Depression in Multiple Idiopathic Parkinson's Study System Atrophy and in Disease: A Pilot Comparative Linda Pilo, Howard Ring, Niall Quinn, and Michael Trimble Multiple system atrophy (MSA) is a disease causing severe parkinsonism in which response to levodopa is classically absent, poor, or transient. Idiopathic Parkinson' s disease (IPD) itself which responds favorably to levodopa, has been associated with the development of disease-related depression. Over and above the clinical and pathological characteristics of IPD, MSA causes additional, more widespread, clinical and pathological deficits. We have compared motor disability and mood in 12 patients with MSA and 12 with IPD. There was more severe motor disability, but no clinical evidence of depression among the MSA patients studied, and their Beck Depression Inventor)' scores did not differ signifi'cantly from the group with IPD. We conclude that depression does not appear to be more common in MSA than in IPD. Key Words: Parkinson's disease, multiple system atrophy, depression, movement disorders, basal ganglia BIOL PSYCHIATRY 1996;39:803-- 807 Introduction Multiple system atrophy (MSA) is a sporadic degenerative disease of the nervous system that involves a number of areas of brain and spinal cord (Oppenheimer 1983). Although it was once considered to be very rare, it is now recognized that MSA accounts for 4-22% (mean, 8%) of brains in parkinsonian brain banks (Quinn 1993), although its population prevalence remains unknown. Most patients with MSA are initially diagnosed as having idiopathic Parkinson's disease (IPD), and many of them are only From Woodbridge Hospital, Singapore (LP); Raymond Way Neuropsychiatry Research Group, London, United Kingdom (HR, MT); and Department of Clinical Neurology, Institute of Neurology, Queen Square, London, United Kingdom (NQ). Address reprint requests to Dr. H. Ring, Academic Department of Psychiatry, Royal London Hospital; Whitechapel Road; London E1 IBB, United Kingdom. Received December 17, 1992; revised January I1, 1995. correctly identified at autopsy. The main clinical emphasis of the motor disorder is sometimes used to separate cases into two main types: striatonigral degeneration (SND), in which parkinsonian features predominate; and the less common olivopontocerebellar atrophy (OPCA), in which cerebellar features predominate. When autonomic features are prominent, and combined with either of the above, the term Shy-Drager syndrome (SDS) is sometimes used (Table 1). The unifying term MSA, suggested by Graham and Oppenheimer (1969), is now widely used to take account of the range and extent of clinical and patholog- ical disturbance in this condition. There exists an extensive literature on the prevalence and nature of affective disorder, particularly depression, in IPD (Mindham 1970; Celesia and Wanamaker 1972; Mayeux et al 1984; Gotham et al 1986; Taylor et al 1986; Huber et al 1990; Sano et al 1990; Starkstein et al 1990; © 1996 L. Pilo et al. 0006-3223/96 SSDI 0006-3223(95)00232-6