Parkinson’s disease and depression

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By Paule Gauthier, Social Worker,

TCMHS Psychogeriatric Team

Parkinson’s disease is a movement disorder which affects various parts of the body, causing stiffness in the muscles, slowness, difficulty when starting movements and tremor in some people.

Parkinson’s disease affects parts of the brain called basal ganglia which play a vital role in the control of voluntary movements.

Symptoms may appear gradually and in no particular order and it make take years before early signs of tremor or movement difficulties become a nuisance. All these problems can usually be helped by medications and rehabilitation therapies. As research continues it should bring the symptoms of Parkinson’s disease under greater control.

Anxiety and depression can be present in 40 percent of patients diagnosed with Parkinson’s. The risk of depression for Parkinson’s patients doubles that of any other chronic condition.

The risk factors for depression are being female, early onset, diagnosis of Parkinson’s given in less than a year, history of depression in patient or family, decrease in mobility and postural problems, extensive vascular problems and hypothyroidism.

Diagnosis of depression should focus on mood. Is the mood poorer in the morning? Is life’s view negative, early awakenings, increase in anxiety and feelings of suicide but with no plan? The masklike face which often is part of Parkinson’s disease can make it more difficult to assess. Apathy can look like depression but can be related to the Parkinson’s disease. Motor slowing can mimic depression. The causes for the increase in depression at times are unknown and it may be attributed to changes in brain transmitters. There may an increase in degeneration in part of the brain. There is also a psychological reaction to the disease.

Treatment options may be as follows: treat any contributing medical condition e.g., thyroid, optimize Parkinson’s medication therapy. Counselling such as cognitive behaviour therapy, supportive counselling or group sessions are often helpful. Your family physician may treat with an antidepressant

Anxiety is also seen in 40 percent of patient’s diagnosed with Parkinson’s disease. Risk is higher in a patient with Parkinson’s than in the general population. Anxiety can appear before the patient has received the Parkinson’s diagnosis. With diagnosis of Parkinson’s there can be an inability to show emotions. Left side motor difficulties and decreased mobility appear to increase the anxiety problem. Anxiety may increase more with dyskenesia (involuntary movement). Psychological fear may also contribute to the anxiety level. The level of anxiety may be a combination of biological and psychological factors. Treatment recommended is optimization of Parkinson medication, education, support and counseling. Relaxation therapy may be another mode of treatment. Again, anxiety can be treated with antidepressants.

Psychosis is prevalent in 15 to 40 percent of patients diagnosed with Parkinson’s disease. Five percent usually develop cognitive dysfunction. Psychosis can be related to delirium, medications, anxiety and depression, sleep disruption, visual and hearing impairment. In these situations it is important to rule out the underlying cases. Treatment options could be to encourage sleep, be aware of sensitivities, medication review and treatment,

Practical solutions to everyday problems are to keep calm, stay positive, stay active, and take your medications as prescribed. You need to recognize your limitations. Try to keep you life as normal as possible. Access services in your community services, seek psychosocial support, and educate yourself and your family.

Information for this article: Presentation from Dr. Wiens from ROH, Parkinson Foundation of Canada For additional information contact Parkinson Society Ottawa 613-722-9238.

For more information or to receive the French version of this article, or to seek professional advice, please call 932-9940 or 1-800-465-8061. Free, confidential services are available in French and English to residents of Dundas, Stormont and Glengarry through their offices in Winchester, Cornwall and Alexandria.

Keeping Health in Mind is a monthly newspaper column made possible with the help of Seaway News and the clinical staff of Tri-County Mental Health Services, a community program of the Cornwall Community Hospital/Hôpital Communautaire de Cornwall.

Organizations: Parkinson Foundation of Canada, Parkinson Society, Seaway News Tri-County Mental Health Services Cornwall Community Hospital/Hôpital Communautaire de Cornwall

Geographic location: Ottawa, Dundas, Winchester Alexandria

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