Provisional diagnostic criteria for depression in Parkinson's disease: Report of an NINDS/NIMH Work Group


  • Laura Marsh MD,

    Corresponding author
    1. Departments of Psychiatry and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    • Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital-Phipps 300, 600 N. Wolfe Street, Baltimore, MD 21287
    Search for more papers by this author
  • William M. McDonald MD,

    1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
    Search for more papers by this author
  • Jeffrey Cummings MD,

    1. Departments of Neurology and Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    Search for more papers by this author
  • Bernard Ravina MD

    1. Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
    Search for more papers by this author


Mood disorders are the most common psychiatric problem associated with Parkinson's disease (PD), and have a negative impact on disability and quality of life. Accurate diagnosis of depressive disturbances in PD is critical and will facilitate the testing and use of new interventions; however, there are no clear diagnostic criteria for depressive disorders in PD. In their current form, strict Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria are difficult to use in PD and require attribution of specific symptoms to PD itself or the depressive syndrome. Additionally, DSM criteria for major depression and dysthymia exclude perhaps half of PD patients with comorbid clinically significant depression. This review summarizes an NIH-sponsored workshop and describes recommended changes to DSM diagnostic criteria for depression for use in PD. Participants also recommended: (1) an inclusive approach to symptom assessment to enhance reliability of ratings in PD and avoid the need to attribute symptoms to a particular cause; (2) the inclusion of subsyndromal depression in clinical research studies of depression of PD; (3) the specification of timing of assessments for PD patients with motor fluctuations; and (4) the use of informants for cognitively impaired patients. The proposed diagnostic criteria are provisional and intended to be defined further and validated but provide a common starting point for clinical research in PD-associated depression. © 2005 Movement Disorder Society