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PAPERS:
Margaret Thorogood, Ben Armstrong, Tom Nichols, and Jen Hollowell
Mortality in people taking selegiline: observational study
BMJ 1998; 317: 252-254 [Abstract] [Full text]
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Joan M Barber   (11 August 1998)

Untitled 11 August 1998
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Joan M Barber

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EDITOR - In their observational study of mortality in people taking selegiline1, Thorogood et al describe antidepressant use as their only available marker of Parkinson's severity. From this, they appear to equate the presence of depression in Parkinson's disease with disease severity. While depression is regarded as the commonest concomitant psychiatric disorder in Parkinson's, opinions are divided as to whether or not it is associated with disease severity2. Gotham et al2 analysed depression in Parkinson's disease and found that higher scores on depression rating scales were significantly associated with severity of illness and functional disability. However, these associations only accounted for a small percentage of the variability in depression scores. MacCarthy et al3 carried out an observational study on the same sample of patients some years later, looking at the physical and psychological predictors of depression. They found that functional disability was the physical index which best predicted depression and it accounted for 14% of the variance in depression scores. Self-esteem and "maladaptive coping" were psychological factors which contributed a further 30% to the variance. Practical support also contributed. These findings suggest that depression in Parkinson's disease is not simply a consequence of a disabling, severe disease and therefore, antidepressant use should not be used as an index of severity at all.

Joan M Barber Senior Registrar in Old Age Psychiatry Ailsa Hospital Dalmellington Road Ayr KA5 5AB

1 Thorogood M, Armstrong B, Nichols T, Hollowell J. Mortality in people taking selegiline: observational study. BMJ 1998;317:252-4 2 Gotham A-M, Brown RG, Marsden CD. Depression in Parkinson's disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry 1986;49:381-389. 3 MacCarthy B, Brown R. Psychosocial factors in Parkinson's disease. British Journal of Clinical Psychology 1989;28:41-52.