How To Treat Anxiety In Parkinson’s

Anxiety And Antiparkinsonian Medications

There is no consensus on whether antiparkinsonian medications are responsible for symptoms of anxiety in Parkinsons disease.

Stein et al found that the levodopa dose was similar in anxious and non-anxious patients. Hendersonet al noted that 44% of patients with Parkinsons disease noticed anxiety symptoms before starting levodopa. Menza et al found that the levodopa dose did not significantly correlate with anxiety levels: they suggested that anxiety in patients with Parkinsons disease is unlikely to be a side effect of levodopa treatment. In contrast, Vasquez et al found that panic attacks were related to levodopa therapy but not to other agonist drugs.

Lang reported anxiety in five of 26 patients when pergolide was added to their treatment regimen. Menza et al found no differences in measures of anxiety in patients receiving or not receiving pergolide. Menzaet al found no differences in measures of anxiety in patients receiving or not receiving selegeline.

The temporal relationship between panic attacks and off periods have led some authors to suggest that panic attacks may be related to falling brain levodopa levels. Anxiety fluctuations may be an important component of levodopa induced fluctuations. In a double blind placebo controlled trial, Maricle et al found that anxiety levels fell and motor performance improved during a levodopa infusion.

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What Are The Symptoms Of Parkinsons Disease Anxiety

Depression and anxiety with or without Parkinson’s disease can be debilitating. You may suffer from a “loop” of anxious thoughts about your illness or the future, or you may find yourself experiencing panic attacks or feeling afraid to go outside. You may also have a negative view of the world and your place in it.

While it’s normal to feel some degree of worry when you are diagnosed with Parkinson’s disease, persistent anxiety that doesn’t go away when you relax may require treatment. Here are some of the most common Parkinson’s disease and anxiety symptoms:

• Constant feelings of worry or dread
• Panic attacks characterized by heart palpitations, sweating, nausea and lightheadedness
• Feeling out of control or helpless
• Long, intense periods of unease
• Feeling unsafe for in normal situations
• Wanting to isolate yourself or being afraid to leave the house
• Avoiding certain situations because they trigger anxiety

Diet And Physical Activity

Exercise and diet play important roles in a persons overall health. A healthy diet can give people the nutrients their body needs to function well and help with weight management. Exercise and physical activity can help to lower symptoms associated with anxiety and improve mood overall.

Before making any drastic changes to diet or exercise, a person should discuss their health with a healthcare professional.

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Anxiety And Depression In Parkinsons And How To Manage Them

Approximately 50-60% of people living with Parkinsons experience varying levels of depression and anxiety. Learn about the differences between depression and anxiety and how they are related different types of depression and anxiety causes of depression and anxiety in people living with PD when and how to treat depression and/or anxiety the latest in treatments, including non-pharmacological interventions. The speaker is Gregory Pontone, MD, director, Johns Hopkins Parkinsons Disease Neuropsychiatry Clinic.

Anxiety And Laterality Of Parkinsons 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 Parkinsons disease was associated with mainly left sided symptoms. If anxiety in patients with Parkinsons 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.

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Medications To Avoid Or Use With Caution

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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.

Changes In Sleeping Patterns

As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.

Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.

REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.

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How Is Depression Diagnosed

There arent any tests to confirm depression. If you have signs of depression, reach out to your healthcare provider. Theyll talk with you about your symptoms, how long youve had them and how much they interfere with your life.

Your healthcare provider may also review your Parkinsons medications with you. Thisll help make sure that:

• Your medications arent causing depression symptoms.
• Your medications are managing your Parkinsons disease symptoms as much as possible.

What are the challenges to diagnosing depression in people with Parkinsons disease?

It can be difficult to tell whether a symptom is actually caused by depression or the physical effects of Parkinsons disease. For example, Parkinsons disease causes muscle weakness, with symptoms that may seem like depression:

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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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.

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

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Stress Management For Pd

It is not uncommon for the stresses of daily life feeling overwhelmed, under prepared and over stimulated to cause anxiety and unrest. These psychological issues can impact your health and even exacerbate the symptoms of Parkinsons disease . That is why it is important to assess what may be causing stress and learn how to deal with the situations that give rise to anxiety. Meditation, yoga or Tai Chi and deep breathing can help restore a sense of calm. Whether you are living with Parkinsons or caring for someone with PD, finding balance can help you cope with the daily stresses of life. This may mean limiting your exposure to environmental stressors or using complementary therapies. Such approaches are wonderful ways to lower anxiety, lower blood pressure and improve your all-around health.

Reviewanxiety: An Ignored Aspect Of Parkinsons Disease Lacking Attention

Anxiety is a neuropsychiatric complication of Parkinsons disease .

Anxiety has been given less attention while treating PD.

Management of anxiety is crucial to improve quality of life of the affected patients.

Use of complementary based medicines could be beneficial.

Alternative approaches will lead to novel therapeutic treatment for PD and various complications associated with it.

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Living With A Dog With Parkinsons Disease

Living with a dog with any kind of degenerative disease can be challenging. Your dog is likely very confused about what is going on with their body. A dog with Parkinsons disease will feel out of control and betrayed by their body almost.

Its important to be gentle with your dog during this time.

Though Parkinsons disease is incurable and progressive, there are some things your vet may recommend that will help with your dogs quality of life for as long as possible.

Where To Find Support

Several organizations offer support for people with Parkinsons disease and their families and carers.

A therapist or healthcare professional may be able to provide information on local support groups for people living with Parkinsons.

The Parkinsons Foundation offers a Helpline for people with Parkinsons at 1-800-4PD-INFO . The hotline can provide up-to-date information on the condition and help with emotional support.

A person can also check out their online resources, which include access to an online community of people with Parkinsons disease for additional help and support.

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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.

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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Types Of Anxiety Disorders Found In Parkinson’s Disease

Generalised anxiety disorder, panic disorder, social phobia, phobic disorder, agoraphobia, obsessive-compulsive disorder, and anxiety disorder not otherwise specified have all been identified in patients with Parkinson’s disease . The diagnoses in the patients with Parkinson’s disease appear to be clustered in the panic disorder, phobic disorder, and generalised anxiety disorder areas.

Box 1: Anxiety disorders found in Parkinson’s disease

• Generalised anxiety disorder

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.

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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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Treatment For Anxiety And Depression

Your doctor might suggest medication, talk therapy, and lifestyle changes like exercise and social activities. Many doctors find that a combination of treatments works best.

Everyoneâs different, so the doctor will base your treatment on your needs. Be patient. It may take time to figure out what works best for you.

Your doctor can prescribe antidepressants like SSRIs, SNRIs, or benzodiazepines, which are anti-anxiety medications. They might adjust the levels of your Parkinsonâs medications to see how it impacts your mood.

Talk therapy, which is also called psychotherapy, can help you understand your anxiety and depression and give you tools to manage your symptoms.

Your therapist may try cognitive behavioral therapy, or CBT, to help you change negative thought patterns and learn how to react to situations in a better way.

You can also get help through group therapy or support groups. Theyâre good for connecting with other people who relate to what youâre going through, sharing your thoughts, and learning from other peopleâs experiences.

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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

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.

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How Is Depression Treated In People With Parkinsons Disease

Depression can make the symptoms of Parkinsons disease worse. Its important to identify and treat depression as soon as possible.

Several strategies can improve your mood and your movement. Theyre much more effective when used together. Treatments for depression when you have Parkinsons include:

• Medications: Many medications can help treat depression. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are the most common type prescribed to people with Parkinsons disease. Your healthcare provider can recommend the right medication for your particular needs.
• Psychological therapy: Counseling, or talk therapy, can help you manage the emotional challenges that come with Parkinsons disease. For example, cognitive-behavioral therapy can help you unlearn negative thoughts and behaviors. Instead, youre encouraged to focus on positive emotions and actions. CBT can help you understand your self-worth, maintain your relationships and solve problems. Support groups, in person or online, can also provide emotional therapy.

Theres increasing evidence that regular exercise and leading a healthy lifestyle also helps lessen feelings of depression in Parkinsons disease. Check with your doctor about the types of exercise you can do safely without injuring yourself. Eat a well-balanced diet, limit alcohol and dont smoke, as well.

Nonpharmacologic Interventions For The Self

Susan K. Chandler

Abstract

Anxiety in Parkinsons disease is underdiagnosed, undertreated, and understudied. As many as 50% of persons diagnosed with Parkinsons disease are reported to suffer from anxiety. Current treatment is largely pharmacologic, which can result in a myriad of undesirable and unsafe side effects. The aim of this paper is to examine intervention studies of self-managed nonpharmacological strategies for the treatment of anxiety. A comprehensive review was conducted on experimental or quasi-experimental trials that included self-management approaches for the nonpharmacologic treatment of anxiety as a primary or secondary aim or outcome measure. Thirteen studies were identified from four databases. Study quality demonstrated variability in design and delivery of self-managed interventions sample sizes were small anxiety was most commonly a secondary aim and the use of anxiety measures varied widely. Statistical significance was evident in slightly more than 50% of the anxiety intervention studies. A common element in the interventions in all studies was the focused use of breath. Further research is needed to determine the feasibility of using focused breathing, alone, as an intervention for the self-management of anxiety in Parkinsons disease.

1. Introduction

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