Friday, January 5, 2024

Certain Antidepressants May Increase Risk of Impulse Control Disorder in Parkinson’s Patients

Taking serotonergic antidepressants such as serotonin and norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs) may increase the risk of patients with Parkinson’s disease developing impulse control disorder, a study in The American Journal of Geriatric Psychiatry has found.

Impulse control disorders—which include a range of behaviors such as excessive gambling, spending, cleaning, and eating—are one of “the most challenging psychiatric syndromes” affecting people living with Parkinson’s disease, wrote Christopher B. Morrow, M.D., M.H.S., of the Johns Hopkins University School of Medicine and colleagues.

Morrow and colleagues examined data from 1,045 individuals (mean age, 63 years) who were participating in the Parkinson’s Progression Markers Initiative (PPMI). The researchers ascertained the presence of impulse control disorder via the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP). Antidepressant use was defined based on medication logs for each participant. Depressive symptoms were captured using the Geriatric Depression Scale. Participants were in the PPMI study for a mean of 7.2 years and had a mean of 7.4 visits during the study period. Data for the current study were collected between July 2010 and June 2023.

Impulse control disorder was present in 10% of participants at visit one and in 27% of participants at some point during the study. In addition, 39% of participants were prescribed an antidepressant during the study.

Patients who took serotonergic antidepressants had a 40% greater risk of having impulse control disorder compared with those who did not take antidepressants. Dopamine agonist use, depression, disease duration, and male sex were also associated with an increased probability of impulse control disorder. The findings also suggest that bupropion, which is not serotonergic, was not associated with an increased risk of impulse control disorder. However, the researchers noted that there were relatively few participants taking bupropion prior to assessments for impulse control disorder compared with those taking serotonergic antidepressants (4% versus 21%), so it is possible their analysis was underpowered to detect the true relationship between impulse control disorder and bupropion.

Morrow and colleagues noted that while one strength of the study is that the data are “from a large, geographically diverse, longitudinal dataset,” there are several limitations to consider, including the use QUIP to define impulse control disorder (they wrote, “a definitive diagnosis of ICD requires a more detailed clinical assessment than the QUIP provides”).

“[C]linicians making treatment decisions for patients with depression/anxiety and co-existing [impulse control disorder] may consider alternatives to serotonergic antidepressants like bupropion, brain stimulation techniques, psychotherapy, or other novel treatment strategies,” the researchers wrote. “Prospective studies are ultimately needed to expand upon our findings, confirm a causal link between antidepressant use and [impulse control disorder], and clarify the neurobiological changes giving rise to these symptoms.”

For related information, see The American Journal of Psychiatry article “Impulse Control Disorders in Parkinson’s Disease.”

(Image: Getty Images/iStock/koto_feja)

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