Treating Depression in Parkinson's Disease: A New Method

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DESCRIPTION (provided by applicant): Depression, the most common psychiatric disturbance in Parkinson's disease (PD), is linked with a faster progression of physical symptoms, greater cognitive decline, and poorer quality of life. Despite the fact that untreated depression accelerates the patients' disability in numerous domains, there is currently no evidence-based standard of care. While some placebo-controlled trials have supported the use of antidepressants for depression in Parkinson's disease (dPD), conclusions have been restricted by methodological shortcomings and tolerability concerns. Similarly, non-pharmacological approaches for the treatment of dPD have received little experimental attention despite strong demonstrated efficacy in other geriatric populations. The primary aim of this K-Award is to evaluate the efficacy of a cognitive-behavioral treatment package, that includes a caregiver-focused social support intervention, for depression and other psychiatric complications in PD. The impact of four patient variables (social support, executive dysfunction, comorbid psychopathology, and motor fluctuations) on treatment response will also be explored (Aim 2). In order to plan for a future trial (Aim 3), the effect of medication use for all purposes (depression, PD, other medical conditions) on treatment outcome will be examined. The recruitment, retention and adverse event rates, and the ability to maintain the blind for this non-pharmacological treatment trial will be compared to those same rates observed in the primary mentor's current R01 examining the impact of antidepressants versus placebo on dPD (Aim 3). A total of 80 patients with PD (without significant motor fluctuations or dementia) and depression (major depression, dysthymia, depression NOS) will be randomly assigned to receive either standard medical care or the cognitive-behavioral treatment package plus standard medical care. The research plan, coupled with the training activities proposed (e.g., mentorship, formal coursework, hands-on learning experiences) will enable the candidate to broaden her knowledge base regarding 1) the brain-behavior mechanisms in PD, 2) the diagnostic complexities of PD depression, 3) the motor and non-motor symptoms, and 4) advanced research design and statistical methods pertinent to treatment outcome research in PD. These are necessary prerequisites to her long term goal- the launching of an independent patient-oriented research career focused on the non-pharmacological management of the psychiatric complications in PD. The proposed primary mentor (Matthew Menza) and the UMDNJ environment will greatly facilitate the candidate's transition from new junior faculty member to independent investigator. This is the first study to evaluate the impact of a cognitive-behavioral treatment for PD depression in a randomized controlled trial. Given the public health impact of improved depression treatment in PD, the knowledge to be gained may be significant and the project could have a direct impact on clinical practice.