Depression is common in people with Parkinson's disease and contributes to faster physical and mental decline, but it is often overlooked and undertreated. Cognitive-behavioral therapy has shown promising results for treating depression in people with Parkinson's, yet many people don't have access to therapists who understand Parkinson's and can provide this evidence-based depression treatment.
The good news is that participating in cognitive-behavioral therapy by telephone may be effective in reducing depression symptoms for people with Parkinson's, according to a study published in the April 1, 2020, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"These results are exciting because they show that specialized therapy significantly improves depression, anxiety and quality of life in people with Parkinson's disease and also that these results last for at least six months," said study author Roseanne D. Dobkin, Ph.D., of Rutgers-Robert Wood Johnson Medical School in Piscataway, N.J., and a member of the American Academy of Neurology. "While these findings need to be replicated, they also support the promise of telemedicine to expand the reach of specialized treatment to people who live far from services or have difficulty traveling to appointments for other reasons."
The study involved 72 people with an average age of 65 who had Parkinson's disease for an average of six years and depression for nearly three years. The majority were taking antidepressants, and many were already receiving other kinds of talk therapy.
For three months, half of the people took part in weekly, one-hour sessions of cognitive-behavioral therapy by telephone, while also continuing their usual medical and mental health care. The cognitive-behavioral sessions focused on teaching new coping skills and thinking strategies individually tailored to each participant's experience with Parkinson's disease. Their care partners, such as a spouse, another family member, or a close friend, were trained to help their partner use these new skills in between sessions. After the three months were up, participants could choose to continue the sessions up to once a month for six months.
The other half of the people received their usual care, which, for many, included taking antidepressants and/or receiving other forms of talk therapy in their community.
At the beginning of the study, the participants had an average score of 21 on a measure of depression symptoms where scores of 17 to 23 indicate moderate depression. After three months of cognitive-behavioral therapy, scores for that group fell to an average of 14, which indicates mild depression. The people receiving their usual care had no change in their scores.
Six months after finishing the weekly cognitive-behavioral sessions, those participants had maintained their improvements in mood.
A total of 40% of those who engaged in cognitive-behavioral therapy met the criteria for being "much improved" in their depression symptoms, while none of the people who simply continued their usual care did.
"Depression affects up to 50% of people with Parkinson's disease and may occur intermittently throughout the course of illness. Additionally, in many instances, depression is a more significant predictor of quality life than motor disability. So easily accessible and effective depression treatments have the potential to greatly improve people's lives," Dobkin said.
A limitation of the study was that it did not include people with very advanced Parkinson's disease or those who also had dementia, so the results may not apply to them. Also, while insurance coverage for telemedicine is growing, it is not yet available in all cases or all states.
Reference: Dobkin, R. D., Mann, S. L., Gara, M. A., Interian, A., Rodriguez, K. M., & Menza, M. (2020). Telephone-based cognitive behavioral therapy for depression in Parkinson disease. Neurology, 10.1212/WNL.0000000000009292. https://doi.org/10.1212/WNL.0000000000009292
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