Use of psychotropics increases in the early stages of Parkinson’s disease

Up to 1 in 3 people with Parkinson’s disease use at least one psychotropic medication, a recent study from the University of Eastern Finland shows. People with Parkinson’s disease were using psychotropics more frequently than controls already before the diagnosis, and psychotropic use increased as the disease progressed.

Parkinson’s disease is a progressive neurological disorder characterized by motor symptoms such as resting tremor, slowness of movement and rigidity. Even before the onset of motor symptoms, the disease may involve neuropsychiatric symptoms, sleep disorders and pain, which are often treated with psychotropics. However, the use of psychotropic medications among people with Parkinson’s disease has not been examined in a longitudinal study, until now.

The study, published in the British Journal of Clinical Pharmacology, examined the use of psychotropic medications over a 10-year period, starting five years before the diagnosis of Parkinson’s disease and ending five years after. Using various nationwide health care registers in Finland, the study included 17,370 community-dwelling individuals with Parkinson’s disease and 115,386 matched controls without Parkinson’s disease.

During the follow-up, the proportion of individuals using a single psychotropic medication increased from 18% to 35% among people with Parkinson’s disease and from 14% to 20% among controls. Similarly, the use of medications from at least two different psychotropic groups was more common among people with Parkinson’s disease than among controls.

At the beginning of the follow-up, 5% of people with Parkinson’s disease used multiple psychotropics, rising to 10% by the end of the follow-up. In both cohorts, the use of psychotropics was most frequent in the oldest age group, among those aged 80 years or older.

Benzodiazepines and related drugs (BZDRs) were the most frequently used psychotropics in the control cohort throughout the entire follow-up period and also among people with Parkinson’s disease up to three years after diagnosis, after which antidepressants became even more commonly used than BZDRs.

According to the researchers, the more frequent use of psychotropics among people with Parkinson’s disease likely reflects the emergence of non-motor symptoms already before diagnosis and the worsening of these symptoms as the disease progresses. It may also be associated with more frequent use of health care services.

A cause for concern is that the use of psychotropics, and particularly psychotropic polypharmacy, increases the risk of falls and related fractures in older people, while those with Parkinson’s disease are already at an increased risk for these events.