Effects Of Pramipexole And Selegiline On Depression Symptoms In Parkinson Disease With Depression

Objective:To evaluate the efficacy of pramipexole and selegiline in the treatment of depression in Parkinson disease(PD)with mild to moderate depression,and to compare the effects of pramipexole and selegiline on quality of life,using the Hamilton Depression Rating Scale and the 39-item Parkinson Disease Questionnaire(PDQ-39).Methods:A total of 88 subjects with PD and depression were enrolled from the PD Clinic or Neurology Ward,Jining NO.1 People's Hospital from June 2016 to February 2018.Subjects were randomized to receive pramipexole(n=48)or selegiline(n=40).Subjects met the criteria of Parkinson disease in China(2016 version),and scored 21 to 35 on the 24 items of the Hamilton Rating Scale for Depression(HAMD).Daily dosages were 0.75 mg for pramipexole and 5 mg for selegiline.Subjects were followed for 12 weeks.The primary outcome measure were the change in MDS-UPDRS-? score,HAMD score,and PDQ-39score from baseline to week 12.A covariance analysis was performed to compare the changes of MDS-UPDRS-? score,HAMD score,and PDQ-39 score in two groups from baseline to week 12.Pearson's correlation analysis was used to analyze the correlations of bivariate.Binary logistic regression analysis was used to evaluate the effects of drugs and sex on the improvement rates of HAMD and PDQ-39 from baseline to week 12.Results:1.Except 5 subjects who couldn't bear the side effects of pramipexole,a total of83 subjects were randomized to receive pramipexole(n=43)or selegiline(n=40).There was significant group difference in gender(male:pramipexole group n=25,selegiline group n=13;x~2=5.488,P=0.019).There were no significant group differences in other aspects.2.Covariance analysis showed that there was significant group difference in the change of MDS-UPDRS-? score from baseline to week 12(F=4.846,P=0.031),and the improvement of PD motor symptoms was more significant in pramipexole group compared to selegiline group.There was significant group difference in change of HAMD score(F=40.853,P=0.000),and pramipexole had significantly improving depression compared with selegiline.There was significant group difference in change of PDQ-39 score(F=4.600,P=0.035),and the improvement of the quality of life in PD was more significant in pramipexole group.3.There was no significant correlation between the improvement of depression symptoms and motor symptoms after treatment with pramipexole.There was a positive correlation between the change of MDS-UPDRS-? score and PDQ-39 score,The change of UPDRS-? score could explain 38.8%of the variation in PDQ-39 score,and 53.4%of the variation in PDQ-39 score could be explained by HAMD score.In the selegiline group,there was no significant correlation between changes of MDS-UPDRS-? and HAMD.There was a positive correlation between changes of MDS-UPDRS-? score and PDQ-39 in the selegiline group,the change of UPDRS-? score can explain 30.7%of the variation of PDQ-39 score.In this group,the change of PDQ-39 score is positively correlated with the change of HAMD score,29.3%of the variation of PDQ-39 score can be explained by the change of HAMD score.4.Logistic regression analysis showed that pramipexole was superior to selegiline in the treatment of depressive symptoms(Waldx~2=18.769,P=0.000),and gender had no significant effect(Waldx~2=2.393,P=0.122).The gender factors had a significant effect on the score of quality of life(Waldx~2=7.156,P=0.007).The effect of male was better than that of female.The effects of the two drugs on the score of quality of life was similar(Waldx~2=0.593,P=0.441).5.There are 8 components in PDQ-39 scale,the change of score in mental health subgroup is greater in pramipexole group compared to selegiline group over 12 weeks(t=3.823,P=0.000).6.There were little serious adverse reactions in both groups.Conclusions:1.Pramipexole has better antidepressant efficacy than selegiline,and the effect on depression scores was independent of motor improvement.2.There are little significant group difference in improving the quality of life in Parkinson disease with the two drugs.