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Parkinson’s And Mental Health

When To Seek Help For Mental Health Issues

Mental Health and Parkinson’s Disease

One question that readers may have is when do I seek help for my mental health issues and when do I consider my concerns just to be a normal part of life? There is no one right answer to this question, but as a rule, if the mental health issue that has arisen is interfering with your normal level of function, then it is time to seek out medical advice. Most issues can be improved with counseling, other lifestyle adjustments, changing your PD meds, or adding other medications, so there is no need to struggle in silence.

Exacerbation Of Pd Symptoms

Treating MH comorbidities, especially psychosis, in patients with PD often leads to an exacerbation of PD symptoms. First-generation antipsychotics and second-generation antipsychotics have been linked to an increase in PD symptoms, owing primarily to prolonged use of dopamine receptor blockers. PD patients may experience worsening of extrapyramidal symptoms , including akathisia, parkinsonism, dystonia, and tardive dyskinesia .23

TD develops in approximately 20% of patients on long-term antipsychotic therapy, and there is some debate over a lower incidence with SGAs.23 It can present after brief exposure to a dopamine-blocking agent, but mostly develops after months or years of therapy.23 The comparatively lesser severity of EPS with SGAs is postulated to be due to dual serotonin-dopamine receptor antagonism.6 The risk of TD development in PD patients poses a problem for therapy.

SGAs are thought to have a more favorable side-effect profile than FGAs. The mechanisms of these agents will be discussed in the treatment recommendations section.

Add A Digestive Detoxifying Elixir

An easy way to prepare your gut for the day is to drink a combination of raw apple cider vinegar , lemon, and warm water first thing in the morning on an empty stomach.

Raw apple cider vinegar is a scientifically proven antifungal, helps stabilize blood sugar, and stimulates digestion while lemons are high in Vitamin C. These help kick-start the detoxification of the liver, allowing it to produce bile and move toxins into your stool.


8 ounces of warm water

Juice from ¼ of a lemon

  • Combine and chug. Swish some water around your mouth and teeth after to help with the taste and protect your tooth enamel.

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How Are Cognitive Problems Treated

Much remains to be learned about the basic biology that underlies cognitive changes in PD. Researchers work towards the development of diagnostic tests to identify people who seem to be at greatest risk for cognitive changes and to differentiate cognitive problems in people with PD from those that occur in another disorder related but different known as dementia with Lewy bodies.

Learn More About Mental Health And Parkinsons


Friday, September 179 am 1:15 pm Mountain Daylight Time The Victory Summit Virtual Event: Mental Health is almost here, and its all about the unseen side of Parkinsons. Nearly 80% of people living with Parkinsons report feeling depressed and anxious at some point throughout their disease. Feeling depressed and/or anxious can negatively impact your motor symptoms, relationships, sleep, disease progression, ability to exercise, and more, all of which are critical aspects to living well with Parkinsons. During this event, you will learn from and interact with doctors who specialize in symptoms related to mood. Youll also hear from people with Parkinsons who have experienced various levels of depression and anxiety and the actions theyve taken to reduce these symptoms and live better and thrive with Parkinsons. For more information and to register for the event, here.

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Why Does Parkinsons Cause Non

In Parkinsons, brain cells that produce important neurotransmitters, such as dopamine, are gradually lost over time. The main area of the brain that is affected is the substantia nigra a region of the brain that helps control movement. But researchers now know that Parkinsons is much more complex than this. Changes have been found in areas of the brain stem involved in controlling things such as sleep, and in the frontal part of our brain responsible for things like planning and memory. This could explain why there is such a range of symptoms.

Another explanation for the range of symptoms hinges on the role of neurotransmitters in the brain. They have a vital role in controlling both physical and mental health. In Parkinsons, levels of these chemicals are altered causing a range of symptoms.

While changes in dopamine account for many of the motor symptoms of Parkinsons, changes in other neurotransmitters like serotonin may play more of a role in symptoms such as sleep problems, fatigue and depression. And acetylcholine, another neurotransmitter impacted in the condition, is involved in thinking and memory.

Because symptoms can be due to changes in both dopamine and, or, other signalling molecules, medication that is currently used to replace the lost dopamine in Parkinsons often doesnt help with the management of all non-motor symptoms.

What Causes Cognitive Changes In People With Pd

One cause is a drop in the level of dopamine, the neurotransmitter that is involved in regulating the bodys movements. However, the cognitive changes associated with dopamine declines are typically mild and restricted.

Other brain changes are likely also involved in cognitive decline in PD. Scientists are looking at changes in two other chemical messengers acetylcholine and norepinephrine as possible additional causes of memory and executive function loss in Parkinsons.

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How Are Cognitive Changes In Pd Different Than Alzheimers Disease

Overall, dementia produces a greater impact on social and occupational functioning in PD than with Alzheimers due to the combination of motor and cognitive impairments.

  • There is some overlap between symptoms and biological changes seen in Alzheimers and PD. However, it is less likely for both disorders to occur at the same time.
  • Development of dementia in people with PD represents progression of the disease, usually after several years of motor impairment.
  • Dementia may or may not occur in people with PD. According to recent research, 30 percent of people with Parkinsons do not develop dementia as part of the disease progression
  • See 10 Signs of Alzheimers.

Depression In Parkinson’s Disease

Parkinson’s and Mental Health during Lockdown

Depression has been reported to be very common in patients with PD. In fact the relationship of depression and PD follows a vicious cycle, with the presence of either increasing the risk of other disorder. The risk of PD is patients with depressive disorders have been reported to be more than that seen in general population. A large sample retrospective study of a matched cohort of 23,180 participants , reported that patients with depression were 3.24 times more likely to develop PD compared with the control patients. Another register-based study that had data of 105,416 subjects evaluated the history of depression in patients diagnosed with PD and reported a life time prevalence of depression prior to onset of PD to be 9.2% compared to 4% in the control population and the difference between the two groups was statistically significant and the odds of having depression in patients with PD was 2.5. Few studies have evaluated the incidence of depression in patients with PD and reported the incidence rate to be 1.86-5.1% per year.

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Management Of Dual Diagnosis Of Parkinsons Disease And A Mental Health Disorder

Jasmine Carpenter, PharmD, BCPS

Adepeju Awodipe, PharmD Candidate 2015Howard University College of PharmacyWashington, DC

Washington, DC

US Pharm. 2015 40:34-38.

ABSTRACT: Mental health disorders are frequently seen in patients with Parkinsons disease , possibly as a result of the complex imbalance of neurotransmitters in both disease states. This imbalance poses various treatment challenges, such as the exacerbation of both disease states and drug interactions between the medications used to treat PD and mental health disorders. Owing to these challenges, mental health disturbances in PD patients often go untreated. By assisting with ruling out causative medications and underlying disease states, simplifying antiparkinsonian regimens, and recommending antipsychotics, the pharmacist can help ensure that both of these disease states are adequately treated.

Parkinsons disease , which impacts millions of people worldwide, is a neurodegenerative disorder involving the deterioration of motor, mental, and functional skills.1 This degenerative decline increases mortality rates and negatively affects patients quality of life. Motor movement disorders are heavily emphasized as cardinal signs of PD however, nonmotor manifestations such as depression, anxiety, and psychosis are major concerns that must be addressed in this patient population.

Do Something Nice For Yourself Every Daydo Not Drop Out Of The Mainstream Of Life

Enlist other family members to assist on a regularly scheduled basis Hire aides at home for several hours on a regular basis Participate in exercise programs Participate in education seminars and support groups Consult with a mental health professional Have a home safety evaluation Make use of adult day-care programs

Care partners must be reminded that their health is at stake, and that they are entitled to have some free time to recharge their emotional batteries. Recommendations for alleviating the burden for the primary care partner are listed in Box 2. Care partners should all be encouraged to participate in PD support groups and educational programs, as they will benefit from the advice and experience of others who have had to cope with similar situations. Consultation with a mental health professional is important for care partners who are becoming overwhelmed or depressed.

Family members or friends often say they are willing to pitch in and help the primary care partner without committing to a specific schedule. The assistance of other family members should be arranged on a predictable and regular basis. This might enable the primary care partner to make plans in order to re-engage in the mainstream of life . The assistance of family members on a haphazard basis or only during emergency situations does not ease the ongoing daily burdens for the care partner.

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Risk Of Parkinson’s Disease In Patients With Psychiatric Disorders

The influence of mental illness early in life on the subsequent risk of PD and its clinical picture remain obscure. Several studies have identified certain psychiatric illnesses, particularly anxiety, depression and schizophrenia as risk factors for PD. Anxiety has been suggested to be one of the earliest manifestations of PD in several case-control and cohort studies.

Parkinsons Gut Health Jump Start

improving the mental health of those with parkinsons

Its no surprise that the hunt is on for new therapeutic approaches for Parkinsons that target the gut microbiota . Fortunately, you dont have to wait for the next scientific breakthrough to get a jump start on improving the health of your gut.

The goal of this jump start is to begin to decrease inflammation, heal the gut lining, and restore healthy gut balance through 4 simple strategies that you can start today with very little investment and very little change to your diet.

Lets take a look

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Eat A Healthy Breakfast

The first meal of the day should be packed with nutrients, fiber, and antioxidants needed for gut healing and building a balanced gut microbiome. Eating brain-boosting foods like fresh fruits and vegetables, healthy fats, nuts, and seeds will also keep your blood sugar balanced so you have more energy throughout the day.

Aim to have the first meal of the day be the healthiest, and ride the wave of success the rest of the day!

Exacerbation Of Mh Conditions

The medications used to treat PD often cause psychiatric disturbances specifically, psychosis, impulse-control disorders , and mania.

Psychosis: One of the most prominent and best-documented neuropsychiatric symptoms related to antiparkinsonian drug therapy is psychosis. PD-related psychosis is often characterized by visual and auditory hallucinations, illusions, and delusions.4,5 While auditory hallucinations are infrequent, visual hallucinations occur in 20% to 30% of drug-treated PD patients.4-8

The onset of psychosis-related symptoms related to antiparkinsonian drugs may occur soon after initiation or not until after 1 year of therapy.5,9 Early onset of psychosis is more likely in patients with a past medical history of psychiatric illness, and the psychosis resolves after drug discontinuation or dosage reduction.9

The antiparkinsonian medications associated with psychosis include dopaminergics and anticholinergics, amantadine, and monoamine oxidase B inhibitors .5,10-13 Of these, dopaminergics have the highest potential for inducing psychosis in PD patients.14 Levodopa exhibits dose-related psychiatric symptoms in a high proportion of PD patients.5,14,15

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Parkinsons Disease And Mental Health

Anxiety and depression are two of the most common non-motor symptoms of Parkinsons, with nearly half of all people with the condition experiencing them at some point.

Symptoms may range from mood swings, to feelings of sadness and restlessness. Some of these symptoms can be treated with regular exercise, staying socially active or by taking medication and seeking counselling. Make sure to discuss these concerns with a healthcare professional.

To find out more about mental health symptoms and Parkinsons, visit the EPDA website.

Read more:

Parkinsons Doesnt Just Affect People Physicallyit Can Also Take A Toll On Our Emotions We Asked Clinical Psychologist Louise Marasco About The Mental Impacts Of Pd And How To Manage

Managing mental health and Parkinson’s

Sometimes people with Parkinsons spend so much time concentrating on the physical changes that occur with PD that they neglect to address the mental or emotional impacts of this disease. Stress, anxiety, depression, grief and apathy are common emotions that people with Parkinsons may experience at diagnosis or as the disease progresses.

We recently spoke with Dr. Louise Marasco, a licensed clinical psychologist at Oregon Health & Science University about managing the impacts that Parkinsons disease has on a persons mental and emotional health.

Brian Grant Foundation: What are some common mental health struggles that people with Parkinsons cope with as their disease progresses?

Louise Marasco: The most common mental health struggle I hear about is what people refer to as anxiety. Depression is certainly prevalent, though I would argue that often times it is more an issue of apathy and/or emotionality, difficulty regulating emotions, rather than clinical depression.

BGF: Whats the difference between depression, apathy and grief in relation to Parkinsons, and how do you treat them?

LM: Great question, and sometimes difficult to tease out. Grief is a normal, expected response to loss. People grieve when they lose loved ones, but they also grieve when they cant work anymore, or play squash or walk without assistance. We do not exactly treat grief, but nurture, support and guide people going through this normal response.

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Seeking Help For Cognitive Changes

Cognitive change is a sensitive issue. In fact, the doctor is often as hesitant to address this subject as the person with PD is to ask about it. Sometimes, the doctor will delay discussing cognitive impairment out of concern for the person who is still coping with the shock of a new PD diagnosis or struggling with motor symptoms.

For this reason, the person with PD often needs to be the one to initiate the conversation. Tell your doctor if you or your loved one is experiencing problems that upset the family or cause interruptions at work.

Cognitive issues are never too mild to address with your care team. A doctor can provide ways to help, often, referring psychiatrist, neuropsychologist, speech or occupational therapist for further evaluation and assistance. The neuropsychological evaluation can be particularly useful, especially in the early stages of a cognitive problem. Having this baseline test can help the doctor determine whether future changes are related to medications, the progression of the PD itself or to other factors such as depression.

When reporting symptoms of mild cognitive impairment, the doctor will first want to rule out causes other than PD, such as Vitamin B-12 deficiency, depression, fatigue or sleep disturbances. It should be noted that PD does not cause sudden changes in mental functioning. If a sudden change occurs, the cause is likely to be something else, such as a medication side-effect.

David: On Anxiety Sleep And Focusing On The Positive

David , a 74 year-old man with PD diagnosed two years ago, has been dealing with anxiety and depression for decades. I was in therapy as a teenager and young adult for issues of anxiety and depression. But about five to six years ago, the anxiety worsened, and he sought out the care of the same therapist he saw when he was in his thirties.

The intensification of his anxiety preceded his diagnosis of PD by a few years, a relatively common phenomenon in which particular non-motor symptoms of PD appear before the motor symptoms. In addition, since his diagnosis of PD, he started noticing some cognitive issues specifically trouble with his memory and word-finding difficulties.

Initially, controlling the anxiety and dealing with the cognitive changes were very difficult for David and the two issues were inter-related for him. A word-finding difficulty would inevitably trigger anxiety. I used to go crazy because I couldnt think of particular words. And that anxiety would then make it even harder to find the right word.

He cant emphasize enough the importance of a good nights sleep. He used to get four hours of restless sleep. Now with the help of his more relaxed view of life and current medication regimen, he is able to get 6-7 hours of restful sleep and that has led to a major improvement in his quality of life.

Key lessons that David can share about his mental health include:

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Causes Of Parkinson’s Disease

Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

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