The Neurologist Is In
Monthly insights and advice from a stroke specialist, a movement disorder expert, and a neuromuscular physician.

Thursday, July 21, 2016

Don’t Ignore Depression in Parkinson’s Disease

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BY MELISSA ARMSTRONG, MD, MSC, FAAN

More than half of people with Parkinson's disease have depression. In fact, depression is often the number one symptom affecting their quality of life. It trumps tremor, stiffness, slowness, and other physical problems. But physicians and patients aren't always good at recognizing or acknowledging it.

Depression Is Different

I see examples of this lack of understanding every day in my clinic. When I ask my patients about depression, they often wave their hands dismissively and tell me it's frustrating to live with Parkinson's disease, so of course they're depressed and it's no big deal.

It's easy to blame depression on the challenges of living with a chronic condition, but depression is not just sadness or frustration. People who are depressed persistently feel down and hopeless. They lose interest in activities they used to enjoy. They may feel guilty, worthless, or irritable. They may also have suicidal thoughts. Additionally, depression is associated with chemical changes in the brain due to Parkinson's disease. Dopamine is the chemical most commonly associated with the disorder, but the disease also affects serotonin and norepinephrine. Scientists think that all three chemicals are involved in causing depression in Parkinson's disease.

Pill Power

That double whammy—those chemical changes in the brain and the challenges of living with the disease—affects treatment. Because part of the problem relates to brain changes, you can't just will yourself to overcome depression. Treatment needs to balance the chemistry in the brain. In most cases, doctors prescribe selective serotonin reuptake inhibitors (SSRIs), the same medications used for depression in other circumstances.

Support System

At the same time, it's important to recognize that the frustration and depression related to living with a brain disease don't magically disappear by taking a pill. That's where non-medication approaches can be helpful, such as working with a psychologist or counselor, talking to friends or family, partnering with pastors or priests, or connecting with others through support groups.

Speaking with others can help you work towards accepting your diagnosis and coping with its challenges. Ask for personal recommendations for psychologists and counselors from your doctor or friends and family members. You can also search for local psychologists through the American Psychological Association at http://locator.apa.org/

Be Persistent

Doctors believe untreated depression does not resolve on its own and may worsen in people with Parkinson's disease. Those who do receive treatment usually notice improvement in symptoms and experience a better quality of life. And if one medication fails, another can still be helpful.

Ideally, the approach is two-pronged: taking medication to address the chemical changes in the brain and relying on support systems to cope with life adjustments. By combining approaches—and giving them time to work—you are more likely to manage depression successfully.

Armstrong_Melissa (1).JPGDr. Armstrong is a movement disorders specialist at the University of Florida Health Center for Movement Disorders and Neurorestoration in Gainesville. She is also involved in the American Academy of Neurology's evidence-based guideline program.