Table 3. Conclusions on drugs to treat depression including depressive symptoms^a in PD.

	Efficacy	Safety	Practice implications
Dopamine agonists
Pramipexole	Efficacious	Acceptable risk without specialized monitoring	Clinically useful
Pergolide	Insufficient evidence	Acceptable risk with specialized monitoring	Not useful
TCA
Nortriptyline	Likely efficacious	Acceptable risk without specialized monitoring	Possibly useful
Desipramine	Likely efficacious	Acceptable risk without specialized monitoring	Possibly useful
Amitriptyline	Insufficient evidence	Acceptable risk without specialized monitoring	Investigationalb
SSRIs
Citalopram	Insufficient evidence	Acceptable risk without specialized monitoring	Investigationalb
Sertraline	Insufficient evidence	Acceptable risk without specialized monitoring	Investigationalb
Paroxetine	Insufficient evidence	Acceptable risk without specialized monitoring	Investigationalb
Fluoxetine	Insufficient evidence	Acceptable risk without specialized monitoring	Investigationalb
MAO-Inhibitors
Moclobemide	Insufficient evidence	Insufficient evidencec	Investigationald
Selegeline	Insufficient evidence	Acceptable risk without specialized monitoring	Investigational
Newer antidepressants
Atomoxetine	Insufficient evidence	Acceptable risk without specialized monitoring	Investigational
Nefazodone	Insufficient evidence	Unacceptable risk	Not useful
Alternative therapies
Ω-3 fatty acids	Insufficient evidence	Acceptable risk without specialized monitoring	Investigational
Nonpharmacological interventions
rTMS	Insufficient evidence	Acceptable risk without specialized monitoring	Investigational
ECT	Insufficient evidence	Insufficient evidence	Investigational

Treatments with new conclusions have gray backgrounds and italicized text, and those with no changes have white backgrounds.

^aThe clinical trials reviewed for the treatment of depression used varying inclusion criteria to define depression.

^bWhile the EBM review in 2002 (Goetz et al.⁵) referred to evidence for antidepressant efficacy in non-PD major depression as a criterion for the practical implications for clinical use also in PD, the current recommendations are based solely on evidence available from RCTs performed in PD depression.

^cCombined treatment with either TCAs or SSRIs carries an unacceptable risk.

^dCombined treatment with either TCAs or SSRIs is unacceptable.

PD, Parkinson's disease; TCA, tricyclic antidepressant; SSRI, selective serotonin reuptake inhibitor; rTMS, repetitive transcranial magnetic stimulation; ECT, electroconvulsive therapy; EBM, evidence-based medicine; RCT, randomized controlled trial; MAO-I, MAO-Inhibitors.