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Parkinson's disease - Management
How should I diagnose and assess the severity of depression in people with Parkinson's disease?

  • Have a low threshold for diagnosing depression in people with Parkinson's disease.
  • Consider using a depression rating scale to screen for and assess the severity of depression.
Clarification / Additional information

Rating scales

  • Of the depression rating scales recommended in the Quality and Outcomes Framework [BMA and NHS Employers, 2008], in people with depression and Parkinson's disease:
    • The Beck Depression Inventory is the only rating scale that is useful and valid for both screening and assessing severity. However, it is not freely available, and has to be purchased commercially.
    • The Hospital Anxiety and Depression Scale is a useful instrument for screening, but not for assessing severity [Schrag et al, 2007]. It is available on most primary care computer systems.
Basis for recommendation
  • The recommendation to have a low threshold for diagnosing depression in people with Parkinson's disease is derived from the National Institute for Health and Clinical Excellence (NICE) guideline, Parkinson's disease: national clinical guideline for diagnosis and management in primary and secondary care [NICE, 2006].
  • The recommendation to consider using a depression rating scale is based on: the Quality and Outcomes Framework guidance, which recommends the use of an tool validated for use in primary care to assess severity at the outset of treatment in people newly diagnosed with depression [BMA and NHS Employers, 2008]; and a systematic review of depression rating scales in Parkinson's disease commissioned by the Movement Disorders Society, which found that all reviewed scales had some utility [Schrag et al, 2007].
    • The Quality and Outcomes Framework guidance suggests three severity measures: the Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory Second Edition (BDI-II), and the Hospital Anxiety and Depression Scale (HADS) [BMA and NHS Employers, 2008].
    • In the systematic review of depression rating scales in Parkinson's disease [Schrag et al, 2007]:
      • The BDI was the only rating scale that was found to be useful and valid for both screening and assessing severity. (The BDI is also recommended for screening in the Report of the Quality Standards Subcommittee of the American Academy of Neurology [Miyasaki et al, 2006].)
      • The HADS was found to be a useful instrument for screening, but not for assessing severity.
      • The PHQ-9 was not reviewed.

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