Data Charting And Collating Summarizing And Reporting Results
The research team investigators collectively developed the data-charting form to determine which variables to extract. This form was revised during meetings throughout the stages of the review, and uncertainty was resolved with periodic team meetings and the involvement of a fourth investigator . The following variables were extracted from each study: author, year and country of publication, characteristics of patients investigated , Bupropion primarily indication and dosage, results on effectiveness and safety.
Meds Ease Depression In Parkinsons Patients Without Worsening Other Symptoms
- Meds Ease Depression in Parkinsons Patients Without Worsening Other Symptoms
Todays anti-depressant medications can ease depression in Parkinsons patients without worsening other symptoms of the disease, according to a study published online in Neurology®, the medical journal of the American Academy of Neurology.
Depression is the number-one factor negatively affecting the quality of life for people with Parkinsons disease, said Irene Hegeman Richard, M.D., who led the study. It causes a great deal of suffering among patients. The great news here is that its treatable. And when the depression is treated adequately, many of the other symptoms become much more manageable for patients, added Richard, a neurologist at the University of Rochester Medical Center.
The findings are good news for patients with Parkinsons disease, a chronic neurologic disorder best known for causing slow movement, stiffness, balance problems and other motor difficulties. However, about half of Parkinsons patients also struggle with depression.
Its very important to note that these patients are not depressed simply because they are dealing with a chronic neurological condition, said Richard. Rather, the depression is caused by the underlying disease process, which also causes problems with movement and balance.
Anxiety And Parkinsons: Ask The Expert
Amjad explains that 31% of people with PD will have symptoms of anxiety. This blog post identifies the emotional and physical symptoms of anxiety and the factors that make it more likely someone with PD will experience anxiety. Treatment options include SSRI medications and psychological treatments, like CBT. The best coping strategy is to continue doing things that make us anxious, but in a way that allows us to feel in control. A few ways to do this are outlined.
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Medications To Avoid Or Use With Caution
Sign up for our email list and receive our publication on medications with potential complications you should be aware of.
Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons disease and discuss the pros and cons of each with your physician. It may help to know that there is no right answer, and if you try something that doesnt work for you, you can always adjust your plan.
To learn more about adjusting medication plans, view our webinar on What to Do When Your Medications Stop Working.
Difficulties In Diagnosing Depression In Patients With Parkinsons
- Certain symptoms of depression overlap with symptoms of PD for example, sleep problems and feeling slowed down occur in both conditions.
- Some experts think that depression in PD often involves frequent, shorter changes in mood versus a constant state of sadness daily.
- Many people with PD express less emotion due to the effect the disease has on the muscles of the face. This symptom, called facial masking, makes a person unable to express emotion through facial expressions.
- Many people with Parkinsons do not seek treatment because they often do not recognize they have a mood problem or are unable to explain symptoms. For these reasons, it is helpful to ask a caregiver or loved one if he or she has noticed any changes commonly reported in depression.
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Effectiveness On Depressive Symptoms
Considering the results of the present scoping review, the first question that can be answered relates to Bupropion antidepressant effectiveness in patients with PD. Overall, most of the retrieved reports seem to support its use. Indeed, the RCT and three reviewed open-label studies demonstrated a variable degree of the antidepressant effectiveness of Bupropion in patients with PD. Similarly, the majority of case reports who measured depressive outcomes showed improvement of depressive symptoms, while only one reported no changes. Despite diverse methodology and publication biases , we can conclude that Bupropion is potentially a valuable treatment option to target depressive symptoms in patients with PD. This recommendation is supported by the treatment guidelines from the Neurological Association of Madrid , specifically indicating Bupropion for the treatment of apathy associated with PD, though with a low level of evidence and grade of recommendation . Apathy is a common symptom in PD patients, with a frequency reported between 16.5% and 42% of cases of PD . According to these guidelines, Bupropion is the only antidepressant recommended for apathy: thus, it might be particularly useful in PD patients who manifest an intense lack of feelings, emotions, or interests.
Etiology Of Depression In Pd
There have been several explanations for why depression occurs in PD. A psychological explanation suggests that depression is a reaction to the stress of coping with a chronic and progressively disabling disease. A biomedical perspective argues that depression is a primary neurochemical consequence of the neurodegenerative process of PD, attributing depression in PD to deficits in dopaminergic, noradrenergic, and/or serotonergic systems . Evidence from studies that have examined disease correlates of PD, prevalence rates, and brain abnormalities between depressed and non-depressed PD patients have supported both models and are described below.
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Anxiety And Laterality Of Parkinson’s Disease
A number of studies have examined the relationship between anxiety and laterality of parkinsonian symptoms. These studies have shown that anxiety in patients with Parkinson’s disease was associated with mainly left sided symptoms. If anxiety in patients with Parkinson’s disease was a psychological response to disability, then patients with right sided parkinsonism would be expected to be more anxious: in fact the opposite is the case.
Alternative Treatments And Lifestyle Changes
Your doctor could also recommend alternative therapies like:
- Relaxation techniques
Lifestyle changes can also help manage your symptoms. Regular exercise boosts your mood, helps you sleep better, and could ease symptoms. Eating healthy food, getting enough sleep, and making time to relax might help too. Having social support can make a big difference.
If medication, therapy, and alternative treatments donât work, your doctor may consider things like vagal nerve stimulation, electroconvulsive therapy, or other therapies.
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When Should I Talk To My Healthcare Provider
Talk to your healthcare providers about your mood at every appointment. Talking about it regularly will prompt you to open up. And it will help your healthcare providers notice symptoms of depression early so they can provide care.
If you start to think about hurting yourself, call a healthcare provider immediately. You can also call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.
In an emergency, call 911.
A note from Cleveland ClinicDepression from Parkinsons disease isnt a sign of weakness or something you have to live with. Its related to chemical changes in your brain, and treatments can help. Talk to your healthcare provider about your mood, especially if you feel down for weeks at a time. Several strategies can help you feel better. You can still take part in things you enjoy and better manage the symptoms of Parkinsons disease.
Last reviewed by a Cleveland Clinic medical professional on 12/20/2020.
References
Mood Changes In Parkinson’s
When faced with a diagnosis of Parkinson’s disease , it is understandable to feel depressed or anxious. But mood disorders such as depression and anxiety are clinical symptoms of Parkinson’s, just as are slowness of movement and tremor. In fact, up to half of all people with Parkinson’s may suffer from depression and/or anxiety at some point during the course of their disease. Like all symptoms of PD, mood changes are different for different people. Some people with depression feel sad and lose interest in things they used to enjoy, while others feel irritable and have difficulty sleeping. People with anxiety often feel overly worried or concerned, or say they are “on edge.”
The good news: Over the past decade, researchers have placed increasing focus on these aspects of PD, and today we have a better understanding of how to treat mood disorders in Parkinson’s.
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Depression And Parkinson’s Disease
Depression is a mood disorder that affects more than half of those with Parkinsons.1,2 Its symptoms can affect the way you feel and think, and cause changes to your regular patterns of sleeping and eating, as well as your ability to go to work and interact with friends and family. There are different types of depressive disorders and the symptoms can vary.2
Depression can be diagnosed by a physician and can generally be effectively treated with talk therapy and medications. The treatment approach is very individual based on the symptoms you are experiencing, other medications you take, and your personal medical history along with Parkinsons stage. No one drug is effective for everyone, and it may take trying several before finding the one or combination that works best for you. It is important to carefully follow the prescribed instructions when taking antidepressants and report any side effects to your physician.
What To Do During A Panic Attack
If a person senses the onset of a panic attack, it is best to resist the urge to fight it. It may help to remember that the feeling will pass, is not dangerous or life threatening, and will not harm them physically.
Finding a peaceful spot may help if possible, as sights and sounds can intensify a panic attack. A person can also try some relaxation techniques, such as:
- taking long, slow, deep breaths
- smelling a soothing scent, such as lavender
- focusing on a physical object in the environment to help them feel more grounded
- repeating a mantra, which is a word, phrase, or sound that may help shift their focus away from fear
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Longtime Antidepressant Could Slow Parkinsons
- Date:
- Michigan State University
- Summary:
- Scientists now have early proof that an antidepressant drug thats been around for more than 50 years could slow the progression of Parkinsons.
Michigan State University scientists now have early proof that an antidepressant drug thats been around for more than 50 years could slow the progression of Parkinsons.
In a proof-of-concept study, published in the journal Neurobiology of Disease, the drug nortriptyline, which has been used to treat depression and nerve pain, stopped the growth of abnormal proteins that can build up in the brain and lead to the development of the disease.
Depression is a very frequent condition associated with Parkinsons, so we became interested in whether an antidepressant could modify how the disease progresses, said Tim Collier, lead author of the federally funded study and a neuroscientist at MSU.
Collier and collaborator Katrina Paumier, an assistant professor of molecular medicine, began looking at previous patient data to see if individuals who were on antidepressants experienced any delay in their need to go on a standard Parkinsons therapy called levodopa. This type of therapy increases levels of dopamine, a natural chemical in the body that sends signals to other nerve cells and can significantly decrease in cases of Parkinsons.
The medication also treats many of the symptoms associated with the disease such as tremors and poor muscle control.
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Parkinsons Disease And Depression
Parkinsons disease is a chronic, progressive neurodegenerative disorder clinically diagnosed by a combination of cardinal motor signs: bradykinesia, resting tremor, rigidity, and postural instability. The pathological hallmarks of Parkinsons disease include the loss of dopaminergic neurons within the substantia nigra and the presence of Lewy bodies, intracytoplasmic inclusions comprised mainly of alpha-synuclein . While the estimated prevalence for Parkinsons disease has varied widely, a recent meta-analysis reported the worldwide prevalence to be approximately 0.3% in the general population, suggesting that there are 7.5 million people living with the disorder worldwide . The incidence has been found to rapidly increase in populations over 60 years of age, with a mean age at diagnosis of 65 years . A male predominance has also been observed in many but not all epidemiologic studies, suggesting that men may have a higher risk for developing the disease than women .
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Management Of Depression In Parkinsons Disease
Although traditionally considered a purely motor disorder, Parkinsons disease is increasingly recognized as a complex disease process with diverse neuropsychiatric complications in addition to its motor symptomatology. The range of neuropsychiatric complications associated with Parkinsons disease is broad and includes depression, anxiety, apathy, psychosis, cognitive impairment, impulse control disorders, and sleep disturbances. These neuropsychiatric complications become increasingly prevalent over the course of the disease and are often associated with poorer quality of life, increased disability, worse outcomes, and greater caregiver burden . As mental health providers commonly encounter depression in the Parkinsons disease population, it is important to be familiar with available, validated treatment options for this illness.
Anxiety As An Early Warning Sign
It may be that anxiety disorders that are diagnosed as much as two decades before Parkinsons disease may be a harbinger of the disease, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic. Parkinsons disease, like Alzheimers disease, has what experts call a long approach, he says, and anxiety may be part of that long approach.
One theory is that the anxiety that comes before Parkinsons results from the same underlying changes in brain chemistry and circuitry. Others believe that Parkinsons disease and anxiety share a common genetic risk factor. Either way, taking a closer look at the link can help doctors understand the causes of Parkinsons and treat patients with the disease.
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Depression In Pd Versus Other Illnesses
Whether depression is found more frequently in PD relative to other non-neurological illnesses is unclear. If PD patients are at greater risk for developing depression, then the affective disturbances found in PD can be related to neurological disease as opposed to a psychosocial stress response in reaction to having a chronic and disabling illness. Several studies examined rates of depression between PD patients and other disabled clinical populations. Again, the collective evidence does not support either a biomedical or psychological interpretation. For instance, three separate studies found that PD patients were significantly more depressed than paraplegics, amputees, and patients suffering from various medical/surgical conditions . However, the comparison groups in these studies were not equivalent to the PD sample with respect to age and duration of illness.
Focus On Depression In Parkinsons Disease: A Delphi Consensus Of Experts In Psychiatry Neurology And Geriatrics
Luis Agüera-Ortiz
1Servicio de PsiquiatrÃa, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
2Centro de Investigacion Biomedica en Red de Salud Mental , Madrid, Spain
3Movement Disorders Unit, Servicio de NeurologÃa, Hospital ClÃnico San Carlos, Complutense University, Madrid, Spain
4Movement Disorders Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
5Service of Psychiatry, University Hospital Ramón y Cajal. CIBERSAM, IRYCIS. University of Alcalá, Madrid, Spain
6Service of Neurology, HGU Gregorio Marañón, Madrid, Spain
7Memory Disorders Unit, HM Hospitales, Madrid, Spain
8Service of Psychiatry, Hospital Universitario San Jorge, Huesca, Spain
9Neurological Rehabilitation Unit, ClÃnica Ubarmin, Pamplona, Navarra, Spain
10Service of Neurology, Instituto de Neurociencias, Hospital ClÃnico San Carlos, San Carlos, IdISSC, Madrid, Spain
Abstract
1. Introduction
Neuropsychiatric disorders such as depression very often accompany core motor impairments of Parkinsons disease . More and more, they are perceived as significant contributors to PD morbidity and caregiver burden as they have a major impact on patients function, quality of life, and long-term outcomes. In fact, it has been suggested that PD should be classified as a neuropsychiatric disease itself rather than a movement disorder .
2. Materials and Methods
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How Do I Cope With Depression Related To Parkinsons Disease
Besides treatments, other strategies can boost your mood and increase your self-worth:
- Ask for help. Remember, depression isnt a sign of weakness. Its caused by chemical changes in your brain.
- Connect with Parkinsons disease support groups in person or online.
- Exercise several times a week.
- Maintain your hobbies and activities.
- Schedule fun activities in advance so you have things to look forward to.
- Identify small tasks you can accomplish each day, such as completing a chore, exercising or calling a friend.
- Take part in social activities so you dont feel isolated.
- Try complementary therapies, such as music therapy, relaxation techniques, massage, acupuncture and meditation.
Moving With Mood Changes In Aging And Parkinsons: A Look At Depression And Anxiety
In this one-hour webinar a panel of physicians and people with PD that include a psychiatrist, neurologist, and a music producer discuss how and why mood changes, such as depression and anxiety, happen in Parkinsons, how you and your loved ones can talk about these symptoms with each other and with your providers, and what treatment options are available.
Webinar Notes on the Stanford PD Community Blog
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Anxiety And Parkinsons Research
What does this finding mean for the future of diagnosis or treatment of Parkinsons? Ongoing research is compelling, says Pontone. Part of what we are doing is looking at anxiety disorders that occur long before the onset of Parkinsons to see if there are characteristics that may differentiate that anxiety or predict an increased risk of Parkinsons disease.
Meanwhile, because theres an established link between anxiety and Parkinsons disease, patients and their families should be upfront with their doctors about anxiety symptoms. Behavioral therapy and medications for example, anti-anxiety meds or antidepressants can effectively treat anxiety disorders. Theres no need for anyone to suffer in silence.
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