Provided by the National Institute of Mental Health
Symptoms of Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed,
including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks
and interfere with routine daily activities such as work, self-care, and
childcare or social life, seek an evaluation for depression.
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Introduction
Depression can strike anyone, but people with Parkinson's disease, a progressive
brain disorder affecting more than 500,000 Americans,1 may be at greater risk.
Treatment for depression helps people manage both diseases, thus improving the
quality of their lives.
The true prevalence of depression among people with Parkinson's disease is
difficult to determine because there are no standardized assessment tools
designed to evaluate depressive symptoms in the context of this illness.
However, it is estimated to be quite common—as many as half of people with
Parkinson's may suffer from depression.2
Despite the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. People with Parkinson's, their families
and friends, and even their physicians may misinterpret depression's warning
signs, mistaking them for inevitable accompaniments to Parkinson's disease. In
addition, men, who are more likely to develop Parkinson's, are more likely than
women to have difficulty acknowledging depression.
Symptoms of depression may overlap with those of Parkinson's and other physical
illnesses. However, skilled health professionals will recognize the symptoms of
depression and inquire about their duration and severity, diagnose the disorder,
and suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and
the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that almost 10 percent of American adults, or about 19 million
people age 18 and older, experience some form of depression every year.3
Although available therapies alleviate symptoms in over 80 percent of those
treated, less than half of people with depression get the help they need.3,4
Depression results from abnormal functioning of the brain. The causes of
depression are currently a matter of intense research. An interaction between
genetic predisposition and life history appear to determine a person's level of
risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever
its origins, depression can limit the energy needed to keep focused on treatment
for other disorders, such as Parkinson's disease.
People with depression who have Parkinson's disease have a different symptom
profile than those without Parkinson's.2 The Parkinson's profile includes higher
rates of anxiety, sadness without guilt or self-blame, and lower suicide rates
despite high rates of suicidal thoughts. Hormonal imbalances such as
hypogonadism and hypothyroidism, which can cause depressive symptoms, need to be
looked at carefully in these individuals. More research is needed to understand
the relationship between Parkinson's disease and depression, dementia, anxiety
disorders, and psychosis.
Parkinson's Disease Facts
Parkinson's disease is a chronic and progressive disorder of the brain primarily
affecting the motor system, but also affecting thinking and emotion. It results
from the loss of brain cells that produce dopamine, a chemical messenger that
controls movement. The four primary symptoms of Parkinson's are tremor or
trembling in hands, arms, legs, jaw, and face; rigidity or stiffness of the
limbs and trunk; bradykinesia, or slowness of movement; and postural
instability, or impaired balance and coordination. Individuals may also have
difficulty walking, talking, or completing other simple tasks. Early symptoms
are subtle and occur gradually. At present, there is no way to predict or
prevent Parkinson's disease.
Parkinson's disease affects both men and women. The disease is considerably more
common in the over-50 age group. With the increased life expectancy in this
country and worldwide, an increasing number of people will develop Parkinson's
disease.
A variety of medications provide dramatic relief from the symptoms. However, no
drug yet can stop the progression of the disease, and in many cases medications
lose their benefit over time. In such cases, surgery may be considered. Some
doctors recommend physical therapy or muscle-strengthening exercises. Some new
drugs have recently been approved offering a wider choice of medications for
individuals with Parkinson's, while others are under investigation in this
country and overseas in an effort to obtain better therapeutic results with
fewer side effects. Ongoing research is aimed at discovering the cause of
Parkinson's disease, finding better treatments, and ultimately preventing and
curing the disorder.
Get Treatment for Depression
Treating depression can help people feel better and cope better with their
Parkinson's treatment. While prescription antidepressant medications are
generally well-tolerated and safe for people with Parkinson's, more research is
needed to determine which antidepressants work best for people with different
subtypes of Parkinson's.2 Specific types of psychotherapy, or "talk" therapy,
also can relieve depression. Studies have demonstrated the improvement of
Parkinsonian symptoms in patients receiving electroconvulsive therapy.5 Although
there are many different treatments for depression, they must be carefully
chosen by a trained professional based on the circumstances of the person and
family.
Treatment for depression in the context of Parkinson's disease should be managed
by a mental health professional—for example, a psychiatrist, psychologist, or
clinical social worker—who is in close communication with the physician
providing the Parkinson's disease treatment. This is especially important when
antidepressant medication is needed or prescribed, so that potentially harmful
drug interactions can be avoided. In some cases, a mental health professional
that specializes in treating individuals with depression and co-occurring
physical illnesses such as Parkinson's disease may be available. People with
Parkinson's who develop depression, as well as people in treatment for
depression who subsequently develop Parkinson's disease, should make sure to
tell any physician they visit about the full range of medications they are
taking.
Use of herbal supplements of any kind should be discussed with a physician
before they are tried. Recently, scientists have discovered that St. John's wort,
an herbal remedy sold over-the-counter and promoted as a treatment for mild
depression, can have harmful interactions with some other medications.
Recovery from depression takes time. Medications for depression can take several
weeks to work and may need to be combined with ongoing psychotherapy. Not
everyone responds to treatment in the same way. Prescriptions and dosing may
need to be adjusted. No matter how advanced the Parkinson's disease, however,
the person does not have to suffer from depression. Treatment can be effective.
Other mental disorders, such as bipolar disorder (manic-depressive illness) and
anxiety disorders, may occur in people with Parkinson's, and they too can be
effectively treated. However, some Parkinson's medications may worsen mania in
persons with co-occurring bipolar disorder.5 The prevalence of bipolar disorder
among individuals with Parkinson's is unknown, but people in treatment for
Parkinson's should be alert for symptoms of bipolar disorder. Bipolar disorder
is characterized by intense mood swings and changes in behavior. For more
information on bipolar disorder and other mental illnesses, contact NIMH.
Remember, depression is a treatable disorder of the brain. Depression can be
treated in addition to whatever other illnesses a person might have, including
Parkinson's. If you think you may be depressed or know someone who is, don't
lose hope. Seek help for depression.
For more information about depression
Please visit the following links for more information about organizations that
focus on depression and other illnesses and mental health research.
References
1Parkinson's disease backgrounder. National Institute of Neurological Disorders
and Stroke. July 1, 2001. http://www.ninds.nih.gov/health_and_medical/pubs/parkinson's_disease_backgrounder.htm
2Cognitive and emotional aspects of Parkinson's disease. National Institute of
Neurological Disorders and Stroke, National Institute on Aging, and National
Institute of Mental Health working group meeting, January 24-25, 2001.
Unpublished summary.
3Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
4National Advisory Mental Health Council. Health care reform for Americans with
severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65
5McDonald W. Personal communication, 2001.
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All material in this brochure is in the public domain and may be reproduced or
copied without permission from the Institute. Citation of the National Institute
of Mental Health as the source is appreciated.
NIH Publication No. 02-5007
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
May 2002
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