Managing Mental Health in Parkinson's

Mental health encompasses emotional, psychological, and social well-being, constituting a crucial aspect of overall health for all individuals. Just as symptoms of Parkinson’s disease (PD) vary significantly among individuals, the spectrum of mental health challenges experienced by people with Parkinson’s (PwP) also varies widely. Some may have minimal mental health concerns, while others grapple with issues like depression, anxiety, psychosis, or cognitive impairments, all of which can manifest as non-motor symptoms of PD. During the progression of the disease, a majority will experience at least one clinically significant neuropsychiatric issue, and many will simultaneously contend with multiple mental health issues. These can range from depression and anxiety to hallucinations, memory problems, and dementia (M. Pontone & D. Weiss, 2018).

Anxiety and depression are particularly prevalent among individuals with Parkinson's disease, with nearly half of all individuals living with Parkinson's experiencing one of these challenges (Parkinson Society BC, 2019). These symptoms can emerge due to various factors, including the emotional strain of receiving a Parkinson's diagnosis and the physiological changes in the brain resulting from the condition itself.

Anxiety

Anxiety can be characterized by excessive fear, concern, and stress. It is a prevalent issue in Parkinson's, affecting up to 50% of PwP at some point during the course of the disease (M. Pontone & D. Weiss, 2018). It can take various forms, such as generalized anxiety disorder, panic attacks, social anxiety, or specific phobias, and often overlaps with multiple types (Gallagher & Schrag, 2012). Distinguishing it from occasional situational anxiety is essential, as anxiety disorders tend to be persistent and can significantly impact daily life (Schrag & Taddei, 2017). Living with Parkinson's can introduce a sense of uncertainty and unpredictability, which can further exacerbate these anxious feelings. Furthermore, the physical symptoms of the disease, such as tremors and gait disturbances, can lead to self-consciousness and fears of social judgment, exacerbating anxiety symptoms. Anxiety can also manifest during "off" periods when the PD medication wears off before the next dose.

Symptoms of Anxiety

People with anxiety may experience some of the following:

A sense of dread
Constant worry
Difficulty concentrating
Feeling unable to relax
Difficulty sleeping

Physical symptoms can also manifest from anxiety. These can include:

Sweating
A pounding or racing heart (palpitations)
Tightness of the chest or feeling breathless
Dizziness
Trembling
Indigestion, nausea, and stomach-ache or cramps
Headaches
Loss of appetite
A dry mouth
Muscle pain and tension
Restless legs and difficulty maintaining restful sleep

Please be aware that this list of main symptoms of anxiety is not exhaustive. Anxiety can manifest in various ways, and individual experiences may differ.

While there's no definitive cure for anxiety, proactive strategies can help manage symptoms and restore a sense of control. It's crucial to discuss anxiety with a healthcare professional, as it can exacerbate other Parkinson's symptoms like dyskinesia, tremors, and balance issues (Parkinson's UK, n.d.). Treatments for anxiety in PD include medication such as antidepressants and psychotherapy. Individuals taking antidepressants alongside Parkinson's medications should exercise caution and consult their healthcare provider for appropriate monitoring and management (Schrag & Taddei, 2017). Additionally, applied relaxation techniques and participation in support groups have shown efficacy in managing anxiety symptoms and developing coping strategies. Applied relaxation involves learning to relax muscles quickly in anxiety-inducing situations, typically taught by a qualified therapist over a period of 3-4 months (Gallagher & Schrag, 2012). It is recommended that you speak to your doctor about what may be the best solution for you. Moreover, joining a support group is easily accessible and offers a safe space for individuals with PD experiencing anxiety to share their experiences and feelings. These groups foster a sense of belonging and understanding, often leading to a reduction in isolation and the exchange of effective coping strategies.

Tips to Manage Anxiety

Set aside time for your worries: By doing so, you can reassure yourself that you haven’t forgotten them. You can also write them down to consciously separate and isolate your worries from impacting the whole day.
Track your feelings: Keep a diary of how you feel when you get anxious and write about the circumstances or situation. This can help you and your counsellor or therapist identify patterns in what triggers your anxiety.
Distract yourself: If your anxiety is starting to feel overwhelming, find a simple activity like watching funny videos, or talking to a friend allowing you to shift your focus.
Use your voice: Sing around the house, in the shower or join a choir. Singing engages deep breathing and releases endorphins which can promote relaxation and reduce stress.
Go outside: Being outdoors has various benefits for anxiety by providing exposure to nature, fresh air, physical activity, sunlight, a change of environment, opportunities for mindfulness, social interaction, and a break from digital devices. These can contribute to a sense of relaxation and reset.

Depression

Depression is typically diagnosed when persistent feelings of extreme sadness or a pervasive sense of emotional 'emptiness' endure over an extended period. It extends beyond temporary episodes of sadness, discontent, or frustration and can significantly hinder one's ability to carry out daily tasks. Studies have indicated that around 40% of individuals with Parkinson's experience symptoms of depression at some point during their illness (Parkinson's Foundation, n.d.). This elevated risk of depression can be attributed to both biological changes in the brain and the psychosocial challenges associated with the diagnosis.

Depression in Parkinson's is not solely a reaction to physical limitations; it is also associated with neurochemical imbalances, particularly involving dopamine, serotonin, and norepinephrine. These neurotransmitters play pivotal roles in regulating mood, and their dysfunction can contribute to depressive symptoms (Parkinson Society BC, 2019). Additionally, depression can have a genetic component, making individuals with a family history of depression more susceptible to developing it (Schrag & Taddei, 2017).

Symptoms of Depression

A lack of interest in, or pleasure from, usual activities
Feeling down or hopeless nearly every day
Feeling anxious or feeling constantly worried or afraid
Difficulty concentrating
Low energy and tiredness
Trouble sleeping (waking in the early hours of the morning can be a typical sign) or excessive sleeping
A loss of appetite, usually connected with weight loss
Increased appetite and weight gain
Feelings of worthlessness or guilt
In severe cases, thoughts of death or self-harm, and suicidal ideas

Diagnosing depression in individuals with Parkinson's disease can be challenging due to the overlap of certain symptoms. For instance, sleep disturbances are common among those with Parkinson's, leading to feelings of fatigue and reduced energy levels. However, these symptoms alone may not necessarily indicate depression. Both Parkinson's and depression can manifest as fatigue, characterized by an overwhelming sense of tiredness. Additionally, the fluctuating nature of PD symptoms throughout the day can result in mood fluctuations, which may not necessarily signify depression. In some cases, these mood changes could be linked to adjustments in Parkinson's medication. To differentiate between the two conditions, it is crucial to seek a comprehensive assessment by a healthcare professional, preferably a neurologist or psychiatrist specializing in PD and mood disorders, to provide a more accurate diagnosis and a tailored treatment plan (Schrag & Taddei, 2017).

Patients and caregivers should remain vigilant in recognizing signs of depression, as timely intervention—whether through counselling, psychotherapy, or medication—can alleviate depressive symptoms and enhance overall quality of life. Cognitive Behavioural Therapy (CBT) and counseling serve as valuable treatment options for individuals with Parkinson's contending with depression. CBT is a structured, evidence-based therapeutic approach that focuses on identifying and altering negative thought patterns and behaviours contributing to depression. It equips patients with practical tools and coping strategies to manage their emotions and improve their overall well-being. On the other hand, counselling offers a supportive and empathetic environment for individuals to express their feelings and concerns (Yang et al., 2012). Both approaches provide crucial emotional support, helping individuals with Parkinson's better comprehend and manage their depression, ultimately enhancing their quality of life and emotional resilience.

Tips to Manage Depression

Keep active: Research has shown that being physically active 2 to 3 times a week, especially as part of a group, can boost your mood and help you sleep well. It doesn’t have to be high impact, find something that you enjoy!
Maintain a healthy diet: Depression can lead to changes in your appetite therefore it is important to make an effort to have a balanced diet to improve low mood and overall well-being. • Prioritize sleep: Sleep disorders can be symptoms of depression. Maintain sleep hygiene to improve the amount and quality of sleep. This includes making sure your bedroom is quiet and comfortable and following a sleep schedule.
Carve out time for relaxation: Engage in activities that you enjoy, such as reading a book or listening to your favorite music. Consider exploring relaxation techniques like aromatherapy, or meditation which you may find beneficial.
Practice mindfulness: Mindfulness involves embracing the present moment with undivided attention, free of distractions or judgment. It empowers you to observe your thoughts and emotions without becoming entangled in them, offering benefits that extend to both your physical and mental well-being.
Seek support: Engaging in support groups can provide a sense of community and shared experiences, reducing feelings of isolation. Additionally, discussing your depression with a healthcare professional ensures access to tailored treatment options and guidance. There is no shame in reaching out for help.

As it relates to Parkinson's disease, the significance of mental health often takes a backseat to physical well-being. However, it is essential to remember that one's mental health is just as crucial as their physical health. Experiencing anxiety or depression is not a sign of weakness, but rather a natural response to the challenges posed by this complex condition. Seeking support and treatment should never be accompanied by shame or hesitation. Instead, it is a courageous step toward regaining control, fostering resilience, and ultimately achieving a higher quality of life, where both mental and physical health are given the attention and care they rightfully deserve. Remember, you are not alone, and there is help available to navigate the emotional landscape of Parkinson's with strength and dignity.

Sources

Gallagher, D. A., & Schrag, A. (2012). Psychosis, Apathy, Depression and Anxiety in Parkinson’s Disease. Neurobiology of Disease, 46(3), 581–589. https://doi.org/10.1016/j.nbd.2011.12.041

M. Pontone, G., & D. Weiss, H. (2018, May). Mental Health and Parkinson’s Disease. Practical Neurology. https://practicalneurology.com/articles/2018-may/mental-health-andparkinsons-disease

Parkinson's Foundation. (n.d.). Depression. https://www.parkinson.org/understanding-parkinsons/non-movementsymptoms/depression#:~:text=Research%20estimates%20that%20at%20least

Parkinson's UK. (n.d.). Parkinson’s and Mental Health. https://www.parkinsons.org.uk/information-and-support/parkinsons-and-mentalhealth#:~:text=These%20can%20range%20from%20depression

Pontone, G. M., Williams, J. R., Anderson, K. E., Chase, G., Goldstein, S. A., Grill, S., Hirsch, E. S., Lehmann, S., Little, J. T., Margolis, R. L., Rabins, P. V., Weiss, H. D., & Marsh, L. (2009). Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson’s disease. Movement Disorders, 24(9), 1333–1338. https://doi.org/10.1002/mds.22611

Schrag, A., & Taddei, R. N. (2017). Chapter Twenty - Depression and Anxiety in Parkinson’s Disease. ScienceDirect, 133, 623–655. https://www.sciencedirect.com/science/article/abs/pii/S0074774217300818

Yang, S., Sajatovic, M., & Walter, B. L. (2012). Psychosocial Interventions for Depression and Anxiety in Parkinson’s Disease. Journal of Geriatric Psychiatry and Neurology, 25(2), 113– 121. https://doi.org/10.1177/0891988712445096

This content was published in the October 2023 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.

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