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Many Parkinson's disease patients struggle with anxiety and depression. How do you recognize the symptoms, and what treatments are available to help you?

Anxiety and depression are both extremely common in Parkinson's disease patients — they may set in because the diagnosis is hard to come to terms with, as the disease progressively robs people of their independence, or because the neurological changes associated with Parkinson's change brain chemistry. This means that depression and anxiety can be issues at any stage of Parkinson's. 

Anxiety is a normal, healthy part of life when it strikes in response to worrying things in your environment. It is considered a medical problem when you feel anxious even when there's no objective reason to, or your anxiety is more extreme than warranted. While the mental signs of anxiety include worry, fear, obsessive and ruminating thoughts, trouble concentrating, and difficulty sleeping, physical signs can also be present:

  • An increased heart rate
  • Hot and cold flashes
  • A tight, uncomfortable feeling in your chest — some people having anxiety attacks even believe they're having a heart attack

Common symptoms of depression — which is more than a short-term adjustment or low mood in response to upsetting life changes — include:

  • A dominant state of mind of helplessness or hopelessness — feeling like nothing will get better
  • No longer being interested in activities that were previously meaningful or enjoyable
  • Social isolation
  • Low self esteem of confidence
  • Anger and irritability
  • Trouble concentrating

Physical symptoms include insomnia or oversleeping, low energy, and appetite and weight changes. 

Because some of the symptoms of anxiety and depression can also be caused by either Parkinson's disease or the medications you take for it, it may take you and your treating doctor a while to realize what is going on. Proper diagnosis and treatment are extremely important, however. Untreated depression and anxiety may have the knock-on effect of worsening your Parkinson's symptoms, which in turn can make you more depressed and anxious. The good news is that many things can help you feel better. 

Who should Parkinson's disease patients talk to if they're anxious or depressed?

While people without Parkinson's are more likely to talk to their family doctor or a psychologist about depression and anxiety, Parkinson's patients won't be making the wrong choice by having a chat with their neurologist either. Your neurologist will be familiar with the fact that Parkinson's disease patients often suffer from depression and anxiety, and will be able to advise you what to do next.

Once you talk to a doctor about your symptoms — whether you've chosen a primary care provider, a neurologist, or a mental health professional — you can expect the following steps:

  • Diagnosis, which may be made by a family doctor, a psychologist, or psychiatrist
  • A closer look at whether your Parkinson's or medications might be causing your depression or anxiety
  • Your doctor and you can now discuss treatment options — both pharmacological and non-pharmacological
  • Once you start the decided treatment, you'll check back in to let your healthcare provider know how you are getting on — a social worker may also be part of this process, and they can help you with practical things like improving your living conditions (by enabling access to home adaptations, for instance) as well

How are depression and anxiety treated?

Your treatment should be tailored to your personal needs to be effective. It may include anything from increased physical activity or having a home help to assist you with daily living activities to talk therapy and antidepressants or anti-anxiety meds.

Talk therapy

Talk therapy is a powerful tool that can help depressed and anxious people deal with the root causes of their conditions as well as help them build better coping skills as they move ahead. Commonly used techniques include:

  • Cognitive behavioral therapy (CBT) is one of the most popular kinds of therapy for people with depression and anxiety that often helps patients see results within a few sessions. During CBT, you and your therapist will analyze your thought patterns and attempt to come to more productive ways of seeing your situation and coping with it.
  • Interpersonal therapy (IPT) addresses interpersonal issues, meaning, broadly, the relationship you have with the world and the people in it. For some people with depression, it is as effective as antidepressants. IPT may also help with anxiety. 

Pharmacological management

If your depression or anxiety are severe, antidepressants or other medications may be the best way forward. When considering whether pharmacological treatments are right for you, your doctor should consider the potential side effects as well as how the medications may interact with drugs you are taking for Parkinson's. More commonly used medications include:

  • SSRIs, or selective serotonin reuptake inhibitors, are antidepressants that can also be used to treat anxiety disorders. Patients who experience anxiety attacks should take low doses, as higher doses can make their symptoms worse. Parkinson's patients who take selegiline (Zelapar) cannot use SSRIs.
  • Other antidepressants, like tricyclic antidepressants, are suitable for people with depression.
  • Dopamine agonists, commonly used in the treatment of Parkinson's disease, have antidepressant properties; if you do not already take one, your doctor may propose that you do. 
  • Benzodiazepines like diazepam (Valium) and lorazepam (Ativan) work well for anxiety, but they can induce confusion, memory issues, and increased motor symptoms in people with Parkinson's.

Lifestyle changes to help treat anxiety and depression

Exercise should be an essential part of your routine. Not only has it been shown to reduce the motor symptoms of Parkinson's, regular exercise also helps fight depression and anxiety — especially if you exercise outdoors. Any exercise that is otherwise considered safe for you, like walking, Tai Chi, yoga, swimming, aquarobics, and dance is an option. Choose an exercise that you enjoy or at least don't hate, so you're more likely to stick with it. 

Other things that can help include:

  • Massage has a relaxing effect and helps temporarily reduce muscle stiffness too.
  • Acupuncture is beneficial for overall wellbeing and may help your motor symptoms as well.
  • Meditation and breathing techniques can help with anxiety. 
  • Physical therapy, home adaptations, or home help — anything that makes life physically easier for you can help boost your mood.

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