Depression and Seasonal Affective Disorder
Over 50% of people with Parkinson’s disease (PD) experience mental health challenges. Mood and anxiety disorders can be caused by the way people cope with their diagnosis, the progression of their condition, and worries about the future. These challenges are also commonly associated with Parkinson's-related changes in the brain's structure and chemistry, including a decreased supply of the neurotransmitter dopamine.
Unlike sadness, which is a temporary emotion, depression is a feeling of melancholy that persists for several weeks or longer. Depression is often used to discuss a casual form of sadness or low mood but it is a real mental health challenge. Common symptoms of depression may include the following that last for at least 2 weeks or more (Whelan, 2017):
- Constant feelings of sadness
- Irritability
- Fatigue or difficulty concentrating
- Changes in sleeping or eating patterns
- Loss of interest or enthusiasm
- Feelings of worthlessness
- In some cases, thoughts about harming oneself, death, or suicide
Sometimes, individuals are reluctant to seek help for their depression, as mental health challenges have been historically stigmatized in society. However, the most important thing to remember is that depression and other mental health challenges are real illnesses, and legitimate symptoms of PD that can and should be treated.
Seasonal Affective Disorder
For people with PD and their carepartners, the winter can be a stressful time of year. In some cases, individuals may notice an onset of mental health challenges in the winter, but not during other times of year. This can be an indication of seasonal affective disorder (SAD). SAD is thought to be caused by reduced levels of light which disrupt your circadian rhythm – your body’s biological clock – and a disturbance in brain chemicals and hormones that help regulate mood and sleep, such as serotonin and melatonin (Mayo Clinic, 2017). SAD symptoms are similar to depression and may also include low energy, restlessness, feelings of hopelessness, and in more severe cases, extreme difficulties with daily functioning, or delusions.
While depression, anxiety, and other mental health challenges are common in people with PD, SAD can also impact those who do not normally experience these other conditions. Even if your symptoms tend to disappear once the sun comes out, it is important not to write off SAD as the “winter blues” – healthcare professionals can offer support and ways to manage SAD to help you live better throughout the entire year.
Coping with Mental Health Challenges
Regardless of the severity of your mental health symptoms, and what time of year you may experience them, there are a variety of effective treatment options available to help with mental health concerns. Firstly, there are many different types of medications used to treat mood and anxiety disorders – speaking with your doctor can help you identify which one may be the right option for you. It is important to always speak to your doctor before beginning or stopping a medication. Professional counselling may also help monitor your mental health changes and provide you with support in establishing self-management strategies. Parkinson Society British Columbia offers free, short-term, confidential and non-judgmental counselling services for people touched by Parkinson’s. Visit www.parkinson.bc.ca/counselling to learn more.
Self-management Strategies
Alongside receiving professional support, there are also things you can do on your own to improve your mental health and overall wellbeing. Some of these strategies include physical activity, eating a balanced diet, or joining a support group. Physical activity promotes the release of endorphins in your body that decrease symptoms of depression and anxiety, while a balanced nutritious diet can steady your mood, and make it easier to focus and cope with stress. In the winter time, ensuring an adequate intake of vitamin D may help prevent and manage depression (Mayo Clinic, 2016). Joining a support group can offer opportunities to stay social and connect with others who may be facing similar challenges.
Studies have indicated that light therapy – also known as phototherapy – can also be an effective at-home treatment for SAD. Light boxes may ease symptoms by mimicking outdoor light and causing chemical changes in the brain that lift your mood (Mayo Clinic, 2016). It is best to speak to your healthcare provider before choosing a light box, but generally individuals should look for boxes that provide 10,000 lux of light, with little to no UV light.
Mindfulness and Cognitive Behavioural Therapy
Mindfulness-based stress reduction (MBSR) and Cognitive Behavioural Therapy (CBT) are scientifically proven therapies that may be used to help improve mental health conditions. MBSR is a mindfulness program that trains you to calm your mind and body by focusing only on the present moment. Paying attention to only one thought or sensation at a time, with no judgement, encourages individuals to let go of unwanted feelings or regrets from the past, and can help promote better control over the mind and emotions.
The following examples are a few ways you can practice MBSR on your own (HealthLink BC, 2019):
- Focus your attention on your entire body, starting with your feet and ending at your head. As you do this ‘body scan’, note your breath, and places of tension or pain.
- Focus on thoughts and distractions that run through your mind, but don’t judge them. Simply note thoughts and feelings that may arise, and then focus your attention back on the present moment. It is ok if your mind wanders, just keep trying to return to the present moment.
- Take a slow walk by yourself and focus on counting your steps, your breath, or feeling the temperature in the air.
- Imagine your mind as a sky and your thoughts as clouds, and simply watch the thoughts float across your ‘mind’s sky’, letting them pass by without judgement.
While stress and pain can often make you feel out of control, it is actually possible to control your body and mind’s response. MBSR helps break habitual ways of reacting to difficult situations and instead promotes a more positive, peaceful mindset.
Cognitive Behavioural Therapy (CBT) is a strategy that also works to modify thought and behaviour patterns in order to improve mental health. You and your counsellor or psychologist may work together on CBT, but the principals can also be applied outside of professional sessions. CBT is based on the idea that negative actions and feelings are a result of distorted perceptions of situations (Holland, 2018). For example, if a friend does not return a missed phone call, you may assume they are mad at you, when in reality they may simply be busy that day and have no time to socialize. CBT treatment involves learning to identify false beliefs, adjust your response, and practice self-talk that is positive, accurate, and balanced (Holland, 2018). Reforming thought patterns can help break through inaccurate or destructive perceptions that may be causing negative feelings and contributing to your mental health concerns.
Sources
HealthLink BC. (2019). Mindfulness-Based Stress Reduction. Retrieved from https://www.healthlinkbc.ca/health-topics/abl0293
Holland, K. (2018). Cognitive-Behavioral Therapy for Depression. Retrieved from https://www.healthline.com/health/depression/cognitive-behavioral-therapy
Mayo Clinic. (2016). Seasonal affective disorder treatment: Choosing a light therapy box. Retrieved from https://www.mayoclinic.org/diseases-conditions/seasonal-affectivedisorder/in-depth/seasonal-affective-disorder-treatment/art-20048298
Mayo Clinic. (2017). Seasonal affective disorder (SAD). Retrieved from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptomscauses/syc-20364651
Whelan, C. (2017). Depression vs. Sadness: What's the Difference? Retrieved from https://www.healthline.com/health/depression/depression-vs-sadness
This content was published in the January 2021 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.