Psychotherapy for the Treatment of Anxiety and Depression in Patients with Parkinson Disease: A Meta-Analysis of Randomized Controlled Trials

Chien-Tai Hong; Shennie Tan; Tsai-Wei Huang

doi:10.1016/j.jamda.2021.03.031

Psychotherapy for the Treatment of Anxiety and Depression in Patients with Parkinson Disease: A Meta-Analysis of Randomized Controlled Trials

J Am Med Dir Assoc. 2021 Nov;22(11):2289-2295.e2. doi: 10.1016/j.jamda.2021.03.031. Epub 2021 May 3.

Authors

Chien-Tai Hong¹, Shennie Tan², Tsai-Wei Huang³

Affiliations

¹ Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. Electronic address: tsaiwei@tmu.edu.tw.

PMID: 33957132
DOI: 10.1016/j.jamda.2021.03.031

Abstract

Objective: Anxiety and depression are major psychiatric nonmotor symptoms (NMSs) of Parkinson disease (PD). Although several studies have investigated the effects of psychotherapeutic interventions, particularly cognitive-behavioral therapy (CBT), for alleviating anxiety and depression in patients with PD, the findings have been inconclusive because of the small sample size and the lack of a unified protocol for such treatments. Thus, the present meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effect of psychotherapy on PD-related anxiety and depression.

Design: Systematic review and meta-analysis.

Setting and participants: Relevant RCTs were extracted from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases. This study was registered in PROSPERO under the number CRD 42020165052.

Measures: The primary and secondary outcomes were changes in the anxiety score and depressive symptoms, respectively.

Results: Fourteen RCTs including 507 patients with PD were analyzed. The interventions were classified as CBT and non-CBT. CBT significantly reduced anxiety at the end of the study (standardized mean difference = -0.85, 95% confidence interval = -1.12 to -0.58, P < .001, I² = 0%), whereas non-CBT did not. Greater heterogeneity in the effects of non-CBT treatment was observed. CBT was significantly beneficial for depression (standardized mean difference = -0.83, 95% confidence interval = -1.26 to -0.40, P < .001, I² = 55%). Despite the greater heterogeneity in the effects, non-CBT interventions were also effective in alleviating depressive symptoms.

Conclusion and implications: CBT is effective for the management of anxiety and depression in patients with PD. Routine treatment for patients with this condition is strongly recommended.

Keywords: Parkinson disease; anxiety; depression; meta-analysis; psychotherapy.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Anxiety / therapy
Depression* / therapy
Humans
Parkinson Disease* / complications
Parkinson Disease* / therapy
Psychotherapy
Randomized Controlled Trials as Topic