***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 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 Depression is one of the most common psychiatric disturbances in Parkinson 's disease ( PD ) . Recent review s have highlighted the lack of controlled trials and the ensuing difficulty in formulating recommendations for antidepressant use in PD . We sought to establish whether antidepressants provide real benefits and whether tricyclic and selective serotonin reuptake inhibitor ( SSRI ) antidepressants differ in their short-term efficacy , because the time to onset of therapeutic benefit remains an important criterion in depression . The short-term efficacy ( after 14 and 30 days ) of two antidepressants ( desipramine , a predominantly noradrenergic reuptake inhibitor tricyclic and citalopram , a SSRI ) was assessed in a double-blind , r and omized , placebo- controlled study of 48 nondemented PD patients suffering from major depression . After 14 days , desipramine prompted an improvement in the Montgomery Asberg Depression Rating Scale ( MADRS ) score , compared with citalopram and placebo . Both antidepressants produced significant improvements in the MADRS score after 30 days . Mild adverse events were twice as frequent in the desipramine group as in the other groups . A predominantly noradrenergic tricyclic antidepressant induced a more intense short-term effect on parkinsonian depression than did an SSRI . However , desipramine 's lower tolerability may outweigh its slight short-term clinical advantage Objective : To evaluate the efficacy and safety of a selective serotonin reuptake inhibitor ( SSRI ) and a serotonin and norepinephrine reuptake inhibitor ( SNRI ) in the treatment of depression in Parkinson disease ( PD ) . Methods : A total of 115 subjects with PD were enrolled at 20 sites . Subjects were r and omized to receive an SSRI ( paroxetine ; n = 42 ) , an SNRI ( venlafaxine extended release [ XR ] ; n = 34 ) , or placebo ( n = 39 ) . Subjects met DSM-IV criteria for a depressive disorder , or operationally defined subsyndromal depression , and scored > 12 on the first 17 items of the Hamilton Rating Scale for Depression ( HAM-D ) . Subjects were followed for 12 weeks ( 6-week dosage adjustment , 6-week maintenance ) . Maximum daily dosages were 40 mg for paroxetine and 225 mg for venlafaxine XR . The primary outcome measure was change in the HAM-D score from baseline to week 12 . Results : Treatment effects ( relative to placebo ) , expressed as mean 12-week reductions in HAM-D score , were 6.2 points ( 97.5 % confidence interval [ CI ] 2.2 to 10.3 , p = 0.0007 ) in the paroxetine group and 4.2 points ( 97.5 % CI 0.1 to 8.4 , p = 0.02 ) in the venlafaxine XR group . No treatment effects were seen on motor function . Conclusions : Both paroxetine and venlafaxine XR significantly improved  depression in subjects with PD . Both medications were generally safe and well tolerated and did not worsen motor function . Classification of Evidence : This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD AIMS We determined whether the start of selective serotonin reuptake inhibitors ( SSRI ) in levodopa users was followed by a faster increase of antiparkinsonian drug treatment . METHODS Selected were all levodopa users of 55 years and older from the PHARMO prescription data base . The rate of increase of  antiparkinsonian drug treatment  was compared using Cox 's proportional hazard model for starters of SSRI ( n = 15 ) with starters of tricyclic antidepressants ( TCA ) ( n = 31 ) and with patients not using antidepressants ( n = 304 ) , and was adjusted for age , gender , and duration of levodopa use . RESULTS The hazard ratio for the SSRI group compared with the TCA group was 4.2 ( 95 % confidence interval 1.4 , 12.6 ) and compared with the second control group was 2.7 ( 1.2 , 5.2 ) . CONCLUSIONS The start of SSRI therapy in levodopa users is followed by a faster increase of antiparkinsonian drug treatment Nineteen patients with L‐DOPA treated parkinsonism involving depressive symptoms , the therapeutic effect of nortriptyline was compared to placebo in a controlled trial . The depressive and neurological symptoms were evaluated by rating scales . Nortriptyline had a clinical significant effect with regard to the depressive symptoms , whereas the neurological parameters were unchanged . The authors suggest the depression in Parkinson 's disease to be of both reactive and endogenous origins Current management guidelines for the treatment of patients with Parkinson 's disease ( PD ) are limited due to the lack of knowledge of factors that influence health-related quality of life ( HRQL ) . To assess the HRQL of people with PD , and to systematic ally identify and evaluate those factors ( other than disease severity and medication , which could have an impact ) , we undertook a cross-sectional , r and omized selection , multicenter international survey of patients with PD , caregivers , and clinicians . Face-to-face interviews were conducted with subjects in six countries . Disease severity , medication , and other factors hypothesized to influence HRQL were assessed using a combination of specially developed question naires and vali date d instruments including the Parkinson 's Disease Question naire-39 ( HRQL ) , Hoehn and Yahr Stage ( disease severity ) , and Beck 's Depression Inventory ( BDI ; depression ) .  Multiple linear regression models were used to demonstrate whether the factors investigated contribute significantly to HRQL . The results obtained indicated that Hoehn and Yahr stage and medication explained only 17.3 % of the variability in HRQL of patients with PD , although both were significant ( R2 = 0.173 , P < 0.05 ) . Other factors increased the explanatory power to adjusted R2 = 0.597 , with BDI being the most significant predictor of variability in HRQL ( adjusted R2 = 0.582 ; P < 0.001 ) , followed by " Satisfaction with the explanation of the condition at diagnosis " and " Current feelings of optimism " ( both P < 0.05 ) . These factors , in addition to disease severity and medication , explain 59.7 % of the variability in HRQL across the population . In conclusion , depression ( as measured by the BDI ) in PD , " satisfaction with the explanation of the condition at diagnosis " and " current feelings of optimism " have a significant impact on HRQL . The completion of this initial analysis is the first step towards developing management guidelines that truly influence the HRQL of patients with PD . © 2001 Movement Disorder Society 
    Output:
    
No specific antidepressant class was superior to placebo .
In general antidepressant medications were well tolerated .
The results suggest antidepressants may be efficacious in the treatment of dPD .
In fact , the small number of trials and method ological drawbacks preclude definitive conclusions about their efficacy and tolerability in dPD