Parkinson's disease (PD) is clinically based on the presence of a set of cardinal motor signs including rigidity, bradykinesia, resting tremor and postural reflex disturbances. However, in many cases, nonmotor alterations (anxiety, depression, sleep, gastrointestinal and cognitive functions) precede the classical motor symptoms in PD, and the management of these nonmotor symptoms is clinically challenging (
1-
3).I have added this reference to the reference section. Anxiety/depression in PD is thought to result from factors such as disappearance of dopaminergic, noradrenergic and serotoninergic neurons, as well as from psychogenic reactions associated with the onset of disease (
4). A pattern of regional neurodegeneration that varies considerably depending upon the affected neuronal population may explain different symptoms observed in such patients. In fact, differential mechanisms of neuronal vulnerability within the substantia nigra pars compacta suggests that factors other than location contribute to the susceptibility of these neurons (
3).
Several lines of evidence have shown that 5-HT1A receptors play an important role in controlling motor functions and ameliorate various extrapyramidal disorders such as PD (
5-
9) and L-DOPA-induced motor disabilities (
10-
13). In addition, 5-HT1A receptors are implicated in the pathogenesis and treatment of mood disorders (anxiety/depression) (
8). Loss of 5-HT neurons in the raphe nuclei has been reported (
14). Therefore, 5-HT content and the density of 5-HT transporters (a marker for 5-HT nerve terminals) in the forebrain regions (i.e., striatum and neocortex) are reduced in patients with PD. Postsynaptic 5-HT1A and 5-HT2A receptors are upregulated in response to the functional deficits of 5-HT neurons (
14). Furthermore, recent clinical studies have demonstrated that patients with Parkinson and depression show further pronounced dysfunction of 5-HT neurons as compared to those without depression (
15). Thus, there is a close association between dysfunction of the serotonergic system and PD (
Figure 1).
Although the monoamines, specifically serotonin and norepinephrine have been targets for the development of novel antidepressants. Some of the effectiveness of the classical SSRI’s is mediated via the dopaminergic system; Wellbutrin ® (bupropion) is a classic example (
16). Dopaminergic antidepressant drugs, such as specific dopamine reuptake inhibitors like amineptine, the presynaptic dopamine antagonist amisulpride, and the D2/D3 agonist roxindole and pramipexole, all cause rapid relief of symptoms. Low levels of dopamine metabolites have been detected in CSF of patients with depression (
17). Reports of low levels of dopamine metabolite dihydroxyphenylacetic acid in CSF of patients with depression (
18) and in the basal ganglia of postmortem brains of patients with depression who committed suicide (
19), lend additional support to a theory of dopamine abnormality in depression. The aim of our study was to investigate the dopaminergic/serotonergic mechanism-of-action to induce anxiety/depression.