If you or a loved one is diagnosed with Parkinson's disease, depression probably won't be among your first concerns—but it should be. New findings from a clinical study done by the National Parkinson Foundation reveal that about half of Parkinson's patients suffer from depression at some point after diagnosis, and that the impact of that depression on their overall health is actually twice as large as that of the motor impairments that we associate with the disease.
Although we've long known that there's a relationship between depression and Parkinson's, this is the largest clinical study on the subject to date," says Joyce Oberdorf, President and CEO of the National Parkinson Foundation. "It's surprising to learn that depression is actually far more troubling to Parkinson's patients than mobility impairment."
Annual Depression Screening Recommended
Based on this research, the NPF is recommending that all people with Parkinson's get screened for depression every year, and getting the word out that treating depression can be an important part of Parkinson's therapy. In addition, they want people to know that depression can be an early sign of Parkinson's. "It's part of the chemistry of the disease," says Oberdorf. "Parkinson's affects neurotransmitters in the brain, including dopamine, a feel-good neurotransmitter that also affects mobility. When there are less of these neurotransmitters it affects cognition."
Dan Baker, a retired high school administrator in Fairview, Oregon could have benefitted from depression screening when he was diagnosed with Parkinson's ten years ago, at age 55. His physical symptoms hardly bothered him—when on the treadmill he'd noticed that his left arm didn't swing as high, and that and some changes in his gait were what led to his diagnosis—but he became anxious and depressed about the future. "Right after I was diagnosed I got involved in a research study which meant spending time around patients who were in advanced stages of the disease," says Baker, a married father of two grown daughters. "My brain projected myself into the future and I started worrying about my worth to the world and my family." Within a couple of months Baker was in a deep depression, suffering from insomnia that left him unable to sleep for days on end. It got so bad that worried family members took him to the ER, and Baker finally got help.
Rx: Therapy, Medication and (Lots of) Exercise
"Once I understood that my depression could be a symptom of Parkinson's I started seeing a psychiatrist to manage it," says Baker. A combination of therapy, prescription medication (a sleeping aid and the antidepressant Zoloft) and an exercise regimen pulled Baker out of his depression. "It took a while for me to re-establish my value in my own mind," he says. Baker was still working as a school administrator at the time and says, "I started to understand the importance of sharing my diagnosis with other people, and when I did I was overwhelmed by the amount of support I received from my colleagues."
Ten years later, Baker has vanquished his depression and has staved off the most debilitating effects of Parkinson's. He has almost entirely weaned himself off of prescription medications for depression. Although he's retired he and his wife of 42 years stay active by volunteering in local schools.
The thing that Baker says may have been most crucial in allowing him to beat depression: Exercise. "Exercise has been key for me, both physically and mentally," he says. He does Tai Chi and Pilates with a Parkinson's support group, and also goes to a gym where he swims, does strength training and spends time on the treadmill. "I'd always been active but during my depression I stopped exercising," he says. "Once I started again it really helped me."
Oberdorf confirms that exercise is an essential component of treating Parkinson's-related depression. "Exercise is like a prescription for treatment of these patients," she says. "It's usually a combination of exercise, counseling and medications that works."
How to Spot Depression in a Parkinson's Patient
If you or a relative has been diagnosed with Parkinson's, be alert for signs of depression. "All too often people don't notice it," says Oberdorf. Parkinson's patients often have a masked facial expression, and that plus the fact that Parkinson's and depression share some symptoms, such as fatigue, can make depression hard to recognize. In addition to being screened for depression annually, Parkinson's patients should discuss mood changes with their doctors, and bring a family member along with them to appointments so the family member can report on any mood changes he or she has observed.
It's essential that a depressed Parkinson's patient gets help, not just for his or her happiness, but for the sake of physical health. "Once these patients are treated for depression they eat better, they sleep better, they're more likely to exercise and be social, and it makes a big difference for those who love and care for them as well," says Oberdorf. "Once depression is diagnosed it's eminently treatable, with significant improvement in quality of life."
You can learn more about Parkinson's Disease and the Parkinson's Outcomes Project (the source of this research) at the National Parkinson Foundation website.
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