human
***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: INTRODUCTION On average 40 % of all patients suffering from Parkinson s disease ( PD ) undergo bouts of depression . It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits , together with hypometabolism in the orbital , cau date nucleus and frontal dorsolateral tract regions . AIMS The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD . PATIENTS AND METHODS The study examined a total of 77 patients ( 34 females and 43 males ) , with an average age of 68.2 years , who had been suffering from PD ( according to the diagnostic criteria of Calne et al , in stage II of Hoehn and Yahr ) for an average of 6.9 years . They were divided r and omly into two groups which received fluoxetin ( 37 patients , dosage : 20 40 mg/day ) or amitriptyline ( 40 patients , dosage : between 25 and 75 mg/day ) . A basal evaluation and four others ( at 3 , 6 , 9 and 12 months of treatment ) were performed , including the STMS ( Short test of mental status ) , the Hamilton scale , and extent of functional disability using the UPDRS . A statistical analysis was performed by comparing the variance of the above mentioned parameters and the c2 test with Yates correction or the Fisher exact two tailed test , to evaluate the reasons for dropping out . In both cases a value of p < 0.05 was accepted as significant . RESULTS 58 patients finished the study . Drop out because of side effects only took place in the group that received amitriptyline ( p < 0.02 ) , which was better than fluoxetin at controlling the depression ( p < 0.009 , 0.001 , 0.002 and 0.00006 ) at 3 , 6 , 9 and 12 months , respectively . CONCLUSIONS At an average dosage of 35.2 mg/day , amitriptyline is effective in controlling the depression presented by patients with PD . However , despite the low dosage , the side effects it caused forced 15 % of the patients ab and on the treatment In addition to treating the motor symptoms of Parkinson ’s disease , the dopamine agonist pramipexole has shown an antidepressant effect . The trials , however , included patients with motor complications , raising the question of whether the antidepressant benefit represented only a treatment – related motor improvement . To address this issue , we have conducted a 14–week r and omized trial comparing pramipexole with an established antidepressant in patients without motor complications . At seven Italian centers , 67 Parkinsonian out patients with major depression but no history of motor fluctuations and /or dyskinesia received open – label pramipexole ( at 1.5 to 4.5 mg/day ) or sertraline ( at 50 mg/day ) . In both groups , the Hamilton Depression Rating Scale ( HAM – D ) score decreased throughout 12 weeks of treatment , but in the pramipexole group the proportion of patients who recovered , as defined by a final HAM – D score ≤ 8,was significantly higher , at 60.6 % versus 27.3 % ( p = 0.006 ) . Patients ’ self – ratings improved in both groups . All adverse events were mild or moderate , but five patients ( 14.7 % ) withdrew from the sertraline group . Despite the absence of motor complications , the pramipexole recipients showed improvement on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) motor subscore . We conclude that dopamine agonists may be an alternative to antidepressants in Parkinson ’s disease 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 We assessed the effect of 3-month treatment of sertraline ( 50 mg ) or low-dose amitriptyline ( 25 mg ) on depression and quality of life in 31 patients with Parkinson 's disease in a prospect i ve single-blind r and omized study . Both drugs significantly reduced the Hamilton Depression Rating Scale ( HDRS-17 ) score . Completion rate was 75 % for sertraline ( 12 of 16 ) and 73 % for amitriptyline ( 11 of 15 ) . Responder rate ( HDRS-17 score reduction > /= 50 % ) was 83.3 % for sertraline and 72.7 % for amitriptyline . Sertraline but not amitriptyline treatment determined a significant benefit on quality of life ( PDQ-39 scale ) . We found no change in Unified Parkinson 's Disease Rating Scale scores . However , the improvement in specific PDQ-39 subscores ( mobility , activities of daily living , and stigma ) suggests that depression affects patient self-perception of motor function and further emphasizes the need for its treatment Objective : To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation ( rTMS ) in treating depression in patients with Parkinson ’s disease . Methods : 42 patients were enrolled into two groups : group 1 , active rTMS ( 15 Hz rTMS for 10 days ) and placebo drug treatment ; group 2 , sham rTMS and fluoxetine 20 mg/day . A specially design ed sham coil was used for sham stimulation . The unified Parkinson ’s disease rating scale ( UPDRS ) , activities of daily living ( ADL ) , Hamilton rating scale for depression ( HRSD ) , Beck depression inventory ( BDI ) , and mini-mental state examination ( MMSE ) were assessed by a rater blinded to treatment arm . Results : HRSD and BDI were improved to the same extent in both groups after two weeks of treatment ( 38 % and 32 % for group 1 , 41 % and 33 % for group 2 , respectively ) . At week 8 there was a tendency for worse motor UPDRS scores in group 2 ( NS ) . ADL showed improvement at week 8 only in group 1 . MMSE improved in both groups after treatment , but faster in group 1 than in group 2 . There were fewer adverse effects in group 1 than in group 2 . Conclusions : rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement , with fewer adverse effects Idiopathic Parkinson 's disease ( IPD ) is characterized by motor signs such as akinesia , rigidity , and often tremor at rest . In addition to these symptoms , depression is a common finding affecting 40 % of patients with IPD . This study evaluates the effect of the selective serotonin reuptake inhibitor , citalopram , on motor and nonmotor symptoms of depressed and nondepressed patients with IPD . Forty-six nondemented patients with IPD ( 24 men , 22 women ; mean age 64 ± 5.3 years ; mean ± SD disease duration , 6.4 ± 3.2 years ; mean ± SD Hoehn-Yahr stage , 2.8 ± 1.2 ) were included in the study . Patients were divided in two subgroups : depressed ( n = 18 ) and nondepressed ( n = 28 ) . Citalopram was added in an unblinded manner , starting with 10 mg/d , and , after a week , increased up to 20 mg/d in the depressed subgroup ( n = 18 ) and in half of the nondepressed subgroup ( n = 14 ) . Parkinsonian and depressive symptoms were evaluated before and after 1 and 4 months of treatment . Statistical evaluation was made by analysis of variance for repeated measures . Citalopram  did not worsen motor performance in IPD , but improved bradykinesia and finger taps after 1 month and 4 months of treatment both in patients with and without depression ( p < 0.05 versus baseline ) . A clear improvement in mood was also observed in 15 of 16 patients with depression . Although case reports indicate that citalopram can potentially worsen the motor symptoms in patients with PD , to date this effect has not been confirmed . Many of the symptoms , typically associated with depression , can be observed in nondepressed patients with IPD , because signs thought to represent depression can be produced by Parkinson 's disease . In this study , we observed that when combined with levodopa , citalopram  induces an improvement of motor performance , in particular of subscores 23 and 31 of Unified Parkinson 's Disease Rating Scale both in depressed and in nondepressed patients with IPD Some of the selective serotonin reuptake inhibitors (SSRI)-induced motor side effects are mediated by stimulating 5-HT2 receptors in the basal ganglia , probably because serotonin inhibits the subsequent neuronal dopamine release . We hypothesized that nefazodone , a serotonin 2 antagonist/reuptake inhibitor ( SARI ) that selectively blocks 5-HT2 receptors , could disrupt the aforementioned inhibitory pathway . Therefore , increased dopamine levels in the postsynaptic milieu and an improvement in the motor symptoms in depressed patients with Parkinson disease ( PD ) should be observed . This study was design ed to determine whether nefazodone has a dual activity as an antidepressant and as an agent capable of reducing the extrapyramidal symptoms in depressed parkinsonian patients . Depressed patients with PD were r and omly assigned to 2 therapeutic groups : nefazodone or fluoxetine . Patients were evaluated by a psychiatrist and were blindly assessed by a neurologist with an array of scales . Patients on nefazodone ( n = 9 ) showed a significant improvement over time in the total Unified Parkinson Disease Rating Scale score ( UPDRS ) ( part II + part III ) ( P = 0.004 ) and in the UPDRS subscore part III ( P = 0.003 ) . None of these scores changed over time in the fluoxetine group ( n = 7 ) . Both , nefazodone and fluoxetine were equally effective as antidepressants : Beck Depression Inventory scores significantly improved ( P < 0.001 ) , with no significant differences between treatment groups ( P = 0.97 ) . If our results can be confirmed in a larger clinical trial , nefazodone ought to be considered over fluoxetine given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms in depressed PD patients 
    Output:
    
agent
An acceptability analysis showed that SSRIs were generally well tolerated .
Conclusions These results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD .
***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: INTRODUCTION On average 40 % of all patients suffering from Parkinson s disease ( PD ) undergo bouts of depression . It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits , together with hypometabolism in the orbital , cau date nucleus and frontal dorsolateral tract regions . AIMS The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD . PATIENTS AND METHODS The study examined a total of 77 patients ( 34 females and 43 males ) , with an average age of 68.2 years , who had been suffering from PD ( according to the diagnostic criteria of Calne et al , in stage II of Hoehn and Yahr ) for an average of 6.9 years . They were divided r and omly into two groups which received fluoxetin ( 37 patients , dosage : 20 40 mg/day ) or amitriptyline ( 40 patients , dosage : between 25 and 75 mg/day ) . A basal evaluation and four others ( at 3 , 6 , 9 and 12 months of treatment ) were performed , including the STMS ( Short test of mental status ) , the Hamilton scale , and extent of functional disability using the UPDRS . A statistical analysis was performed by comparing the variance of the above mentioned parameters and the c2 test with Yates correction or the Fisher exact two tailed test , to evaluate the reasons for dropping out . In both cases a value of p < 0.05 was accepted as significant . RESULTS 58 patients finished the study . Drop out because of side effects only took place in the group that received amitriptyline ( p < 0.02 ) , which was better than fluoxetin at controlling the depression ( p < 0.009 , 0.001 , 0.002 and 0.00006 ) at 3 , 6 , 9 and 12 months , respectively . CONCLUSIONS At an average dosage of 35.2 mg/day , amitriptyline is effective in controlling the depression presented by patients with PD . However , despite the low dosage , the side effects it caused forced 15 % of the patients ab and on the treatment In addition to treating the motor symptoms of Parkinson ’s disease , the dopamine agonist pramipexole has shown an antidepressant effect . The trials , however , included patients with motor complications , raising the question of whether the antidepressant benefit represented only a treatment – related motor improvement . To address this issue , we have conducted a 14–week r and omized trial comparing pramipexole with an established antidepressant in patients without motor complications . At seven Italian centers , 67 Parkinsonian out patients with major depression but no history of motor fluctuations and /or dyskinesia received open – label pramipexole ( at 1.5 to 4.5 mg/day ) or sertraline ( at 50 mg/day ) . In both groups , the Hamilton Depression Rating Scale ( HAM – D ) score decreased throughout 12 weeks of treatment , but in the pramipexole group the proportion of patients who recovered , as defined by a final HAM – D score ≤ 8,was significantly higher , at 60.6 % versus 27.3 % ( p = 0.006 ) . Patients ’ self – ratings improved in both groups . All adverse events were mild or moderate , but five patients ( 14.7 % ) withdrew from the sertraline group . Despite the absence of motor complications , the pramipexole recipients showed improvement on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) motor subscore . We conclude that dopamine agonists may be an alternative to antidepressants in Parkinson ’s disease 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 We assessed the effect of 3-month treatment of sertraline ( 50 mg ) or low-dose amitriptyline ( 25 mg ) on depression and quality of life in 31 patients with Parkinson 's disease in a prospect i ve single-blind r and omized study . Both drugs significantly reduced the Hamilton Depression Rating Scale ( HDRS-17 ) score . Completion rate was 75 % for sertraline ( 12 of 16 ) and 73 % for amitriptyline ( 11 of 15 ) . Responder rate ( HDRS-17 score reduction > /= 50 % ) was 83.3 % for sertraline and 72.7 % for amitriptyline . Sertraline but not amitriptyline treatment determined a significant benefit on quality of life ( PDQ-39 scale ) . We found no change in Unified Parkinson 's Disease Rating Scale scores . However , the improvement in specific PDQ-39 subscores ( mobility , activities of daily living , and stigma ) suggests that depression affects patient self-perception of motor function and further emphasizes the need for its treatment Objective : To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation ( rTMS ) in treating depression in patients with Parkinson ’s disease . Methods : 42 patients were enrolled into two groups : group 1 , active rTMS ( 15 Hz rTMS for 10 days ) and placebo drug treatment ; group 2 , sham rTMS and fluoxetine 20 mg/day . A specially design ed sham coil was used for sham stimulation . The unified Parkinson ’s disease rating scale ( UPDRS ) , activities of daily living ( ADL ) , Hamilton rating scale for depression ( HRSD ) , Beck depression inventory ( BDI ) , and mini-mental state examination ( MMSE ) were assessed by a rater blinded to treatment arm . Results : HRSD and BDI were improved to the same extent in both groups after two weeks of treatment ( 38 % and 32 % for group 1 , 41 % and 33 % for group 2 , respectively ) . At week 8 there was a tendency for worse motor UPDRS scores in group 2 ( NS ) . ADL showed improvement at week 8 only in group 1 . MMSE improved in both groups after treatment , but faster in group 1 than in group 2 . There were fewer adverse effects in group 1 than in group 2 . Conclusions : rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement , with fewer adverse effects Idiopathic Parkinson 's disease ( IPD ) is characterized by motor signs such as akinesia , rigidity , and often tremor at rest . In addition to these symptoms , depression is a common finding affecting 40 % of patients with IPD . This study evaluates the effect of the selective serotonin reuptake inhibitor , citalopram , on motor and nonmotor symptoms of depressed and nondepressed patients with IPD . Forty-six nondemented patients with IPD ( 24 men , 22 women ; mean age 64 ± 5.3 years ; mean ± SD disease duration , 6.4 ± 3.2 years ; mean ± SD Hoehn-Yahr stage , 2.8 ± 1.2 ) were included in the study . Patients were divided in two subgroups : depressed ( n = 18 ) and nondepressed ( n = 28 ) . Citalopram was added in an unblinded manner , starting with 10 mg/d , and , after a week , increased up to 20 mg/d in the depressed subgroup ( n = 18 ) and in half of the nondepressed subgroup ( n = 14 ) . Parkinsonian and depressive symptoms were evaluated before and after 1 and 4 months of treatment . Statistical evaluation was made by analysis of variance for repeated measures . Citalopram  did not worsen motor performance in IPD , but improved bradykinesia and finger taps after 1 month and 4 months of treatment both in patients with and without depression ( p < 0.05 versus baseline ) . A clear improvement in mood was also observed in 15 of 16 patients with depression . Although case reports indicate that citalopram can potentially worsen the motor symptoms in patients with PD , to date this effect has not been confirmed . Many of the symptoms , typically associated with depression , can be observed in nondepressed patients with IPD , because signs thought to represent depression can be produced by Parkinson 's disease . In this study , we observed that when combined with levodopa , citalopram  induces an improvement of motor performance , in particular of subscores 23 and 31 of Unified Parkinson 's Disease Rating Scale both in depressed and in nondepressed patients with IPD Some of the selective serotonin reuptake inhibitors (SSRI)-induced motor side effects are mediated by stimulating 5-HT2 receptors in the basal ganglia , probably because serotonin inhibits the subsequent neuronal dopamine release . We hypothesized that nefazodone , a serotonin 2 antagonist/reuptake inhibitor ( SARI ) that selectively blocks 5-HT2 receptors , could disrupt the aforementioned inhibitory pathway . Therefore , increased dopamine levels in the postsynaptic milieu and an improvement in the motor symptoms in depressed patients with Parkinson disease ( PD ) should be observed . This study was design ed to determine whether nefazodone has a dual activity as an antidepressant and as an agent capable of reducing the extrapyramidal symptoms in depressed parkinsonian patients . Depressed patients with PD were r and omly assigned to 2 therapeutic groups : nefazodone or fluoxetine . Patients were evaluated by a psychiatrist and were blindly assessed by a neurologist with an array of scales . Patients on nefazodone ( n = 9 ) showed a significant improvement over time in the total Unified Parkinson Disease Rating Scale score ( UPDRS ) ( part II + part III ) ( P = 0.004 ) and in the UPDRS subscore part III ( P = 0.003 ) . None of these scores changed over time in the fluoxetine group ( n = 7 ) . Both , nefazodone and fluoxetine were equally effective as antidepressants : Beck Depression Inventory scores significantly improved ( P < 0.001 ) , with no significant differences between treatment groups ( P = 0.97 ) . If our results can be confirmed in a larger clinical trial , nefazodone ought to be considered over fluoxetine given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms in depressed PD patients 
    Output:
    