Ask an Expert: Depression and Parkinson's

Courtney Hanna, MCP, RCC: Born and raised in Ottawa, ON, Courtney completed her Bachelor of Arts in Halifax, NS at Dalhousie University. After her undergraduate degree, and a little soul searching, she decided to follow her dream of becoming a counsellor and moved to Vancouver, BC to pursue a Masters of Counselling Psychology at Adler University (formerly Adler School of Professional Psychology). Now a Registered Clinical Counsellor (RCC) with the British Columbia Association of Clinical Counsellors (BCACC), her personal connection to Parkinson's disease (PD) brought her to Parkinson Society British Columbia (PSBC). Courtney's father was diagnosed with PD over 10 years ago, and recently underwent Deep Brain Stimulation surgery, which has been a successful form of treatment for him. Believing that every individual has the potential to lead a happy and fulfilling life regardless of challenges faced, she brings a unique perspective and skill set to PSBC.

Myriame Lépine Lyons: Myriame completed her Bachelor of Arts (Honors) degree in Psychology and Sociology at Queen's University and her Master of Arts degree in Counselling Psychology at the Adler University, where she researched Educational Assistants' experiences and perceptions of relating with students with an Autism Spectrum Disorder. As a Certified Canadian Counsellor (CCC) with the Canadian Counselling and Psychotherapy Association, she uses a Cognitive Behavioural Therapy approach with a focus on building therapeutic rapport. By cultivating a sense of togetherness, Myriame works with clients faced with anxiety and depression, trauma, life transitions, chronic disabilities and neurodevelopmental disorders. Myriame has a passion for helping individuals lead a healthier lifestyle through mindfulness, resiliency building, and evidence-based practices.

How do I know if I’m depressed?

The normal ups and downs of life will contribute to instances where you may feel sad or have “the blues” from time to time; however, if you experience an ongoing feeling of emptiness and despair that seems to have taken hold of your life, you may have depression.

Depression makes it tough to function and enjoy life in the ways you once did. But, no matter how hopeless you may feel, know that you can get better. Understanding the signs, symptoms, causes and treatments of depression are the first steps in overcoming the problem. The more symptoms you have, the stronger they are and the longer they’ve lasted, the more likely it is that you’re dealing with depression. When these symptoms are overwhelming and disabling, that's when it's time to seek help.

What are the symptoms of depression?*

If you identify with several of the following signs and symptoms—especially the first two—and they just won’t go away, you may be suffering from depression. Signs and symptoms of depression include:

Feelings of helplessness and hopelessness. A bleak outlook on life and the thought that nothing will ever get better and there’s nothing you can do to improve your situation.
Loss of interest in daily activities. You’ve lost your ability to feel joy and pleasure in former hobbies, pastimes, social activities or sex.
Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
Anger or irritability. Feeling agitated, restless or even violent. Your tolerance level is low, your temper short and everything and everyone gets on your nerves.
Loss of energy. Feeling fatigued, sluggish and physically drained. Your whole body may feel heavy and even small tasks are exhausting or take longer to complete.
Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
Reckless behaviour. You engage in escapist behavior(s) such as substance abuse, compulsive gambling, reckless driving and/or dangerous sports.
Concentration problems. Trouble focusing, making decisions or remembering things.
Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles and stomach pain.

The difficult changes that many older adults face such as bereavement, loss of independence and health problems, can lead to depression – especially in those without a strong support system. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate and an increased risk of suicide, so diagnosis and treatment are extremely important. Talk to a healthcare professional today to about starting treatment.

If you have thoughts of suicide please reach out to 1-800-SUICIDE (1-800-784-2433) or 911.

*Please be advised that the information provided is not meant to replace a standardized assessment. If you think you may be suffering from depression, speak to a qualified healthcare professional that will be able to formally assess and address your concerns.

Is depression a symptom of Parkinson’s disease and why might I be feeling depressed?

Parkinson’s disease (PD) is classified as a movement disorder, but in recent years the non-motor symptoms, including changes in mood, have been acknowledged as components of the disease. At least 50% of people with PD will experience depression and/or anxiety. Depression can be the very understandable reaction to your initial diagnosis and to the changes you experience as the disease progresses. It is normal to be worried about symptoms and to wonder about your future.

Depression can also be caused by changes in your brain chemistry. This is referred to as a chemical depression. In addition to the decreasing amount of available dopamine, PD can affect other circuits and neural pathways that control your mood. In many cases, depression can appear prior to the onset of physical symptoms of PD.

What are my options in overcoming depression?

A variety of effective treatment options are available to help with depression. In fact, with the right treatment, 80% of people with depression feel better or no longer experience symptoms at all (Here to Help, 2013).

Here are some important points to consider:

Get informed. Remember that depression and anxiety are real illnesses that can be treated.
Medication. Speak to a doctor about what medications may be available. A new study (http://bit.ly/Parkinsons-Outcomes-Project) from the National Parkinson’s Foundation recommends that you discuss any mood changes with a healthcare professional, as well ensuring that your PD specialist is aware. It is also recommended that physicians screen for depression at least once a year. If you start taking medication for depression, remember that it can take several weeks before you start to feel better. Early side effects usually disappear as your body gets used to the new drug.
Social support. Listen to your family and your physician if they suggest that you might be depressed or are having difficulty coping. Reach out to friends and family, join a support group. Don’t hesitate to ask for help, even if it is just setting aside a time to talk.
Counselling. There are two types of counselling approaches that work best for people with depression, cognitive behavioural therapy (CBT) and interpersonal therapy (IPT). Using the CBT approach, a health professional can teach you skills to help change your view of the world around you. They do this by coaching you to break the negative patterns of depression including the thoughts and actions that contribute to it. A health professional that uses IPT, will teach you skills to improve how you interact with other people so that your relationships do not suffer.
And/or combination of treatments. Most mental health experts will agree that combining medication with a form of therapy is most effective in combatting depression.

How can PSBC’s counselling service help me manage my symptoms of depression?

At PSBC, we are committed to helping you improve your quality of life. In April 2015, the Society opened a free short-term counselling service for individuals affected by Parkinson’s. In the last few months, we have seen an influx in the demand for this service. Currently, we have two registered psychotherapists who are available by appointment.

By reaching out to the Society, the counsellors can work with you to increase awareness and strength using cognitive behavioural therapy, mindfulness-based exercises and resiliency building to overcome symptoms of depression.

How does cognitive behavioural therapy help me?

CBT is a collaborative, scientifically proven therapy approach that aims to provide clients with strategies to cope more effectively with a wide range of problems including depression. It is based on the idea that our thoughts (‘cognitions’) influence, and are influenced by, our feelings and behaviours. This means we can easily become ‘stuck’ in a vicious cycle, where negative thoughts and feelings feed each other and lead to unhelpful patterns of behaviour. Many of these processes happen automatically, and often outside of our awareness, so it can be difficult to change. CBT can help clients to become more aware.

When you exercise new thinking patterns and utilize helpful behaviours and emotions, you are engaging, to a certain degree, in neuroplasticity. You are creating new helpful pathways that your brain will be able to use, instead of the unhelpful thinking patterns that were connected with depression.

In short, CBT is:

Educational. It provides a new way of understanding your problems.
Skill-based. It involves learning new skills and strategies to manage your unhelpful thoughts, feelings and behaviour. These coping mechanisms should be practised in-between sessions.
Goal-oriented. It encourages you to set specific goals and commit to their achievement.
Present-focused. It prioritizes dealing with the problems you are faced with right now over exploring possible root causes (The Mindful Living Centre).

Sources

Here to Help. (2013). Depression. Retrieved from http://www.heretohelp.bc.ca/factsheet/depression

The Mindful Living Centre. (n.d.). What is Cognitive Behavioural Therapy (CBT)?. Retrieved from http://www.mindfullivingcentre.ca/what-is-cbt.html

This content was published in the Winter 2015 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.

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