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Depression in Parkinson's Disease:
Pharmacists' Key Role in Improving Outcomes

Introduction

Parkinson's Disease (PD) is a chronic, progressive, neurodegenerative disorder. As the disease progresses, patients struggle to maintain the balance between the positive and negative effects of pharmacotherapy; as a result, depression is common in patients with PD. The following 2 case studies review some of the challenges a pharmacist can face as they interact with patients with PD and depression.

Case 1: RP

Initial Patient Presentation/History

RP is a 57-year-old man who was diagnosed with PD 6 months ago. His presenting symptoms were a tremor, greater in his left hand than the right, and some slowness of movement. He was initially started on ropinirole 0.25 mg by mouth (PO) 3 times per day (TID) titrated to 1 mg PO TID over a month. He is taking no other medications. His symptoms have improved dramatically on this therapy; however, some tremor is still visible in his left hand. He presents to the community pharmacy where you work for a 3-month refill of his ropinirole.

Today, he seems subdued and doesn't seem as energetic as usual. In a conversation with RP, he tells you that he doesn't feel he will ever be "normal" again, and that he feels he is having trouble keeping up with his sales job. This conversation concerns you enough that you ask him to complete the Patient Health Questionnaire-9 (PHQ-9) (Figure 1).1

Figure 1: Patient Health Questionnaire
Click for large image.
SAMHSA-HRSA Center for Integrated Health Solutions Web site. Accessed October 15, 2015.1

When he returns it, you evaluate his answers using the corresponding PHQ-9 rating scale (Table 1)1.

Table 1. Patient Health Questionnaire Rating Scale
Total Score Depression Severity
1–4 Minimal depression
5–9 Mild depression
10–14 Moderate depression
15–19 Moderately severe depression
20–27 Severe depression
SAMHSA-HRSA Center for Integrated Health Solutions Web site. Accessed October 15, 2015.1

 He has an overall score of 11:

  • Question 1.         Little interest or pleasure in doing things (Score: 2)
  • Question 2.         Feeling down, depressed, or hopeless (Score: 2)
  • Question 4.         Feeling tired or having little energy (Score: 2)
  • Question 6.         Feeling bad about yourself—or that you are a failure or have let yourself or your family down (Score: 2)
  • Question 8.         Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless
  • Question 8.         that that you have been moving around a lot more than usual (Score: 3)

For Question 10, he has indicated that these problems have made his functioning very difficult.

Proceed