Table 3.

Statements & recommendations for Parkinson’s disease

Anxiety
Evidence for the Management & Treatment of Anxiety in PD is Lacking.
Level of Evidence	AAN Level U (Uncertain or Lack of Evidence)
Guidelines	Zesiewicz et al. (2010) [35], Grimes et al. (2012) [34]
Depression
Screening for Depression in PD is recommended.
Level of Evidence	EFNS Level A (Effective), SIGN Grade C (Case Control to Cohort Evidence)
Guidelines	Berardelli et al. (2013) [38], Grosset et al. (2010) [54]
There are several available tools screening for Depression in PD.
Level of Evidence	SIGN Level C & Good Practice Point (GDS, BDI, HADS, MADRS & HDRS) & EFNS Class I (Diagnostic Accuracy Study)(MDS-UPDRS)
Guidelines	Grosset et al. (2010) [54], Berardelli et al. (2013) [38]
Comment	A patient with PD should be screened for depression with either a clinician or self-rated tool. Diagnosis should not be based on the solely on the tool. Those with a positive screening test should be referred for further assessment and diagnosis (including collateral history).
Practitioners should have a low threshold for diagnosing Depression in PD.
Level of Evidence	CFNS Good Practice Point
Guidelines	Grimes et al. (2012) [34]
Treatment of Depression in PD needs to be individualized to each case.
Level of Evidence	CFNS Good Practice Point
Guidelines	Grimes et al. (2012) [34]
Anti-depressant Therapy is recommended; there is little evidence to suggest one agent over another.
Guidelines	Gelenberg et al. (2010) [39], Grosset et al. (2010) [54]
Tricyclic Antidepressants (e.g. Amitriptyline or Desipramine) have some evidence for treatment, but this must be balanced with the adverse effects (e.g. Anticholinergic).
Level of Evidence	CFNS Level C (Possibly Effective)
Guidelines	Grimes et al. (2012) [34], Grosset et al. (2010) [54], Gelenberg et al. (2010) [39]
Selective Serotonin Reuptake Inhibitors have some evidence for treatment, but this must be balanced with the adverse effects (e.g. RLS, PLM, RBD).
Level of Evidence	EFNS Class II (Prospective Matched Group Cohort or Controlled Trial) to Class IV (Uncontrolled Studies), APA Level II (Moderate Clinical Evidence)
Guidelines	Ferreira et al. (2013) [40], Gelenberg et al. (2010) [39]
Certain agents such as Amoxapine or Lithium should be avoided due to worsening of PD Symptoms.
Guidelines	Gelenberg et al. (2010) [39]
There is some evidence for the use of dopamine agonists (e.g. Pramipexole) & MAOI (e.g. Selegiline) for depression, but not for levodopa.
Level of Evidence	EFNS Class I (RCT), Class III (Other Controlled Trial), APA Level I (Recommended with substantial confidence)
Guidelines	Ferreira et al. (2013) [40], Gelenberg et al. (2010) [39], Grimes et al. (2012) [34]
There is insufficient evidence regarding the use of ECT, TCMS and psychotherapy in depression with PD.
Guidelines	Ferreira et al. (2013) [40], Gelenberg et al. (2010) [39], Grimes et al. (2012) [34]