Helping Parkinson’s Patients with Depression

Parkinson’s researchers want to help patients with the disease manage their symptoms to lead more productive and fulfilling lives. Due to changes that Parkinson’s disease causes in the chemistry of the brain, depression is a common side effect—more common than in many other chronic diseases—afflicting at least 50 percent of people diagnosed with Parkinson’s. Although treating depression can significantly improve movement and overall quality of life, most people with Parkinson’s will go undiagnosed or under-treated for depression.

To understand the potential impact of undiagnosed depression in Parkinson’s patients, it is important to consider that by 2030, more than 1.2 million Americans will have the disease. While depression in Parkinson’s most directly affects the patient, it also touches the family, friends, colleagues, and more—all of whom will experience, to varying degrees, consequences of the condition. Improved mental health is extremely important to all, with research showing that “taken together, mood, depression and anxiety have the greatest impact on health status, even more than motor impairments commonly associated with the disease” (The Parkinson’s Foundation Parkinson’s Outcomes Project).

In Parkinson’s, depression may be the result of biological, psychological, and environmental factors. Parkinson’s and depression both affect the same parts of the brain involved in thinking and emotion, as well as the levels of dopamine, serotonin, and norepinephrine, which influence mood and movement. Research shows that many people experience anxiety and/or depression, two to five years before being diagnosed with the disease, suggesting that these conditions are not simply a psychological reaction to having the illness, but part of the disease.

Undeniably, however, psychological factors also play a role, as patients may be prone to dwell on the negatives of living with a serious chronic illness, and find themselves consumed by feelings of sadness, helplessness, and hopelessness. Environmental triggers, including drug side effects and the ongoing stress of coping with the disease, also can contribute to the condition.

Health care providers play a key role in helping determine whether a person with Parkinson’s is suffering from depression, as the patient may not realize it. Asking a family member or caregiver about the patient’s mood can yield valuable information. Also, when speaking to the patient, very specific questions are most fruitful. For example, asking “Are you less interested in pleasurable activities you once enjoyed?” and “Have you noticed any changes in your sleep or appetite?” are more likely to paint a clearer picture of mood, than a more general inquiry regarding how the patient is feeling.

The most common symptoms of depression include persistent sadness, crying, lack of interest in usual activities and hobbies, diminished attention to hygiene, loss of motivation, abnormal sleep and eating patterns (too much or too little) and thoughts of death and suicide, among others. However, diagnosing depression in Parkinson’s patients can be complicated by the fact that certain symptoms—such as sleep problems—are characteristic of both conditions. Additionally, while in the general population depression is typically a mood that lasts two or more weeks, some experts believe that with Parkinson’s depression involves shorter but frequent episodes of sadness. A final difficulty in diagnosing depression stems from effects of the disease on facial muscles or facial masking, which makes a person unable to express emotion through facial expressions.

Once a diagnosis of depression has been made, there are many treatment approaches, the suitability of which varies from patient to patient. While the two main types of treatment for depression include antidepressant medications and psychological counseling, researchers recommend a holistic, comprehensive approach. Evaluating the patient’s PD medication and potential interactions with antidepressants, considering Cognitive Behavioral Therapy (CBT), incorporating exercise—and even some non-conventional therapies, such as meditation, massage therapy, and relaxation techniques—can all work together, increasing the effectiveness of treatment.

By being vigilant for depression in patients with PD, informed about how the condition can mask itself, and committed to developing individualized treatment plans, health care professionals can significantly improve the lives of those affected by the disease, while we continue seeking a cure.