- Rasheda El Nazer, MD
Mood Changes in Parkinson Disease
Although Parkinson Disease (PD) is classically thought of as a movement disorder, mood changes are an important symptom that can be underrecognized in the disease course. Many people living with PD will experience anxiety and/or depression at some stage of their disease course. Sometimes mood symptoms are more bothersome than the motor changes and they can have a bigger impact on an individual’s daily life.
Anxiety is sometimes described as a feeling of fear, restlessness or nervousness which brings about bodily responses such as a racing heartbeat, breathlessness and sweating. Depression is also common to Parkinson disease and can be described as symptoms of sadness, early morning awakening, pessimism, irritability, reduced motivation, or a lack of pleasure in previously enjoyed activities. Sometimes people will think that depression is only present if one experiences crying episodes. This is not true. It is important to recognize that depression can be as mild as just having a reduced feeling of optimism or a slight sense of persistent gloominess. These feelings should not be ignored and are very treatable.
Both anxiety and depression are commonly reported mood changes that sometimes can be related to a feeling of grief after receiving the diagnosis of Parkinson disease, but are also direct symptoms of the disease itself resulting from chemical changes in the brain. Often, it can even be an early finding in the disease course prior to the emergence of motor symptoms. Additionally, it has been correlated with disease duration, severity of motor symptoms and motor fluctuations, with wearing off of your Parkinson specific medication. It would be helpful to keep a diary and log the times of day in which you experience some of your mood changes. If it appears that these occur primarily in the “OFF” state, it may require modification to your Parkinson medications.
If you experience any symptoms of anxiety or depression, it is important that you address this with your provider. Treatment is usually a combination of nonpharmacological therapy such as cognitive behavioral therapy and lifestyle changes such as a structured exercise program and proper sleep hygiene as well as pharmacologic treatments such as antidepressant medications. It is not always necessary to treat symptoms of anxiety or depression with medications. The decision to initiate medication is primarily dependent on severity of symptoms and if it is interfering with your quality of life. Commonly patients have been prescribed anti-anxiety medications from the benzodiazepine drug class such as Valium, Ativan, and Xanax. While these are medications that can immediately improve symptoms, it is not recommended to remain on this chronically as they are sedating and carry risks of dependence, cognitive impairment and increased falls. First line treatment is instead initiated with medications from the selective serotonin reuptake inhibitor (SSRI) drug class as these are not addictive and provide long term relief of symptoms. Keep in mind that it usually takes a few weeks to experience the full effect of these medications.
When a person with Parkinson disease experiences mood changes, they may shy away from seeking help. Talking about symptoms with your health care provider helps you regain a sense of control and enables your provider to better understand how PD is affecting you.
About the Author:
Rasheda El-Nazer, MD is a board certified neurologist. She completed her Neurology Residency at Texas A&M College of Medicine in Temple, TX. Following residency, she moved to Dallas, TX and completed fellowship training in Movement Disorders at UT Southwestern Medical Center. After graduation she stayed on as faculty where she continues to focus her clinical practice on various movement disorders such as Parkinson disease, Huntington Disease, and tremors to name a few. She is passionate about patient education and community outreach. Her research interests involve the investigation of novel therapies for various movement disorders with the primary goal of improving the quality of care.