Anxiety and Parkinson's

Parkinson’s disease (PD) is classified as a movement disorder; however, non-motor symptoms, including changes in mental health, are experienced by many people living with the disease. In fact, at least 50% of people with PD experience anxiety. Stress is a natural and normal emotion that can be experienced by everyone. Whether it be work, family, or everyday challenges, stress can appear in our lives as a response to external situations (Gilbert, 2020). Anxiety, on the other hand, is a response to internal forces; changes in the brain’s chemistry occur, resulting in persistent worrying in the absence of a stressor (Gilbert, 2020). Anxiety is a real medical condition that can affect anyone on an emotional, physical, behavioural, and cognitive level. Even though mental health challenges are acknowledged to be a common symptom of PD, anxiety is undertreated and misdiagnosed in those living with Parkinson’s (Chen & Marsh, 2014).

Causes of Anxiety in PD

Researchers believe that mental health changes in those living with PD are due to the chemical imbalances that are caused by the disease itself (The Michael J. Fox Foundation, n.d.). The pathways that create dopamine, a neurotransmitter and hormone in the brain that affects movement, memory, and motivation, are impacted by Parkinson’s disease (The Michael J. Fox Foundation, n.d.). These same pathways also aid in the creation of the brain chemical serotonin, which is responsible for regulating mood, appetite, and sleep (The Michael J. Fox Foundation, n.d.). As a result, scientists believe that the impact on dopamine and serotonin pathways causes changes in mental health, such as anxiety disorders, for individuals living with the disease.

Barriers to Diagnosis and Treatment

There are many treatments available for anxiety, but several factors can delay early diagnosis and treatment. According to Chen & Marsh (2014), diagnostic imprecision can occur due to symptoms of anxiety overlapping with other mental health challenges associated with PD, such as depression and psychotic anxiety. Other barriers to diagnosis are as follows:

Mental health concerns are stigmatized. Some people can feel embarrassed about what they are experiencing and, as a result, may ignore their mental health. Others may also deny being depressed or anxious.
Many healthcare professionals, including family physicians, are unaware that mood and anxiety disorders are a common symptom of PD. Depression and anxiety may thus go unnoticed and untreated.
The general public does not understand that changes in mental health can be a direct result of PD, making these symptoms more difficult to discuss openly.

Anxiety is most commonly diagnosed by a primary care doctor or mental health professional. During the appointment, the care provider will have a conversation with the individual about any changes in mood and behaviours. They may also ask the individual to fill out a questionnaire that helps assess the symptoms and severity of anxiety (Parkinson’s Foundation, n.d.).

Consider asking yourself the following questions to determine if anxiety is a part of your life with PD:

Have my sleep patterns, appetite, energy levels, or sexual function changed recently? o Am I more irritable and/or worried than I used to be?
Am I having difficulty concentrating?
Am I unmotivated to do things?

If the answer to even one of these questions is yes, you may be experiencing mental health changes and should consider talking to your doctor about anxiety.

Common Anxiety Symptoms

Emotional symptoms:

Feeling fear and/or nervousness
Having excessive worry

Physical symptoms:

Increase in heart rate and blood pressure
Breathing heavily
Feeling dizzy or lightheaded

Behavioural symptoms:

Urges to escape or avoid situations/activities/people

Cognitive symptoms:

Difficulty with ruminating thoughts and realistic thinking

Types of Anxiety

It is important to understand anxiety is a common non-motor symptom of Parkinson’s disease, and not only a reaction to the diagnosis and challenges of life with PD. There are several types of anxiety disorders, and as many as two out of five people with PD will experience one of the following:

General anxiety disorder (GAD):
- Characterized by recurring feelings of nervousness, worrying, and fear, typically lasting consistently for a long period of time. Physical symptoms can include nausea, trouble breathing, increased heartbeat, sweating, and increased tremors (Parkinson’s Foundation, n.d.).
Anxiety attacks:
- Can mimic the feeling of a heart attack and usually start with severe physical and emotional stress. These attack episodes can last from a few minutes to an hour. When they occur during PD ‘off’ periods, such as when levodopa is not working optimally, they can last for longer periods of time (Parkinson’s Foundation, n.d.).
Social anxiety:
- May result in the avoidance of everyday social experiences, which can be due to embarrassment of PD symptoms, such as tremors and dyskinesia (Parkinson’s Foundation, n.d.).
Obsessive-compulsive disorder (OCD):
- May result in the urge to participate in certain routines (compulsions) to control persistent and unwelcome thoughts/images. Some examples include being obsessed with germs, resulting in excessive handwashing. Not engaging in compulsions results in an increase in anxiety (Parkinson’s Foundation, n.d.).

Treatment

Fortunately, there are many options available for treating anxiety. It is best to consult your physician to decide which option is ideal for you. Medications used treat anxiety in PD are also used to treat depression; selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, as well as norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, may be good choices (Gilbert, 2020).

Psychotherapy, Including Cognitive Behavioural Therapy

Cognitive behavioural therapy, also known as CBT, is one of the most empirically researched therapies known to treat mental health disorders. This style of therapy reworks the thinking process, mapping out how situations lead to certain thoughts, emotions, and behaviours. In CBT, you will begin to identify the distorted thinking styles and negative beliefs that provoke anxiety, such as catastrophizing, feelings of unworthiness, and overgeneralization. Through selfawareness of these thought patterns, we can proactively begin to retrain our thoughts and behaviours.

Mindfulness

Learning to stay present is especially helpful when treating anxiety. Through mindfulness and mindful exercises, you are learning more about your mind and how to allow even difficult thoughts to pass, without them eliciting a strong emotional reaction. Simple exercises, such as mindful breathing, walking, or using guided meditations through apps such as Headspace, can transform your thought process and overall lifestyle.

Other Treatment Options

Other practical lifestyle changes and tips to include in your daily life to mitigate anxiety include:

Journaling thoughts and positive affirmations
Staying physically active
The support of friends and family, which is crucial during episodes of depression and anxiety. Do not hesitate to ask for help, even if just to set aside a time to talk to someone
Educating yourself on anxiety, as well as other PD symptoms
Joining a support group. The Society offers support groups in almost all areas BC; learn more here
Counselling, which may help you monitor your mental health changes, and provide you with support in establishing self-management strategies. Consider Parkinson Society BC’s free, short-term counselling.

Sources

Anxiety. (n.d.). Parkinson’s Foundation. https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Anxiety

Chen, J. J., & Marsh, L. (2014). Anxiety in Parkinson's disease: identification and management. Therapeutic advances in neurological disorders, 7(1), 52–59. https://doi.org/10.1177/1756285613495723

Depression & Anxiety. (n.d.). The Michael J. Fox Foundation for Parkinson’s Research. https://www.michaeljfox.org/news/depression-anxiety

Gilbert, R. (2020, February 12). The relationship between stress, anxiety and Parkinson’s disease. APDA. https://www.apdaparkinson.org/article/stress-anxiety-parkinsons-disease

This content was published in the June 2022 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.

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