficacy have been conducted.
METHODS: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey.
CONCLUSIONS: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants.
METHODS: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey.
CONCLUSIONS: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants.
摘要：
背景：虽然抗抑郁药广泛用于帕金森病（PD），很少有精心设计的研究来支持其疗效。
方法：这些临床指南是基于文献综述和AMN运动障碍研究组调查的结果。
结论：证据表明去甲替林，文拉法辛,帕罗西汀,西酞普兰可用于治疗PD中的抑郁症，尽管帕罗西汀和西酞普兰的研究结果相互矛盾。在临床实践中,然而,选择性5-羟色胺再摄取抑制剂通常被认为是治疗的选择.度洛西汀可能是文拉法辛的替代品，尽管这方面的证据较少，文拉法辛加米氮平可能对耐药病例有用。此外，西酞普兰可用于治疗焦虑症，托莫西汀用于失眠症，曲唑酮和米氮平治疗失眠和精神病，安非他酮治疗冷漠.总的来说,抗抑郁药在PD中耐受性良好。然而,临床医生应考虑三环类抗抑郁药的抗胆碱能作用，5-羟色胺-去甲肾上腺素再摄取抑制剂对血压的影响，抗抑郁药的锥体外系作用，以及单胺氧化酶B抑制剂和其他抗抑郁药之间的任何潜在相互作用。
方法：这些临床指南是基于文献综述和AMN运动障碍研究组调查的结果。
结论：证据表明去甲替林，文拉法辛,帕罗西汀,西酞普兰可用于治疗PD中的抑郁症，尽管帕罗西汀和西酞普兰的研究结果相互矛盾。在临床实践中,然而,选择性5-羟色胺再摄取抑制剂通常被认为是治疗的选择.度洛西汀可能是文拉法辛的替代品，尽管这方面的证据较少，文拉法辛加米氮平可能对耐药病例有用。此外，西酞普兰可用于治疗焦虑症，托莫西汀用于失眠症，曲唑酮和米氮平治疗失眠和精神病，安非他酮治疗冷漠.总的来说,抗抑郁药在PD中耐受性良好。然而,临床医生应考虑三环类抗抑郁药的抗胆碱能作用，5-羟色胺-去甲肾上腺素再摄取抑制剂对血压的影响，抗抑郁药的锥体外系作用，以及单胺氧化酶B抑制剂和其他抗抑郁药之间的任何潜在相互作用。
