Parkinson’s Disease Depression Treatment

Depression And Pd: A Non

This 2-page fact sheet explains and recommends cognitive behavioral therapy to manage Parkinsons-related depression. Set goals for daily activities with a focus on exercise, socialization and positive emotional self care. Recognize negative thoughts and implement strategies to minimize them. Work with your care partner to reinforce positive behaviors and implement healthy habits.

Does Lesion Location Predict Post

There has been a lively debate on the subject of lesion location in relation to post-stroke depression. Data from the early 1980s first suggested that there was a relation between proximity of the lesion to the frontal pole and depression. This appeared to have been contradicted by a meta-analysis published in the Lancet in 2000. This analysis was further criticised by others on the grounds that the hypothesis was not specific enough and that some relevant studies had been omitted. When a similar methodology was used but the data looked at separately for each hemisphere, there was a clear relation between proximity of the lesion to the left frontal pole and depression, especially in the first few months after stroke. The results of this second meta-analysis were given further weight by a Finnish study published earlier this year. This study also found that a brain infarct affecting the pallidum was a strong predictive factor for post-stroke depression . This finding also fits with case reports of dysphoria in relation to insertion of deep brain stimulating electrodes in the same area.

Q: What Would Be The Value Of Knowing That Someone Who Has Depression When Theyre In Their 30s Or 40s Might Be At Risk Of Parkinsons Disease Later In Life

A: There are a couple of scenarios that can play out. If we knew that depression was linked to the future occurrence of Parkinsons, we might find a way to mitigate the risk by treating the depression or by some other means. Or, we may be able to use some disease-modifying therapies for Parkinsons earlier. It could redefine how we diagnose and treat Parkinsons. On the other side of things, if Parkinsons disease is affecting the same brain circuitry that causes depression, it may help us learn more about depression. Right now, were still all guessing as to what the broken part is in depression.

Recommended Reading: Stages Of Depression And Symptoms

Dementia Signs And Symptoms

Despite many shared symptoms across Lewy body dementia diseases, people often store and recall information differently, depending on which cognitive disorder they are living with.

Adding and retaining new memories is often difficult for people living with Alzheimer’s disease. It may be challenging for someone with Alzheimer’s to remember a question or conversation just minutes after, or they may have forgotten events from the previous day. Encoding new information can be an issue. However, if a person experiencing PD thinking changes struggles retrieving a memory, they can often pull it up with a clue or a reminder.

This means people with PD dementia can store memories. Rather than primary encoding difficulty, they often experience retrieval challenges an executive dysfunction similar to difficulty multitasking or staying on track during conversations.

People with Alzheimers disease tend to have less awareness that they are hallucinating. A person with PD dementia or dementia with Lewy bodies can more often recognize that they are experiencing hallucinations. Its important for the care provider to ask the person experiencing changes Do you see things? People with PD-related dementia will often acknowledge that they do see things, are aware the hallucinations are not real and are not bothered by what they see.

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.

Recommended Reading: My Boyfriend Is Depressed What Do I Do

Helping As A Caretaker Or Ally

Whether you are a neighbor, friend, family member, or caregiver to someone with PD and depression, know that it’s normal to feel powerless and overwhelmed by their condition and your relationship.

Even though you cannot “fix” what is going on, there is a lot you can do to provide comfort and support. Among them:

• Organize a simple outing to get coffee or see a movie.
• Prepare a home-cooked meal or bring over their favorite snack or flower to show you are thinking of them.
• Assist with household tasks .
• Offer to drive them to therapy or doctor appointments.
• Attend a support group meeting with them.

What Is The Outlook For Depression With Parkinsons Disease

Many people with Parkinsons disease have depression but dont get help for it. They may not notice their symptoms, or may think the symptoms are unavoidable with Parkinsons.

What they may not realize is that medications, therapy and lifestyle changes can help. Many people find some relief from depression. And that helps reduce their symptoms of Parkinsons disease.

Read Also: How To Deal With Stress And Anxiety And Depression

How Are Parkinsons Tremors Treated

Tremor can be unpredictable. Some experts say itâs the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:

• Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Itâs usually the first treatment for Parkinsonâs.
• Propranolol . This drug is also used to treat high blood pressure, heart disease, and migraine.
• Clozapine . This medication is also used to treat schizophrenia. It requires weekly blood tests for the first 6 months.

Those taking levodopa/carbidopa may occasionally experience OFF periods in which their symptoms return. There are treatment options during these periods including a powder form of levopoda which can be inhaled or the medications istradefylline or safinamide .

Chinese Herbal Medicine In The Treatment Of Depression In Parkinsons Disease: From Molecules To Systems

• 1Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
• 2Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China

Depression is one of the most common non-motor symptoms in patients with Parkinsons disease . Depression in PD increases the disability rate and reduces the quality of life of PD patients and increases the caregiver burden. Although previous studies have explained the relationship between depression and PD through a variety of pathological mechanisms, whether depression is a precursor or an independent risk factor for PD remains unclear. Additionally, increasing evidence shows that conventional anti-PD drug therapy is not ideal for DPD. Chinese Herbal Medicine prescriptions exhibit the characteristics of multi-target, multi-pathway, and multi-level treatment of DPD and may simultaneously improve the motor symptoms of PD patients through multiple mechanisms. However, the specific pharmacological mechanisms of these CHM prescriptions remain unelucidated. Here, we investigated the mechanisms of action of the active ingredients of single herbs predominantly used in CHM prescriptions for depression as well as the therapeutic effect of CHM prescriptions on DPD. This review may facilitate the design of new selective and effective treatment strategies for DPD.

Don’t Miss: How To Help Someone With Severe Depression And Anxiety

Treating Depression In Parkinsons 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 Parkinsons 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 Parkinsons patients may be as treatable as it is in the general population.

Show Sources

Effectiveness On Depressive Symptoms

Considering the results of the present scoping review, the first question that can be answered relates to Bupropion antidepressant effectiveness in patients with PD. Overall, most of the retrieved reports seem to support its use. Indeed, the RCT and three reviewed open-label studies demonstrated a variable degree of the antidepressant effectiveness of Bupropion in patients with PD. Similarly, the majority of case reports who measured depressive outcomes showed improvement of depressive symptoms, while only one reported no changes. Despite diverse methodology and publication biases , we can conclude that Bupropion is potentially a valuable treatment option to target depressive symptoms in patients with PD. This recommendation is supported by the treatment guidelines from the Neurological Association of Madrid , specifically indicating Bupropion for the treatment of apathy associated with PD, though with a low level of evidence and grade of recommendation . Apathy is a common symptom in PD patients, with a frequency reported between 16.5% and 42% of cases of PD . According to these guidelines, Bupropion is the only antidepressant recommended for apathy: thus, it might be particularly useful in PD patients who manifest an intense lack of feelings, emotions, or interests.

You May Like: Depression And How It Works

How Can Parkinsons Disease Cause Depression

For many people, the challenges of Parkinsons disease are enough to cause depression.

But scientists believe that depression in Parkinsons might also come from changes to certain chemicals in the brain:

• Losing interest in activities you once enjoyed.
• Losing interest in eating or taking care of yourself.
• Moving or talking too slow.
• Thinking a lot about dying or wishing to die.

Effectiveness Of Bupropion On Other Neuropsychiatric Manifestations

In the general population, Bupropion is approved for depression, seasonal affective disorder, and smoking cessation, while off-label uses often include antidepressant-induced sexual dysfunction, attention-deficit/hyperactivity disorder, depression associated with bipolar disorder, and obesity . In the context of PD, the articles examined in the present review supported Bupropion use to reduce compulsive eating as a consequence of dopaminergic medications and to improve panic symptoms . Although these results represent solitary findings, they might reflect the pharmacodynamics of Bupropion. Indeed, the inhibition of dopamine reuptake in the ventral striatum might lead to a stabilization of dopaminergic transmission in the mesolimbic system . Moreover, Bupropion-mediated inhibition of norepinephrine reuptake in the prefrontal cortex may contribute to further stabilizing cortical-subcortical prefrontal limbic circuitries involved in addictive and compulsive behaviors. The same neurotransmitter might be responsible for the anxiolytic effect, even though an improvement of anxiety symptoms as secondary to improvement of depression might be another potential explanation.

Don’t Miss: What To Do When Your Loved One Is Depressed

Depression Anxiety And Psychosis In Parkinson’s Disease

Parkinson’s disease is associated with depression, demoralization, anxiety, and psychosis. Depression in Parkinson’s disease is overlooked because of the overlap between motor and mental slowing. Treatment includes psychotherapy, pharmacotherapy, and electroconvulsive therapy. Several of the newer antidepressants are effective in patients with Parkinson’s disease, as is electroconvulsive therapy. Anxiety is common in patients with Parkinson’s disease and can interfere with their response to treatment. Psychosis can occur with any of the drugs used to treat Parkinson’s disease. Some of the atypical neuroleptics, as well as electroconvulsive therapy, can be helpful.

Parkinson’s disease is commonly associated with psychiatric morbidity, but fortunately, many effective treatments are available.

Introduction

Parkinson’s disease is commonly associated with psychiatric morbidity, which includes depression, anxiety, and dopaminergic psychosis. These compound the patient’s predicament. Fortunately a variety of effective treatments is available. This article reviews the diagnosis and symptoms of depression, anxiety, and psychosis in Parkinson’s disease, and offers strategies for effective management.

Depression

Symptoms and differential diagnosis

Diagnosis

Treatment

Psychological support

Pharmacotherapy

Electroconvulsive therapy

Anxiety

Psychosis

Table. Parkinson’s disease medication, side effects, and management

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.

Recommended Reading: I Feel Angry And Depressed

For Carers Family And Friends

Its important to realise that the effects of depression can spread beyond the individual, affecting the emotions of family, friends and carers. If untreated, depression may continue for years, so it is vital to recognise the condition and seek help.

Often the person with depression may not recognise their symptoms, so it is important that those around them raise their concerns with the person or with his or her doctor, so that depression can be treated.

Further information on how carers and family can look after themselves so that they can continue to care effectively may also be found in the Caring and Parkinson’s section of this website.

Cognitive Behavioral Therapy Can Help Alleviate Depression And Improve Quality Of Life Rutgers Study Finds

People with Parkinsons disease who engage in cognitive behavioral therapy a form of psychotherapy that increases awareness of negative thinking and teaches coping skills are more likely to overcome depression and anxiety, according to a Rutgers study.

The study was published in the journal Neurology.

About 50 percent of people diagnosed with Parkinsons disease will experience depression, and up to 40 percent have an anxiety disorder.

The psychological complications of Parkinsons disease have a greater impact on the quality of life and overall functioning than the motor symptoms of the disease, said lead author Roseanne Dobkin, a professor of psychiatry at Rutgers Robert Wood Johnson Medical School. Untreated, depression can accelerate physical and cognitive decline, compromise independence and make it more difficult for individuals to proactively manage their health, like taking medication, exercising and visiting the physical therapist.

Depression in Parkinsons patients is underrecognized and often goes untreated. Among those who receive treatment, antidepressant medication is the most common approach, though many patients continue to struggle with depressive symptoms. The researchers investigated how adding cognitive behavioral therapy to the care individuals were already receiving would affect their depression.

You May Like: Best Exercise To Fight Depression

Traditional Chinese Medicine In Depression In Parkinsons Disease Treatment

Traditional single-target antidepressants have unsatisfactory therapeutic effects on DPD and may aggravate MS in PD patients . TCM has a long history of treating depression, especially in Asia, where it is most common in China, Japan, and South Korea . With deepening of the understanding of TCM in the treatment of depression, TCM is gradually being used in the treatment of other neurological diseases with depressive symptoms, including post-stroke depression, depression in Alzheimers disease, depression in epilepsy, and DPD .

TCM has a unique medical theory. As a holistic medicine, TCM emphasizes the integrity of the body and the influence of the environment on homeostasis. In TCM theory, depression is caused by qi deficiency, which is caused by dysfunction of multiple physiological systems in the body, such as qi stasis,blood stagnation, and phlegm obstruction. Restoration of vital energy is the principle in healing depression, but disorders of other physiological systems also need to be corrected by promoting blood circulation and removing stasis, as well as regulating the liver.

TABLE 1. Characteristics of studies on TCM prescriptions in depressed PD.

FIGURE 2. The proportion of single herbal medicines included in Traditional Chinese Medicine prescriptions confirmed clinically in the treatment of depression in Parkinsons disease .

TABLE 2. Effect of antidepressant ingredient in single herbal.

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

Recommended Reading: How To Talk To A Doctor About Anxiety And Depression

Depression In Prodromal Pd

Depression represents one of the earliest and most frequent alerting symptom across age-related neurodegenerative disorders. Prospective historical cohort studies using registry and medical records showed that history of depression is about twice more frequent at the time of PD diagnosis compared with age-matched controls and multiplies the risk to be diagnosed with PD by at least twofold . Meta-analysis regarding risk factors for PD confirmed that the odds ratio for mood disorders was 1.86 , and lag time might be higher for anxiety . Overall, depression may precede motor symptoms by 5 years or more and the risk for depression in premotor patients is regularly increasing until PD diagnosis . Interestingly, all patients with major depressive disorder who developed PD within 10 years were characterized by the triad consisting in mild asymmetric motor slowing, idiopathic hyposmia and substantia nigra hyperechogenicity . Moreover, it was recently demonstrated that patients with depression following PD diagnosis were older and had a twofold risk of dementia in comparison with patients with prediagnostic depression .