How Do You Treat Depression In Parkinson’s Disease
Your depression can be treated with psychological therapy and medication. People seem to do better when they get both types of treatment.
There are many antidepressant medications, and each has pros and cons. Which one your doctor suggests depends on your overall condition and specific needs.
Most people should not take amoxapine because it could temporarily make Parkinson’s symptoms worse.
Psychological therapy can help you rebuild your sense of self-worth. It also can help you keep up good relationships with your caregivers and family members.
Accidental Really Attributional Bias In Patients With Parkinsons Disease
CONCLUSION: To our knowledge, this is the first study to have assessed attributional bias in patients with PD and explored the impact of deep-brain stimulation on this particular subdomain of social cognition. Results suggest that patients exhibit attributional bias, and this impairment may be exacerbated in stimulated patients.Read More
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Treatment Approaches For Mood Disorders
Mood disorders like depression and anxiety can be treated with:4
- Talk therapy
- Medicines
- A combination of therapy and medicines
Research studies have found that people who receive both therapy and medicine have better outcomes compared to those receiving treatment with just 1 or the other. Drugs for mood disorders often take several weeks to start working. As with all medicines, antidepressants and anti-anxiety drugs have side effects. Possible side effects and the risks and benefits of each drug should be discussed with a doctor.4
Research has shown that depression and anxiety in people with PD may be due to changes in brain chemistry caused by the disease. PD affects the pathways that create the neurotransmitter dopamine in the brain. These same pathways also create the hormonal neurotransmitter serotonin. This regulates mood, appetite, and sleep.1,2,5
Some treatments for mood disorders target serotonin, like selective serotonin reuptake inhibitors . Selective norepinephrine reuptake inhibitors are another class of drugs for depression. People taking these treatments should discuss them with a neurologist who is a movement disorders specialist. They are specially trained and understand which medicines are best for people with PD.1,2,5
Treatment for anxiety may include:1
- Anti-anxiety drugs
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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.
Caregiving & Helping Others
Parkinsons disease can be emotionally difficult for caregivers, but it also has its rewards.
Here are some strategies that can be helpful while caring for a person with Parkinsons disease:
According to a 2018 study, the cognitive symptoms of Parkinsons disease had a greater emotional impact on loved ones and caregivers than the physical symptoms. As the dementia progresses, carers may experience a sense of grief and loss, as they feel their loved ones are not themselves anymore.
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How Are Mental Health Problems Treated In Parkinsons Disease
Mental health problems in Parkinson’s disease can be treated with a combination of medication, talking therapy and lifestyle changes. Your doctor may also suggest joining a Parkinsons support group so that you can share your challenges with other PD patients.
Other ways to care for your mental health if you have Parkinson’s include:
Parkinson’s disease and mental health problems are not easily cured. However, there are a variety of treatment options and lifestyle changes that can boost your mental wellbeing and improve your overall quality of life.
Is There A Cure For Parkinsons
Theres currently no cure for Parkinsons, a disease that is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinsons is often misdiagnosed.
Its reported that Parkinsons complications was the
Complications from Parkinsons can greatly reduce quality of life and prognosis. For example, individuals with Parkinsons can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.
Proper treatment improves your prognosis, and it increases life expectancy.
It may not be possible to slow the progression of Parkinsons, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.
Parkinsons disease is not fatal. However, Parkinsons-related complications can shorten the lifespan of people diagnosed with the disease.
Having Parkinsons increases a persons risk for potentially life threatening complications, like experiencing:
- falls
Parkinsons often causes problems with daily activities. But very simple exercises and stretches may help you move around and walk more safely.
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Groups For Care Partners
Care partners may also benefit from joining support groups. The Parkinsons Foundation notes that it is important for care partners to remember to care for themselves as well as their loved ones.
Care partner support groups can offer emotional support and practical advice for those caring for someone with Parkinsons disease. A person can ask a doctor about local support groups or search for them online.
Organizations and websites that offer support for care partners include:
- The APDA: The APDA provides resources and support for care partners as well as people with Parkinsons disease.
- The Parkinsons Foundation: This organization also provides information for caregivers.
- The Family Caregiver Alliance: This organization provides services for caregivers and the people who receive their care. FCA CareNav is an online resource for family caregivers.
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.
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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.
Drug Reactions: Psychosis And Impulse Control Disorders
PD pharmacologic treatment emphasises dopamine replacement, dopamine receptor stimulation, or prevention of enzymatic breakdown of dopamine in the synaptic cleft.3 While these drugs have their effects on a variety of CNS neurotransmitter systems, they primarily affect dopamine transmission. Thus, it is not surprising that they often produce dramatic behavioural changes that cause significant difficulties for patients and their families and carers.5 There are convincing data that suggest that treatment with dopaminergic agents may be associated with the development of a variety of impulse control disorders in some patients.5 Impulse control disorders, including severe gambling and hyper-sexuality as well as shopping and binge eating, can be extremely disruptive to patients and families.
As with psychosis, impulse control disorders are more commonly associated with the dopamine agonists, pramipexole and ropinirole.11 Given the impact of impulse control disorders, clinicians need to educate patients and monitor them for the early signs of these disturbances.5
Delusions are uncommon in the first two years of PD therapy, but may also occur and, as with hallucinations, are often preceded by vivid dreams.5 These delusions are usually persecutory in nature, including fears of being injured, influenced, poisoned, filmed, and/or tape-recorded.5
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Dealing with a chronic, progressive condition like Parkinsons disease can take a big toll on a person. Plus, the neurological changes in the brain can put people with PD at a greater risk for depression and anxiety. Up to 60 percent of people with PD experience depression, and between 25 and 45 percent experience anxiety.1,2
When a person with PD experiences mood changes, they may withdraw from seeking help. However, talking with your doctor about symptoms like mood changes helps create a sense of control. It also helps the doctor to better understand how PD is affecting the person. Many treatment options can help treat mood disorders like depression and anxiety.1,2
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Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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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The Difference Between Psychiatrists And Psychologists
Psychiatrists and psychologists are both mental health professionals who treat depression and anxiety. However, there are important differences between them.3
Psychiatrists are medical doctors who have completed medical school and a residency. Psychiatrists can prescribe medicine, like antidepressants or anti-anxiety drugs. They also conduct talk therapy and can order or perform a number of lab tests. They understand the complex relationship between medical illnesses and emotional health. Their training is more focused on biology and neurochemistry.3
Psychologists have advanced degrees, usually a masters degree or PhD. They also have extensive training in research or clinical practice. Psychologists can perform psychological evaluations and treat mental health problems with psychotherapy and other behavioral interventions. Their training is more focused on behavior.3
Some people work with both a psychiatrist and a psychologist as part of their healthcare team.3
Kathy: On Anxiety Going It Alone And Being Kind To Yourself
Anxiety is also the biggest mental health challenge for Kathy , a 72 year old woman with PD diagnosed 4 years ago. Her mental health concerns are deeply influenced by a major external stressor, namely an adult child who is facing an illness of her own. Kathy was always a very active and capable person, and remains so, but PD is starting to cause some physical limitations for her. She wants to help her daughter as much as she can, but has begun to realize that she cant do everything she used to be able to do. This is extremely frustrating, because not only must she accept her limitations, but others around her must do so as well.
She often feels very lonely. She is not married and finds herself shouldering her own physical and mental struggles, as well as those of her daughter, by herself. She is lucky to have some close friends, but they have health challenges of their own to deal with and cant always be there for her. She finds it mildly exasperating to constantly read how important it is for PD patients to surround themselves with supportive family what if you are alone?
She also finds it irritating to read articles about PD that are relentlessly perky about PD. Yes, exercise can be very helpful and can sometimes help keep symptoms at bay. But there is a down-side to PD as well. You should be allowed to feel that and express that. It is also not your fault if your PD worsens it does not mean that you did not do enough.
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How Are Cognitive Deficits Diagnosed
Common ways to assess and diagnose cognitive disorders:
- Interview the person with PD.
- Ask family members or caregivers about their observations.
- Administer cognitive screening tests such as the Mini-Mental State Examination or Montreal Cognitive Assessment . The neurologist will ask questions that evaluate the persons understanding of where and who they are, the date and year, attention, memory, language and problem-solving skills.
- Neurologist may suggest seeing a clinical neuropsychologist for a more detailed assessment.
- Neuropsychological assessment can be an important diagnostic tool for differentiating PD from other illnesses such as Alzheimer’s disease, stroke or dementia.
Parkinsons Foundation To Present Most Recent Mental Health Research Findings
Non-movement Parkinsons disease symptoms can impact mental health, relationships and quality of life. The Parkinsons Foundation has conducted two recent studies dedicated to learning more about treating non-movement symptoms within its Center of Excellence Network.
Centers of Excellence are medical centers with a specialized team who are up to date on the latest Parkinsons medications, therapists and research to provide the best care to a combined 185,500 people with Parkinsons.
This year, the Parkinsons Foundation will share their research findings at two international conferences: at the International Congress of Parkinsons Disease and Movement Disorders in Nice, France, and at the World Parkinson Congress , which took place in June at Kyoto, Japan.
Both conferences gather thousands of neurologists, researchers and health professionals in the Parkinsons community.
Multidisciplinary Care Models for Parkinsons Disease: The Parkinsons Foundation Centers of Excellence Experience
People living with Parkinsons benefit most from a comprehensive, team-based healthcare approach, where different specialists treat motor and non-motor symptoms as the disease progresses. Every Center of Excellence works with a multidisciplinary team in one of three different care models:
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