Parkinson's Disease - Medications

Testosterone Replacement. One very small and short term study investigated the effects of testosterone replacement on depression and other nonmotor symptoms in PD patients with testosterone deficiencies. (Such deficiencies affect about 20% and 25% of men over 60.) After a month of using a topical testosterone gel, such patients reported improvements in depression, fatigue, and sexual interest. More research is needed to determine if this treatment is actually beneficial and safe in this population. Testosterone replacement is generally not appropriate for men with normal hormonal levels, since it may increase the risk for prostate cancer, benign prostatic hyperplasia, and heart disease.

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Cannabinoids. Drugs derived from cannabinoids, the active ingredients in marijuana, may have nerve protecting properties. Adverse effects include anxiety and sedation. Investigators are studying cannabinoid derivatives, including cannabidiol and dronabinol, which do not have psychologic side effects.

Treatments for Disorders Associated with Parkinson's

Conditions associated with motor impairment and other symptoms of Parkinson's disease may require a variety of treatments. The following is a brief sample of some of them.

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.

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.