Treating Depression In Parkinson’s Disease

Difficulties In Diagnosing Depression In Patients With Parkinson’s

• 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.

How To Take Antidepressants

Your doctor will prescribe an antidepressant that he or she thinks is a good medication to treat your symptoms. It can take time, usually two to four weeks, for an antidepressant to become effective, so be sure to follow instructions carefully. The different classes of antidepressants work differently and have varied side effects, so it may take several tries to find the right medication and dosage to manage your symptoms.6 Do not stop taking the medication without speaking to your medical team. In some cases, antidepressants lose their effectiveness over time so be sure to discuss with your doctor if you begin to experience symptoms that have been previously managed by your medication.

Focus On Depression In Parkinsons Disease: A Delphi Consensus Of Experts In Psychiatry Neurology And Geriatrics

Luis Agüera-Ortiz

1Servicio de Psiquiatría, 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 Neurología, Hospital Clínico 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, Clínica Ubarmin, Pamplona, Navarra, Spain

10Service of Neurology, Instituto de Neurociencias, Hospital Clínico 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

2.1. Study Design

2.2. Participants

2.3. Delphi Methodology

2.4. Statistical Analysis

3. Results

N

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Naturaltreatment For Parkinsons #9 Exercise And Other Alternative Therapies:

Regular exercise has been shown to help Parkinsonssufferers by reducing muscle stiffness, increasing mobility, and enhancing postureand balance. Exercise also increases oxygen levels and neurotransmitters, alongwith releasing potent mood elevating chemicals called endorphins.

The type of exercise performed for PD is crucial. Aqua orwater aerobics can be particularly useful as traditional exercise is usuallyquite difficult for many Parkinsons sufferers. Muscle decline, loss of strength,stiffness and loss of balance can make conventional exercises difficult toperform. The great thing about aqua aerobics is it still has the same benefits as other exercise regimens,but the risk of falling is eliminated.

Other types of exercises that can be beneficial for PDsufferers include Tai Chi, Yoga, dancing, walking, aerobic/jazzercise classes,and general stretching.

For more information on the different exercise programsavailable for Parkinsons patients, you can check out this website Exercise and Physical Therapy for ParkinsonsDisease

Natural Treatment For Parkinsons #1 Cannabis/medicalmarijuana:

Cannabis, aka medical marijuana, is an incredibletreatment for Parkinsons disease. You can have a Parkinsons patient shakingviolently and uncontrollably, and yet within 30-40 minutes of self-administering with some cannabis, their symptoms will almost completely disappear. Watch this short 2minute video from Parkinsons sufferer, Ian Frizell, who shows you what he waslike before self-medicating with cannabis and then again after. The change is truly astonishing!

Taylor French is another Parkinsons patient thatundergoes a remarkable transformation once he ingests what he calls nutritional vegetable extract . This guy has an advanced form ofParkinsons and is normally confined to a wheelchair with limited use of hisbody due to stiff and rigid muscles . But after ingestingsome cannabis hes able to walk, and incredibly, in his video he even getsinto his car and drives off down the road!

You can view it here

Elyse Del Francia also tells the story of her Parkinsonssuffering husband, and the time she decided to smother his morning pancakes withsome canabutter. She said

Within45 minutes of eating a pancake with marijuana on it, he stopped shaking. Thatwas my lightbulb moment. Thats when I knew that I was onto something thatwould relieve his pain and suffering, because its horrible, horrible, to haveParkinsons Disease and not have any relief. I feel that this is something thathelps so many people in so many ways with pain and suffering. 5

Also Check: Parkinson’s Quality Of Life

What Are Symptoms Of Depression

Symptoms of depression will differ from person to person and can range in severity from mild to severe. Although people experience depression in differently, there are common symptoms including:

• Persistent sadness
• Loss of interest in usual activities and hobbies
• Feelings of guilt, self-criticism and worthlessness
• Increased fatigue and lack of energy
• Change in appetite or eating habits
• Loss of motivation
• Complaints of aches and pains
• Feelings of being a burden to loved ones
• Feelings of helplessness or hopelessness
• Reflections about disability, death and dying
• Sleep difficulties
• Poor attention and concentration problems
• Feeling slowed down or restless inside
• Thoughts of death or suicide

Treating Depression In Parkinson’s Disease: Study Results

Patients in all three treatment groups, including the placebo group, showed improvement on a commonly used scale to gauge depression known as the Hamilton Rating Scale.

Those on antidepressants improved more than did those on placebo, Richard says.

On average, those getting Paxil had a 59% improvement. Those taking Effexor had a 52% improvement. Those who got the placebo had a 32% improvement.

Richard evaluated their depression using three other scales and found similar results.

There was no effect on movement ability.

Richard can’t say which antidepressant type is better for treating depression in Parkinson’s disease, she says. The study did not do a head-to-head comparison of the two types.

Each type, SSRI and SNRI, includes many different medicines, so patients have a choice, she says.

Both medicines studied are available as generics, Richard says. At the doses studied, the cost would be about $20 to $30 a month.

Patients reported side effects such as insomnia, constipation, sexual dysfunction, and fatigue. Three patients, including one in the placebo group, had serious side effects. These included chest pressure, bowel obstruction, and heart rhythm problems.

However, only the patient with heart rhythm problems withdrew.

Wyeth Pharmaceuticals provided the venlafaxine XR. Glaxo SmithKline provided the paroxetine.

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Whats The Link Between Parkinsons Disease And Depression

Parkinson’s disease is a neurological condition caused by the loss of dopamine cells in the brain. As many people know, PD causes motor symptoms such as tremor, rigidity and slowed movement, but it can also be responsible for dementia, psychosis, anxiety and depression.

It is estimated that over 50% of people with PD will experience depression at some stage. Common symptoms of Parkinson’s disease depression include:

• Loss of interest in hobbies and day-to-day activities
• Low energy
• Sleep disturbances, such as nighttime waking or insomnia
• Change in eating habits, such as eating too much or too little
• Not wanting to socialize or interact with others
• Feeling tired all the time
• Irritability
• Persistent low mood and apathy not seeing the point in anything
• Pessimistic feelings or views about the world
• Thoughts of self-harm or suicide, known as suicidal ideation

If you experience the symptoms of Parkinsons disease depression, its important to report them to your doctor so you can access help and support. Parkinson’s can take its toll physically and emotionally, but there is no need to suffer in silence. Depression is common in those with and without Parkinson’s disease, and there are plenty of ways to treat it.

Help For Depression And Anxiety

Depression is a serious matter for anyone. For people with Parkinson’s, it can affect critical elements of disease management such as staying socially connected, exercising and proactively seeking needed care.

It is not always easy to recognize depression in oneself. Be on the lookout for a lack of interest in activities and situations that once brought you joy. Pay attention to observations made by family and friends, and talk to your doctor if you’re not feeling like yourself. Sometimes, your physicians may not even ask you about these conditions if you don’t mention changes in mood or outlook.

Depression and anxiety can be treated with medications, lifestyle changes , and therapy or counseling with a qualified practitioner. Support groups also may be a source of help.

NOTE: If you are in crisis, call the National Suicide Prevention Lifeline at or visit www.suicidepreventionlifeline.org.

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Treating Depression In Parkinson’s Disease: Perspective

The study has ”critical information” for patients and caregivers, says Michael S. Okun, MD, national medical director of the National Parkinson Foundation. He reviewed the findings.

“The bottom-line message is that treatment for depression in Parkinson’s disease matters,” he says. “An important aspect of this particular study was that it had a placebo group, and that the investigators showed that either antidepressant performed better than placebo for Parkinson patients.”

An editorial that accompanies the study concludes that depression in Parkinson’s patients may be as treatable as it is in the general population.

The Diagnosis Of Depression In Pd

In most recent research studies, depression in PD has been diagnosed based on standardized criteria for major depression, such criteria from the Diagnostic and Statistical Manual of Mental Disorders , fifth edition . The main problem of using these criteria is that some symptoms of depression, such as psychomotor retardation, insomnia, and loss of energy, are also frequently found in PD. A committee convened by the National Institute of Neurological Disorders and Stroke raised the important question of whether DSM criteria for major depression, which were designed for individuals without PD, are valid in the context of a disease with a variety of motor and nonmotor manifestations. The committee recommended that depressed mood must be present and that evaluations should be done in the on state for patients who experience fluctuations. Furthermore, to avoid falsenegatives, the National Institute of Neurological Disorders and Stroke committee suggested using the inclusive approach to diagnosis, which consist of rating the presence of all symptoms of depression, independent of whether they may be related to the motor disorder.

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Managing Anxiety And Depression In Parkinsons Disease

A combination of medication and other therapies can help ease non-motor symptoms affecting those with Parkinsons disease.

Most people think of Parkinsons disease as marked only by tremors, muscular rigidity and slow, imprecise movements, but Parkinsons is more than a movement disorder.

Most people with Parkinsons also have quite a few non-motor symptoms, such as anxiety, depression and psychosis. Many of these symptoms may have started before the Parkinsons disease became obvious.

The effects are widespread. Several years ago, a large clinical study of more than 1,000 people with Parkinsons disease of various durations demonstrated that only 1.4 percent of the participants did not report any non-motor symptoms.In other words, 98.6 percent of the study participants had some form of NMS. Psychiatric symptoms accounted for 60 percent, while visual hallucinations that could have signified psychosis were present in about 35 percent of patients.

Thats why taking action is important. If you or a loved one has had a new diagnosis of Parkinsons disease, we recommend an immediate evaluation for depression, mood and cognitive problems. Frequent monitoring should also be done throughout the course of the disease.

Here are some of the common symptoms and treatment methods for Parkinsons patients with depression and dementia:

Effect On Parkinsons Patients

Depression affects around 40% of patients with PD, but its diagnosis is often missed. One reason for this is that the symptoms of PD and depression, like lack of energy or trouble sleeping, often overlap.

Depression may also be missed as doctors focus the bulk of their appointment time on addressing more obvious or “visible” physical/motor symptoms like speech or walking problems.

Likewise, patients may be hesitant to discuss their feelings or emotions with their doctor. Perhaps they worry about being a burden to their family or care partner or assume their depressive symptoms are unfixable or simply part of their PD.

Unfortunately, the unintended effect of not diagnosing and treating depression worsens disability and leads to a poorer quality of life for patients with PD.

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Role Of Serotonin In Parkinsons Disease

Studies have shown that the 5-HT transmission system also undergoes degeneration in PD . The neuronal degeneration in the midbrain raphe nuclei is known to lead to reductions in 5-HT and 5-HT transporter levels in brain areas such as the striatum and prefrontal cortex . However, 5-HT neurons have the ability to store and release DA synthesized from systematically administered DA medication such as levodopa . For instance, in a 6-OHDA lesioned rat model of PD with severe nigrostriatal dopaminergic neuron degeneration, it has been shown that striatal reuptake of levodopa-derived DA can occur through 5-HT transporters . Further, it has been shown that monoamine transporter inhibitors such as selective serotonin reuptake inhibitors can modify striatal dopamine reuptake and metabolism so as to improve motor symptoms of PD . A new treatment approach for PD may therefore consist of blocking 5-HT transporters to enhance and/or prolong the antiparkinsonian effects of drugs that have the potential to increase extracellular DA in the striatum including SSRIs.

Psychosocial Reactivity And Depression

Psychosocial variables, such as coping style and amount of social support, may predict depression more reliably than severity, illness duration, and functional disability . For instance, examined the influence of psychosocial variables in predicting depression in PD patients. Overall, the best predictors of depression were functional disability, low self-esteem, and avoidant coping. These variables accounted for 46% of the variance in depression. Furthermore, positive affect and cognitive coping significantly predicted lower depression. This study found that disease-related variables do not predict a large portion of the variance in the depression that is experienced in PD. The observed inconsistent findings suggest that the reactivity model is in need of revision and should also include psychosocial variables .

In summary, as evidence does not permit discrete choice between the biomedical or psychological position with respect to the etiology of PD depression, a more parsimonious perspective should include a combination of endogenous and exogenous factors . Therefore, we further examined the literature on treatment options for PD depression to understand its etiology towards improving quality of life for this neuropsychiatric population.

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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.

Q: Does Depression Thats Possibly An Early Sign Of Parkinsons Disease Look Or Feel Any Different From Non

A: No, it looks the same. As of yet, we have not identified anything about which we could say, thats linked to Parkinsons theres nothing that allows us to pick those people out of a crowd. Its not specific enough. There are other prodromal symptoms of Parkinsons disease, such as REM sleep behavior disorder , that we can formally diagnose and define and that makes their link to Parkinsons clearer. Our research is trying to find markers in depression or anxiety, for that matter to see if we can find some that are specific to the risk of Parkinsons. Its tough, though, because depression is a lot more variable. Its possible that someday we can identify a combination of depression and other symptoms as a reliable marker for Parkinsons.

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The Treatment Of Depression In Pd

Our PRISMA review included all RCTs for depression in PD, patientcontrol studies, and case series collected as described above. We focused on efficacy and side effects, and the results of pharmacological and nonpharmacological treatments are summarized below.

Pharmacological treatment

Efficacy of antidepressant medication

We also reviewed published metaanalyses of antidepressants in PD that included several older RCTs. A metaanalysis by Skapinakis and colleagues focused on the efficacy of SSRIs only and included 10 studies that used citalopram, sertraline, fluoxetine, paroxetine, or fluvoxamine. There was no efficacy for SSRIs in patients with PD, with a crude response rate of 34% for SSRIs and 36% for placebo. This response rate is similar to that reported for placebo in metaanalysis for antidepressants in nonPD depression, suggesting that depression in PD is responsive to treatment but that the efficacy is rendered nonsignificant by a high placebo effect. STAR*D , a drug trial for primary depression that included patients who had clinical profiles similar to patients who attended general practices, showed a remission rate for citalopram of 27% as measured by the Hamilton Rating Scale for Depression. Skapinakis et al. also concluded that the small number of RCTs that used TCAs does not allow conclusive recommendations regarding this type of antidepressant.

Efficacy of antiparkinsonian medication

Psychotherapy

Repetitive transcranial magnetic stimulation