Optimal Treatment of Depression and Anxiety in Parkinson's Disease

•What is the primary question addressed by this study? This article discusses the optimal treatment of anxiety and depression in Parkinson's disease.•What is the main finding of this study? The treatment of anxiety and depression in Parkinson's disease are complicated by overlap with the neurodegenerative process.•What is the meaning of the finding? Collaboration and careful coordination of multidisciplinary care are required to achieve optimal outcomes for anxiety and depression in Parkinson's disease. Depression and anxiety are highly prevalent and have major adverse effects on function and quality of life in Parkinson's disease (PD). Optimal management requires that motor symptoms and psychiatric symptoms be simultaneously addressed. While there is fairly robust evidence for the treatment of motor symptoms, there are no completed randomized controlled trials to guide pharmacological treatment of anxiety in PD and no nonpharmacologic interventions have proven efficacious. Several high-quality trials for depression in PD suggest a number of antidepressants and cognitive behavioral therapy may help, but there is no data on rates of recurrence, comparative efficacy, or augmentation strategies. In order to address the gaps in knowledge, the authors provide a summary of the current evidence for treating depression and anxiety in PD and offer an algorithm that extends beyond the current literature based on clinical experience working in a multidisciplinary specialty center.