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Answer 6
  1. Optimize treatment with pramipexole, then reevaluate depressive symptoms. Mild depression should be treated in this patient group. Pramipexole has been effective in the treatment of depression in patients with Parkinson’s disease.10 Although SSRIs are considered first-line therapy for depression in patients with Parkinson’s disease, pramipexole alone initially can be used to treat this patient’s parkinsonian symptoms and depression before adding an antidepressant.11 Buspirone is used to treat anxiety and should not be used in this case. If the patient was more severely depressed or suicidal, more intensive interventions would be indicated.

    10. Barone P, Scarzella L, Marconi R, et al; Depression/Parkinson Italian Study Group. Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease: a national multicenter parallel-group randomized study. J Neurol 2006;253:601-7.

    11. Okun MS, Watts RL. Depression associated with Parkinson’s disease: clinical features and treatment. Neurology 2002;58(4 Suppl 1):S63-70.

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