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Depression and Parkinson’s Disease

Claudia GibsonBy Claudia Gibson, Lead Counselling Professional, Heather Hill Pathways.

How do you tell a Black Hole from a Grey Day?

Depression is one of the most significant and prevalent challenges experienced by people living with Parkinson’s Disease (PD).  Most people experience sadness occasionally in their lives. As a society, we would be considered normal to experience sadness and stress when faced with a difficult disease such as PD.  However, prolonged sadness can become a significant problem if it persists and becomes clinical depression and is left untreated regardless of the etiology.

What would you notice?

With Parkinsonism, there are other mental health problems that may emerge- such as hallucinations, delusions, and paranoia. These mental health symptoms increase the risk of generalised anxiety for the person with PD and their families and are all possible complications of Parkinson’s disease and/or its treatment. Fortunately, for most people with Parkinson’s disease, depression and mental disturbances can be controlled. Unfortunately, 60% of people with PD who suffer from depression are underdiagnosed.

The early recognition of depression in people with PD may also be complicated by the fact that depression may be present many years before any of the other symptoms of Parkinson’s disease become evident. Therefore, the person with PD may have established norms of mood and affect. So, the doctor, and their families may not recognise the symptoms or prolonged nature of the ‘sadness’

What is the difference?

In a person without the co-morbidity of PD, sadness is transient, depression is persistent. People who experience depression find that they cannot find any joy in their life. A person who is depressed may have little energy and may struggle to get out of bed in the morning.  Other symptoms of depression can include poor appetite, sleep disturbances, fatigue, feelings of guilt, self-criticism and worthlessness, irritability and anxiety.  Some people may begin having persistent thoughts that they would be better off dead or may even begin planning on ending their life.  The presence of these symptoms on most days for two weeks suggests a diagnosis of depression and should be discussed with a physician. A referral to a psychologist is recommended. Symptoms of Depression include:

  1. Persistent depressed mood
  2. An inability to find pleasure in things that were once pleasurable
  3. Sleep disturbances (inability to sleep or sleeping excessively)
  4. Change in appetite
  5. Fatigue
  6. Altered level of activity
  7. Difficulty with concentration
  8. Low self-esteem
  9. Thoughts of death

With the person who has PD. depression can actually increase the physical effects of Parkinson’s disease and possibly cause a faster progression of the disease.

The 10 Signs of Depression in Parkinson’s are:

1.  Excessive Worrying
2.  Persistent Sadness
3.  Crying
4.  Loss of interest in usual activities and hobbies
5.  Increased fatigue and lack of energy
6.  Feelings of guilt
7.  Loss of motivation
8.  Complaints of aches and pains
9.  Feelings of being a burden to loved ones
10. Ruminations about disability, death, and dying

How can Depression in Parkinson’s Disease be Treated?

In Parkinson’s disease, depression may be treated with psychological therapy, as well as with medications. People seem to do better when they receive both psychological and drug treatments.  There are many antidepressant medications available, each with their own advantages and disadvantages. The choice of antidepressant for patients with Parkinson’s disease depends on their overall condition and specific needs.

What can you do?

Where possible, it is important to link in with a specialist in Parkinson’s disease or geriatrician. Parkinson’s sufferers experience uncontrolled “on-off” periods and freezing episodes and doctors can assist people to control these symptoms.  The same is true of some other problems, such as, poor sleep, constipation and fatigue. All may need to have medical intervention to reduce the impact on the individual.

It is important to make the effort to exercise regularly, to eat well and to stay socially involved.  Regular exercise is an effective tool in helping the symptoms of both depression and PD.  Eating a healthy diet and staying involved in social and recreational activities are lifestyle approaches that can help feelings of well being.

Psychological treatments such as stress management, relaxation and cognitive behavioral therapy as well as peer group support.  Counselling and peers can help to cope with stresses, improve social relationships and find solutions to practical day-to-day impairments.

People with Parkinson’s should be aware that many medications are available for depression in PD.  The pharmacological treatment of depression in Parkinson’s disease needs to be individualized and may involve a variety of strategies.

If you are concerned, please contact your doctor and discuss.

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