Cognitive behavioral therapy (CBT) was associated with significant improvements in depressive symptoms in patients with Parkinson disease, according to study data published in the International Journal of Geriatric Psychiatry.
Investigators conducted a randomized controlled trial to assess the efficacy of CBT combined with clinical management as treatment for depression in patients with Parkinson disease. Patients (ages 35-85 years) with Parkinson disease and depression were randomly assigned to 10 weeks of either CBT with clinical management or clinical management only. Caregivers were also involved in the trial and had daily contact with patients. CBT sessions were administered weekly, 60 to 90 minutes in length, and comprised behavioral activation, cognitive restructuring, sleep hygiene, and anxiety management. The intervention arm also provided 4 biweekly psychoeducational sessions for caregivers during the course of the study. Clinical management entailed 6 detailed interviews over the 10 study weeks. All patients continued routine clinical care during the study, regardless of treatment assignment.
As primary outcome measures, depressive symptoms were assessed with the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) subscales at baseline, midpoint (week 5), end of treatment (week 10), and at 1-month follow-up (week 14). Treatment response was defined as a “much improved” or “very much improved” response on the Clinical Global Impression-Improvement Scale.
The final study cohort comprised 41 patients in the CBT arm and 39 in the clinical management arm. The sample was 60% men and had a mean (standard deviation) age of 64.56 (10.53) years. Mean (standard deviation) Parkinson disease duration was 6.34 (5.51) years at baseline. The majority (81%) of patients met diagnostic criteria for primary major depressive disorder, and an addition 56.3% had a secondary anxiety disorder diagnosis. Among those taking antidepressant medications at baseline (54%), the mean length of time on their current regimen was 2 years. The spouse was the identified caregiver for 62% of participants.
At the end of treatment, 56% of patients in the CBT arm and 8% in the clinical management arm met criteria for treatment response (P <.0001). CBT treatment response was associated with significant improvements across all subscales of the HAMD: core mood, anxiety, somatic symptoms, and sleep. CBT responders also improved across all BDI subscales: negative attitudes towards self, performance impairment, and somatic symptoms. Compared with somatic symptoms, cognitive and behavioral clusters showed the greatest magnitude of change for both depression scales. A statistically significant interaction between CBT response and stabilized antidepressant use was observed on the somatic subscales of the HAMD and the BDI. Antidepressant use did not appear to enhance the impact of CBT on mood, negative thoughts, or behavioral symptoms.
According to these data, CBT was effective in treating several symptoms of depression in patients with Parkinson disease, particularly in the cognitive and behavioral domains. For patients with primarily somatic complaints, CBT combined with antidepressants may be most effective. Further research is necessary to parse out the optimal treatment regimen for patient subgroups within depression and Parkinson disease.
Please refer to original article for funding information and a complete list of authors’ financial disclosures.
Dobkin RD, Mann SL, Interian A, Gara MA, Menza M. Cognitive-behavioral therapy improves diverse profiles of depressive symptoms in Parkinson’s disease [published online February 4, 2019]. Int J Geriatr Psychiatry. doi: 10.1002/gps.5077