Medical Health Encyclopedia

Depression. Although depression is very common in PD, there have been surprisingly few controlled studies that will help physicians determine the right antidepressant for these patients. Antidepressants used for PD include tricyclics, particularly nortriptyline (Pamelor, Aventyl), and selective serotonin-reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). A number of studies suggest, however, that SSRIs may worsen Parkinson symptoms. Patients taking SSRIs should be monitored.

Psychotic Side Effects. Some studies indicate that the drug clozapine (Clozaril) and quetiapine (Seroquel), normally used in schizophrenia, may be the optimal agents at this time to help offset the psychiatric side effects. In one study quetiapine also improved memory and concentration. These drugs have some serious side effects and need to be used with caution. (Some studies have suggested that similar drugs, such as risperidone or olanzapine, do not have the same benefits.)

Dementia. Drugs used to treat Alzheimer's disease (donepezil, tacrine, galantamine) are also being investigated from this problem.

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Daytime Sleepiness. Modafinil (Provigil), an agent used to treat narcolepsy, is proving to be very helpful for PD patients with sleepiness related to their disease.

Drooling. In search of a simple solution for the problem of drooling, scientists have reported that injections of very small amounts of botulinum toxin A effectively reduce saliva production and drooling. In such small amounts the toxin is safe.

Constipation. Cisapride is being investigated for relieving constipation.

Voice Loss. A relatively simple procedure using collagen injections in the neck appears to be a safe and effective method of improving the voice and speech disorders caused by PD. The procedure augments the collagen in the vocal fold and works best in patients who can still initiate speech. A 2001 study reported improvements that lasted from two to seven months in 61% of patients.

Impotence. Sildenafil (Viagra) is proving to be very helpful for men who suffer from impotence from Parkinson's disease. However, the agent may worsen orthostatic hypotension, which may be a side effect of some of the PD medications.