Parkinson’s Disease and Depression

Mental Health and Parkinson’s Disease
Parkinson’s disease (PD) is a progressive nervous system disorder that generally affects movement. Usually, symptoms start gradually and worsen over time. A slight tremor in one hand is often the first symptom of PD, but other primary symptoms can include stiffness or slow movement. These describe some of the motor symptoms associated with PD. However, often times we fail to recognize the non-motor symptoms associated with this condition.


According to the Parkinson’s Foundation, about 50% of people with PD experience depression and/or anxiety related to their condition. Depression can be described as a mood disorder in which feelings of hopelessness and sadness interfere with a person’s ability to carry out daily living activities. Some symptoms of depression include crying, loss if interest in hobbies, feelings of fatigue, loss of motivation, feeling like a burden, experiencing aches and pains, and more. Results from the Parkinson’s Outcomes Project found that the combination between mood, depression, and anxiety impact ones health status even more-so than the motor impairments caused by PD. Some other non-motor symptoms associated with PD include irritability, fatigue, and unexplained pain. All of these symptoms can be a result of various factors, including the stress surrounding diagnosis, side effects of medication, and brain changes caused by the condition itself.

Diagnosis
Feelings of sadness, fear, and uncertainty are common in reaction to a PD diagnosis. However, it is important to note the difference between these short term emotions, and depression. It is normal to experience grief after learning about a PD diagnosis, but depression is different. Grief and sadness are temporary feelings, while depression is persistent and can last for weeks or more. After being diagnosed with PD, it is important to get emotional support from your social circle in order to prevent the onset of depression.

Medication
Most often, PD patients are prescribed with Levodopa and Carbidopa to treat the symptoms of their disease. PD symptoms are caused by a lack of dopamine, which is a naturally occurring hormone in the brain. Levodopa is a central nervous system agent which works by being converted into dopamine in the brain. Carbidopa, on the other hand, works by preventing levodopa from breaking down before reaching the brain. While this medication can be very helpful in minimizing tremors, slowness, and stiffness, it does have some side effects. Some people taking Levodopa report feeling anxious, dizzy, forgetful, confused, and have trouble sleeping at night. All of these side effects can make a patient experience feelings of depression. Seemingly, depression is not usually a direct side effect from PD medication. However, taking these medications may indirectly cause a person to feel depressed.

Brain Changes
On top of the stress accompanying a PD diagnosis and the side effects of PD medication, it is also important to consider the changes in brain chemistry resulting from PD. PD causes changes to the brain in areas that produce the hormones dopamine, serotonin, and norepinephrine. These hormones are involved in regulating mood, energy, motivation, appetite, and sleep. As you can imagine, a disruption to these brain areas can cause someone to feel down, irritable, and mentally exhausted.

Difficulties in Diagnosing Depression in PD Patients
While depression is a common symptom of PD, it is ofter overlooked and goes untreated. It can be difficult to diagnose a PD patient with depression for a number of reasons. First of all, some symptoms of depression can overlap with PD symptoms. Sleep problems and fatigue, for example, are symptoms of both PD and depression. Sometimes, people with PD do not seek treatment for their depression because they may not realize they are suffering from a mood problem. Additionally, many PD patients have a hard time expressing emotion due to facial masking. Facial masking happens as a results of the effect the disease has on a persons face, making them unable to express emotions through facial expressions. As a result, it is helpful to ask a family member or caregiver if they have noticed any changes in the patients mood.

Recommendations and Treatment options
Thankfully, there are a number of suitable treatment options for people with PD associated depression. The two main approaches include antidepressant medications and/or psychotherapy. Most drugs prescribed to people with depression are selective serotonin re uptake inhibitors. Essentially, these drugs keep serotonin, the “happy hormone,” circulating in the brain for a prolonged period of time in order to provide the patient with effects of feeling happy. Psychotherapy, on the other hand, refers to a variety of counselling methods. Cognitive Behaviour Therapy, or CBT is one of the most common and effective methods of treating depression related to PD. The Parkinson’s Foundation has recommended that patients take a holistic and comprehensive approach in combating their depression. This means that the best approach likely results from a combination between medications, counselling, physical activity and social support. Below are some helpful recommendations if you think you may be suffering from depression as a result of PD:

  • Get screened for depression at least once a year
  • Seek support groups and communities of people who share the same condition as you, and experience similar symptoms
  • Bring a family member with you to your appointments
  • Engage in daily physical activity, such as walking or yoga, to stimulate endorphins - Consider cognitive behavioural therapy, which can help people recognize their thoughts and change their behaviour
  • Maintain social ties - plan to connect with friends or family at least once a week - Set goals and celebrate successes - big or small!

Overall, it is important to recognize and treat the non-motor symptoms associated with PD. Depression related to PD can be cause by a combination of anxiety surrounding diagnosis, side effects from medication, and/or brain changes caused by the disease itself. Fortunately, there are a number of ways to treat depression. If you or a loved one feels like they may be experiencing depression related to PD, you are not alone! Do not be afraid to reach out to family, friends, physicians, or PD support groups for help. After-all, mental health = physical health. In order to minimize any motor symptoms related to PD, it is crucial to be mindful of your mental health, and keep a positive outlook!

Sources:
Parkinson’s Foundation. (N.d). Depression. https://www.parkinson.org/Understanding Parkinsons/Symptoms/Non-Movement-Symptoms/Depression
Korczyn, A.D. (2004). Drug treatment of Parkinson's disease. Dialogues Clin Neurosci, 6(3): 315-322. doi: 10.31887/DCNS.2004.6.3/akorczyn

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