Depression and Anxiety in Parkinson’s Disease

Depression and Anxiety are among clinical and non-motor symptoms of Parkinson’s disease (PD). As per an estimate, about 50% PD fighters experience depression and anxiety. As confirmed by studies, these mood disorders are not linked to PD progression and can be prevalent before diagnosis or develop much later on. While some PD fighters experience anxiety and depression together, some may be diagnosed with either one of the mood disorders.

Anxiety shows itself in form of a constant feeling of being overwhelmed, excessive worry, anticipation, being concerned with details, emotional reactivity or fearfulness. All or any of the common anxiety symptoms of restlessness, trouble sleeping or trouble concentrating can overlap with common PD symptoms.

Anxiety along with depression can make the PD fighter’s movement symptoms, particularly Tremors more disabling, regardless of how much PD has advanced. Depression can be seriously detrimental and can create hindrance in critical elements of overall treatment regimen such as exercising to manage motor symptoms, socializing to forget grief or being proactive about seeking care. Just like any other PD symptom, cause and severity of depression can differ from person to person.

Options to treat Depression and Anxiety in Parkinson’s disease

If anxiety is a reflex of swallowing difficulties or frustration of not being able to complete activities of daily living (ADL), Occupational Therapy and Speech Therapy can help reduce anxiety triggers. Curing PD-led sleeping disorder can also improve the PD fighter’s mood and reduce depression and anxiety. This way, medication for insomnia can indirectly cure mild depression. Also, exercising regularly and dietary changes can improve mood and attempt to treat depression.

However, the mainline treatment of depression and anxiety remains Psychological Counseling and Antidepressants. Yoga, for being a complete physical activity, is emerging as a popular practice to treat depression and anxiety completely.

At times, a holistic, comprehensive approach is used to treat depression and anxiety. In case of clinical depression, the best approach is a combination of antidepressant, counseling, exercise and dietary changes. The tolerability and effectiveness of several complementary therapies such as Light therapy, Massage Therapy, Acupuncture and Music Therapy are still under research.

Medications

There are a number of medications available for easing non-motor symptoms of PD such as depression and anxiety. By promoting regulated blood pressure and good night sleep, these medications attempt to minimize episodes of Anxiety. Most commonly prescribed Antidepressants include Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) and Tricyclic Antidepressants (TCAs).

Psychotherapy

Psychotherapy refers to a variety of counseling or talk therapies, which is often used in combination with medication. Research has found that rates of depression are lowest among PD patients receiving care in the form of counseling. One such subcategory of Psychotherapy – Cognitive behavioral therapy (CBT) helps people change negative thinking patterns and behaviors to reduce depression. CBT helps people learn coping skills better and think positively for the long term.

Exercising and Yoga

Exercising on regular basis has been found to be a simple therapeutic approach for improving mood and curing mild depression. It can include brisk walking, stretching, yoga and any other basic forms of physical activity.

Various research studies mention that Yoga improves balance (though one-leg postures) and reduce the fear of falling among PD fighters. By helping patients increase flexibility, improve posture, relax tight, painful muscles, Yoga can save PD fighters from slipping into clinical depression and anxiety. Postures like Mountain Pose (Tadasana), Standing forward bend (Uttanasana) and Warrior Pose (Virabhadrasana) help to reduce stiffness and improve mood. Pranayama discipline of Yoga may also improve the sense of well-being and hence reduce depression or anxiety.

Just like other therapeutic treatments of the disease, Yoga Therapy has to be individualized to yield best results. Cow’s Face Pose (Gomukhasana), Lotus Pose (Padmasana), Corpse Pose (Savasana), Child Pose (Balasana), Intoxicating Bliss Pose (Ananda Madirasana), Standing Forward Bend (Uttanasana), Downward Facing Dog (Adho Mukha Svanasana), Cat Stretch Pose (Marjariasana), Reclining Bound Angle Pose (Supta Badha Konasana) and Half Lord of the Fishes Pose (Ardha Matsyendrasana) are among mostly prescribed Yoga postures to induce calm.

Healthy Diet

Omega-3 rich foods reduce depression in PD patients. Since Fatty fish and walnuts provide significant amounts of omega-3 fatty acids, they promote cardiovascular health and henceforth improve the PD patient’s emotional health. A healthy diet can help PD fighters to maintain normal body weight, reduce constipation and boost their immune system, decreasing risk factors for depression and anxiety. However, certain food groups or the timing of meals can interfere with PD medication. This is why an individual should ask his physician about any dietary precautions whenever he is prescribed a new medication.