Researchers from the University of Iowa School of Medicine report on the frequency of severe depression across the stages of Huntington’s disease. Dr. LaVonne Veatch Goodman summarizes the findings and stresses the need for treatment of this serious component of HD with drugs that are available now.
The Goal To study the frequency and severity of self-reported depression symptoms in a large number of Huntington’s patients at all stages of disease. Because information was obtained at a single interview of each patient, this study did not address lifetime rates of depression in Huntington’s. The Method The authors analyzed 2835 patient responses to standard UHDRS interview questions relating to depression. Patients were asked to rate presence, frequency, and severity of sad mood, low self-esteem, and anxiety on a scale from 0 (none) to 4 (most severe). Only the results of those reporting scores of 3 or 4 (in other words, high severity) were analyzed. The Results More than 40% of patients reported current major symptoms of depression at the time of this single interview. More than 50% had received treatment for depression in the past. More than 10% had made a suicide attempt. Depressive symptoms varied across stages, with symptoms increasing during the early stages of disease and slowly diminishing during middle and later stages of the disease. The authors did not report rate of concurrent treatments for depression at the time of patient interview. Why is it Important? It’s important because depression is treatable. Although it did not receive major emphasis in this article, this is the real take home point for HD people; depression is treatable with drugs we have now. Treating this disabling symptom is vitally important in itself for improving quality of life and preserving function (Marder et al 2000). Further, antidepressant treatments may be neuroprotective, slowing disease progression. This is certainly the case in mouse models of HD when treated with the SSRIs paroxetine (Paxil®) and sertraline (Zoloft®). (Duan et al 2004; Duan et al 2005).

There are no systematic studies of the therapeutic benefit of antidepressant use in Huntington’s people. It is unfortunate that the Iowa study did't take this next step. The best alternative is to learn from studies done in Parkinson’s (PD), a neurodegenerative disease similar to HD. In Parkinson’s it has been shown that depression is associated with more rapid disease progression (Starkstein et al 1990; Starkstein et al 1992). Importantly, treatment with the SSRI citalopram (Celexa®) improved (bradykinesia) motor symptoms and mood in both depressed and non-depressed PD patients (Rampello et al 2002).

Comment Huntington’s families know first hand that depression in HD is common; much more so than this study using self-reported data suggests. We also know that depression is frequent and profound for those at genetic risk, and for spouses and partners. What we need to remember is that depression is treatable, and that antidepressant drugs are far too underused. They can probably slow down nerve damage. My opinion is that they should be considered a first line treatment for Huntington’s, and offered at every doctor’s visit. If the doctor doesn’t offer, you should ask. The Report

Paulsen JS, Nehl C, Hoth KF, Kanz JE, Benjamin M, Conybeare R, McDowell B, Turner B. Depression and stages of Huntington's disease. J Neuropsychiatry Clin Neurosci. 2005 Fall;17(4):496-502. PubMed abstract

References

Duan W, Guo Z, Jiang H, Ladenheim B, Xu X, Cadet JL, Mattson MP. Paroxetine retards disease onset and progression in Huntingtin mutant mice. Ann Neurol. 2004 Apr;55(4):590-4. PubMed abstract
Duan W, Peng Q, Zhao M, Ladenheim B, Masuda N, Cadet JL, Ross CA (2005) Sertraline Retards Progression and Improves Survival in a Mouse Model of Huntington's Disease. Society for Neuroscience 2005 (Abstract).
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Rampello L, Chiechio S, Raffaele R, Vecchio I, Nicoletti F. The SSRI, citalopram, improves bradykinesia in patients with Parkinson's disease treated with L-dopa. Clin Neuropharmacol. 2002 Jan-Feb;25(1):21-4. PubMed abstract
Starkstein SE, Bolduc PL, Mayberg HS, Preziosi TJ, Robinson RG. Cognitive impairments and depression in Parkinson's disease: a follow up study. J Neurol Neurosurg Psychiatry. 1990 Jul;53(7):597-602. PubMed abstract
Starkstein SE, Mayberg HS, Leiguarda R, Preziosi TJ, Robinson RG. A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1992 May;55(5):377-82. PubMed abstract