Antidepressant Use Associated With Impulse Control Disorder in Parkinson Disease

Serotonergic antidepressant use among patients with Parkinson Disease (PD) is temporally associated with the emergence of impulse control disorder (ICD), according to study results published in the American Journal of Geriatric Psychiatry. These findings may help physicians better tailor psychiatric care for this population.

In addition to the neurodegenerative effects of PD, many patients with this disorder develop ICD. While there is not a definitive etiology of ICD in PD, dopamine agonists have been considered the primary driver. However, few studies have explored the potential contribution of antidepressants in the development of ICD in PD. To this aim, researchers conducted a retrospective analysis of data from the Parkinson’s Progression Markers Initiative (PPMI) to determine whether initiation of antidepressants is associated with the emergence of ICD in PD.

The PPMI is a multi-center observational study that recruits individuals with early-stage (disease duration of 2 years or less) PD.  The current study obtained PPMI data in July 2023, and their primary outcome of interest was ICD hazard among those using antidepressants before and during ICD measurement relative to those not using antidepressants. The researchers used the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) to record the presence of ICD and medication logs were used to define antidepressant, dopamine agonist, monoamine oxidase B inhibitor, and amantadine use.

A total of 1045 patients were included in the analysis. On average, participants were aged 63 (SD, 9.6) years, 60.6% were men, and 7.1% were non-White. At baseline, 10% of patients had ICD and 27% developed ICD at some point during the study. Antidepressants were prescribed for 39% of patients during the study, mainly women (P =.002).

The researchers found that patients with PD who were using antidepressants were more likely to have ICD at some point during the study, relative to those not using antidepressants (39% vs 20%; χ2 =46.0; P <.001). When stratified by the temporal development of ICD in response to antidepressants, the researchers observed that initiation of new serotonergic antidepressants was significantly associated with newly emergent ICD (χ2 =370.1; P <.001). In addition, newly emergent ICD was associated with a longer period of antidepressant use (1.8 vs 1.3 years; z = -5.5; P <.001; Cohen’s d =0.15).

The researchers then conducted hazard regressions and mixed effects logistic regressions which adjusted for dopamine agonist use, amantadine, monoamine oxidase B inhibitors, bupropion, depression status, levodopa dosage, disease duration, sex, and age. In these models, antidepressant use was associated with a hazard ratio for ICD of 1.4 (95% CI, 1.0-1.8; P =.04) and increased odds of ICD development (odds ratio [OR], 1.9; 95% CI, 1.4-2.7; P <.001)

Study authors concluded, “[C]linicians making treatment decisions for patients with depression/anxiety and co-existing ICD may consider alternatives to serotonergic antidepressants like bupropion, brain stimulation techniques, psychotherapy, or other novel treatment strategies.”

The study was limited by the lack of validated clinician assessments to confirm ICD diagnoses following the QUIP, measures of hypomania/mania, and structural or functional neuroimaging correlates of ICD in PD.

This article originally appeared on Psychiatry Advisor