***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Parkinson disease ( PD ) is a common neurodegenerative disease affecting up to 1 million individuals in the United States . Depression affects up to 50 % of these patients and is associated with a variety of poor outcomes for patients and their families . Despite this , there are few evidence -based data to guide clinical care . Methods : An NIH-funded , r and omized , controlled trial of paroxetine CR , nortriptyline , and placebo in 52 patients with PD and depression . The primary outcomes were the change in the Hamilton Depression Rating Scale ( HAM-D ) and the percentage of depression responders at 8 weeks . Results : Nortriptyline was superior to placebo for the change in HAM-D ( p < 0.002 ) ; paroxetine CR was not . There was a trend for superiority of nortriptyline over paroxetine CR at 8 weeks ( p < 0.079 ) . Response rates favored nortriptyline ( p = 0.024 ) : nortriptyline 53 % , paroxetine CR 11 % , placebo 24 % . In planned contrasts of response rates , nortriptyline was superior to paroxetine CR ( p = 0.034 ) . Nortriptyline was also superior to placebo in many of the secondary outcomes , including sleep , anxiety , and social functioning , while paroxetine CR was not . Both active drug treatments were well tolerated . Conclusions : Though relatively modest in size , this is the largest placebo-controlled trial done to date in patients with Parkinson disease ( PD ) and depression .  Nortriptyline was efficacious in the treatment of depression and paroxetine CR was not . When compared directly , nortriptyline produced significantly more responders than did paroxetine CR . The trial suggests that depression in patients with PD is responsive to treatment and raises questions about the relative efficacy of dual reuptake inhibitors and selective serotonin reuptake inhibitors . ARR = absolute risk reduction ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders , 4th edition ; HAM-A = Hamilton Anxiety Scale ; HAM-D = Hamilton Depression Rating Scale ; MMSE = Mini-Mental State Examination ; NNT = number needed to treat ; PD = Parkinson disease ; PDQ = Parkinson ’s Disease Question naire ; PSQI = Pittsburgh Sleep Quality Index ; SCID = Structured Clinical Interview ; SSRI = selective serotonin reuptake inhibitor ; TCA = tricyclic antidepressant ; UPDRS = Unified Parkinson ’s Disease Rating Scale Objective : To evaluate the effects of ropinirole on selected nonmotor symptoms of Parkinson 's disease ( PD ) , including anxiety , depressive symptoms , sleep disturbances/excessive daytime sleepiness , and sexual functions . Methods : Forty-four consecutive PD patients with or without motor complications ( MC+ group and MC− group , respectively ) ; 6-month prospect i ve study ; scales administered in the " on " motor state : Unified Parkinson 's Disease Rating Scale , Hamilton Anxiety Scale ( HAMA ) , Montgomery-Asberg Depression Rating Scale ( MADRS ) , Parkinson 's Disease Sleep Scale , Epworth Sleep Scale , International Index of Erectile Function , and Female Sexual Function Index ; serum sexual hormones collected . Results : The median ropinirole dose was 10 mg , and the median L-dopa dose was decreased in both groups . In addition to motor symptoms and motor complications improvement , both median HAMA and MADRS scores dropped significantly in MC+ group ; patients in our MC− group had little or no anxiety and depression at the baseline visit . In men , the baseline anxiety score was negatively correlated with the serum testosterone level . We did not observe any changes in the scales assessing sleep and sexual functions . Changes in Unified Parkinson 's Disease Rating Scale III scores significantly correlated with ropinirole dosage . Changes in HAMA and MADRS correlated only with changes in Parkinson 's Disease Sleep Scale scores . Conclusion : In addition to controlling motor symptoms , ropinirole improved both anxiety and depressive symptoms  in PD patients with motor fluctuations and /or dyskinesias .  Changes in mood and anxiety correlated with changes in sleep scores Background : Although face-to-face cognitive – behavioral therapy ( CBT ) was found to be beneficial for the treatment of depression in Parkinson disease ( dPD ) in a recent r and omized-controlled trial , access to care was identified as a critical issue that needs to be addressed in order to improve the management of this nonmotor complication in PD . The purpose of this study was to examine the feasibility and effect of telephone-based CBT for dPD . Methods : Twenty-one depressed people with PD participated in a National Institutes of Health – sponsored uncontrolled pilot trial of  telephone-based CBT  in an academic medical center from October 2009 to February 2011 . The Hamilton Depression Rating Scale was the primary outcome . Treatment was provided to people with PD for 10 weeks , modified for delivery over the phone , and supplemented with 4 separate phone-based caregiver educational sessions . Assessment s were completed at baseline and 5 ( midpoint ) , 10 ( end-of-treatment ) , and 14 weeks ( follow-up ) post-enrollment . Results : Twenty ( 95 % ) people with PD completed the study treatment  . Phone-based CBT was associated with significant improvements in depression , anxiety , negative thoughts , and coping . Mean Hamilton Depression Rating Scale change from baseline to week 10 was 7.91 points ( P < .001 , Cohen d = 1.21 ) . Conclusions : Telephone-based CBT may be a feasible and helpful approach for treating dPD and warrants further exploration in r and omized-controlled trials . Results were comparable to those observed in the few in-person cognitive – behavioral treatment studies for dPD conducted to date BACKGROUND Anxiety disorder and anxiety symptomatology are common in Parkinson 's disease ( PD ) , with up to 25 % patients experiencing significant worry . There is no systematic evidence base for the management of anxiety or anxiety related symptoms such as worry in PD . OBJECTIVES To investigate whether cognitive therapy , delivered as bibliotherapy , is an effective intervention for worry in PD . METHODS 54 participants were r and omly allocated to a guided reading group and a control group . The guided reading group were given a CBT based self-help re source called What ? Me Worry ! ? ! to work through over eight weeks , with telephone support at two week intervals . Controls were given information about worry only , and one phone call . Measures of worry , intolerance of uncertainty , metacognitions and health status were taken at baseline and after 3 months . RESULTS Analysable data were obtained for 15 controls and 17 from the guided reading group . Worry and intolerance of uncertainty were significantly reduced in the guided reading group . However , no significant differences were found for the follow up measures between the groups . CONCLUSIONS Bibliotherapy has the potential to be useful and cost effective as a management strategy for the treatment of worry in people with PD Parkinson 's disease ( PD ) is a common neurodegenerative disease affecting up to one million individuals in the United States . Depression is found in 40 to 50 % of these patients and is associated with a variety of poor outcomes for both patients and their families . Despite this , there are few evidence -based data to guide clinical care . This was an NIH-funded , r and omized , controlled trial of paroxetine , nortriptyline , and placebo . It included an 8 week acute phase and a 16 week blind extension phase . This report details the impact of depression treatment on quality of life ( QoL ) and disability in the acute and extension phase of this study . Secondary outcomes included relapse , tolerability , safety , and the impact of depression treatment on PD physical functioning . Patients who had improvement in depression , compared with those who did not , had significant gains in measures of QoL and disability ( PDQ-8 , P = 0.0001 ; SF-36 , P = 0.0001 ) at 8 weeks and maintained their gains in the extension phase . Patients who were on active drug were significantly less likely to relapse in the extension phase than those on placebo ( P = 0.041 ) . Though relatively modest in size , this trial provides the first controlled data on the impact of treatment of depression on QoL and disability in PD . It suggests that successfully treating depression in PD leads to important , sustained improvements in these outcomes and that patients who improve on antidepressants are less likely to relapse than are patients who initially improve on placebo BACKGROUND Depression is common in patients with Parkinson 's disease , but evidence on the efficacy of antidepressants in this population is lacking . Because depression in patients with Parkinson 's disease might be related to dopaminergic dysfunction , we aim ed to assess the efficacy of the dopamine agonist pramipexole for treatment of depressive symptoms in patients with Parkinson 's disease . METHODS We did a 12-week r and omised , double-blind , placebo-controlled ( 1:1 ratio ) trial of pramipexole ( 0.125 - 1.0 mg three times per day ) compared with placebo in patients with mild-to-moderate Parkinson 's disease . Patients from 76 centres in 12 European countries and South Africa were included if they were on stable antiparkinsonian therapy without motor fluctuations and had depressive symptoms ( 15-item geriatric depression scale score > or = 5 and unified Parkinson 's disease rating scale [ UPDRS ] part 1 depression item score > or = 2 ) . Patients were r and omly assigned by centre in blocks of four by use of a r and omisation number generating system . Clinical monitors , the principal investigator , and patients were masked to treatment allocation . The primary endpoint was change in Beck depression inventory ( BDI ) score and all treated patients who had at least one post-baseline efficacy assessment were included in the primary analysis . We also did a pre-specified path analysis with regression models to assess the relation between BDI and UPDRS part 3 ( motor score ) changes . This trial is registered with Clinical Trials.gov , number NCT00297778 , and EudraCT , number 2005 - 003788 - 22 . FINDINGS Between March , 2006 , and February , 2008 , we enrolled 323 patients . Of 296 patients r and omly assigned to pramipexole or placebo  , 287 were included in the primary analysis : 139 in the pramipexole group and 148 in the placebo group .  BDI scores decreased by an adjusted mean 5.9 ( SE 0.5 ) points in the pramipexole group and 4.0 ( 0.5 ) points in the placebo group ( difference 1.9 , 95 % CI 0.5 - 3.4 ; p=0.01 , ANCOVA ) . The UPDRS motor score decreased by an adjusted mean 4.4 ( 0.6 ) points in the pramipexole group and 2.2 ( 0.5 ) points in the placebo group ( difference 2.2 , 95 % CI 0.7 - 3.7 ; p=0.003 , ANCOVA ) . Path analysis showed the direct effect of pramipexole on depressive symptoms accounted for 80 % of total treatment effect ( p=0.04 ) . Adverse events were reported in 105 of 144 patients in the pramipexole group and 101 of 152 in the placebo group . Adverse events in the pramipexole group were consistent with the known safety profile of the drug . INTERPRETATION Pramipexole improved depressive symptoms in patients with Parkinson 's disease , mainly through a direct antidepressant effect . This effect should be considered in the clinical management of patients with Parkinson 's disease OBJECTIVE Despite the negative effects of depression in Parkinson 's disease , there is currently no evidence -based st and ard of care . The purpose of this study was to examine the efficacy of individually administered cognitive-behavioral therapy ( CBT ) , relative to clinical monitoring ( with no new treatment ) , for depression in this medical population . METHOD Eighty depressed ( based on DSM-IV criteria ) patients with Parkinson 's disease participated in a r and omized , controlled trial of CBT relative to clinical monitoring ( 1:1 ratio ) in an academic medical center from April 2007 to July 2010 . All patients continued to maintain stable medication regimens under the care of their personal physicians . The 17-item Hamilton Depression Rating Scale ( HAM-D ) total score was the primary outcome . CBT was modified to meet the unique needs of the Parkinson 's disease population and provided for 10 weeks . Assessment s were completed by blind raters at baseline and 5 ( midpoint ) , 10 ( end of treatment ) , and 14 weeks ( follow-up evaluation ) postr and omization . RESULTS The CBT group reported greater reductions in depression ( change in HAM-D score ) than the clinical monitoring group . At week 10 , the mean HAM-D score change was 7.35 for CBT relative to 0.05 for clinical monitoring . CBT was also superior to clinical monitoring on several secondary outcomes ( i.e. , Beck Depression Inventory scores , anxiety , quality of life , coping , Parkinson 's disease symptom ratings ) . There were more treatment responders in the CBT group than the clinical monitoring group ( 56 % versus 8 % , respectively ) . CONCLUSIONS CBT may be a viable approach for the treatment of depression in Parkinson 's disease . Further research is needed to replicate and extend these findings The context for 
    Output:
    
We found brief psychotherapy is probable effective in the management of depression in PD patients .