ADepT-PD – Antidepressants And More

What is it about?
The progression of Parkinson’s can affect the whole brain, not just the movement-related centres. This leads to a wide range of so-called “non-motor” symptoms, including difficulties with mood and control of emotions. Persistent low mood is one of the major non-motor symptoms affecting people with Parkinson’s.

There are several different classes of drugs that your GP can prescribe to counteract low moods. “Tricyclic” drugs are of extra interest because they have been shown to stimulate the birth of neurons, and the release of biomolecules that help the glial cells that surround and support neurons. Another class, selective serotonin reuptake inhibitors (SSRIs) are also often prescribed for people with Parkinson’s; they have a more favourable side effect profile than tricyclics.

The release of dopamine by neurons is central to movement. A cardinal  biological feature of Parkinson’s is the abnormal behaviour of the alpha-synuclein protein. This protein, for reasons we do not yet fully understand, can form toxic clumps inside cells. It is believed that these clumps are directly responsible for obstructing the release of dopamine.  Researchers are looking for ways to prevent alpha-synuclein clumping, or reduce the extent to which it happens (its “gene expression”),  or encourage the clearance of it from the glial cells.

The outcomes of repairing these biological mechanisms could be a slowing down or a halt to the progression of our symptoms, or a reduction of the burden they impose. These three outcomes are increasingly referred to collectively as “disease modification”.  

This is a randomised double-blind placebo-controlled trial , which means that neither you nor the Trial Unit will know who is taking what.  It is a big trial, recruiting over 400 people in many centres throughout the UK.

What is the objective?
The primary objective of the Antidepressants Trial in Parkinson’s Disease (ADepT-PD) is to examine whether Escitalopram, a SSRI, and Nortriptyline, a Tricyclic, are effective and safe for the treatment of persistent low mood in people with Parkinson’s.

The tricyclic drug Nortriptyline has been shown to interfere directly with the production of alpha-synuclein, so the trial has an important subsidiary objective of finding whether these two drugs (one each of two classes) are effective in delaying the slowing down of movements associated with Parkinson’s. A novel feature of the trial involves the use of wearable technology to allow continuous measurement of movement over a week.

Where is it?
At Home

How long does it take?
12 months. As a result of Covid restrictions the trial protocol has been completely revised to exclude hospital visits.

What does it involve?

  • A daily pill of Escitalopram, Nortriptyline or a placebo.
  • Video consultations. You will need to be able to conduct video-based conversations in your home. if you have the technology but not the knowledge to use it, ask for help.
  • Completing questionnaires on changes in symptoms of low mood.
  • Wearable technology for measurements of motor function.

Who is eligible?
Age 18 to 85 years with a diagnosis of idiopathic Parkinson’s and a clinical diagnosis of persistent low mood. Enrolment on the trial is subject to a comprehensive review including a video meeting.

How do I enrol?

  • Addresses in Cornwall: Christine Schofield, Royal Cornwall Hospitals NHS Trust, Treliske.  email christine.schofield1@nhs.net
  • Addresses in the Plymouth area and North Cornwall:
    Jemma Inches, University Hospitals Plymouth NHS Trust, Derriford. email  jinches@nhs.net
  • Note:- The areas overlap as regards the locations of the Consultants and Parkinson’s care services. PenPRIG is pleased to advertise a choice!

Subject to confirmation.

Addresses in Devon:
Contacts tba