Dr. Julie Pilitsis speaks about Parkinson's disease at Albany Med on Friday afternoon, August 15, 2014, in Albany N.Y. (Selby Smith/Special to the Times Union)
Its tough to know if a person with Parkinson's disease is depressed.
Muscle stiffness can cause even the most content person with Parkinson's to have a mask-like, inexpressive face or soft, monotone speech.
But patients, caregivers and doctors should not dismiss those symptoms merely as signs of physical disease, local experts in mental health and movement disorders said. Recent research shows a significant number of people with Parkinson's disease suffer from depression, sometimes in response to being ill, but sometimes due to changes in brain chemistry caused by the illness itself.
Even well-informed medical providers don't always catch it, they said."Depression can be missed, even by the patient, and is not aggressively treated," said Robin Tassinari, a psychiatrist at Albany Medical Center.
Even well-informed medical providers don't always catch it, they said."Depression can be missed, even by the patient, and is not aggressively treated," said Robin Tassinari, a psychiatrist at Albany Medical Center.
The recent death of actor Robin Williams has focused attention on both depression and Parkinson's disease. Williams, found dead from an apparent suicide a week ago, was suffering from both conditions, according to his widow.
Williams was said to be in the early stages of Parkinson's, and had struggled with depression for years. So it's unlikely that being diagnosed with Parkinson's disease caused his depression, though there's no telling from published reports whether it worsened his mental state.
Parkinson's disease is a progressive neurological disorder caused by the loss of brain cells that produce dopamine, a chemical that plays roles in pleasure, motivation and control of movement. The condition's most common symptoms are tremor — trembling in hands, arms, legs and face — stiffness, slowness, and lack of balance or coordination.
Being diagnosed with a disease like Parkinson's can cause depression for some people, Tassinari said. No matter how it is treated, a patient's condition will worsen. The diagnosis can bring on grief from the loss of a healthy life.
"It was very uneasy," 56-year-old Mark Burek, a mail carrier who lives in Castleton, said of his diagnosis six years ago. "I was just a little afraid of how it would impact my life."
Burek said he keeps his spirits up through his work with the Capital District Parkinson'sSupport Group and by training for the New York City Marathon, which he has run for six years. He's not sure he'll be able to do it this year, though, because his muscles are freezing up on him more frequently.
Sometimes, patients will become depressed during the course of the illness, especially after experiencing a decline, experts said.
And research over the last five to 10 years has also shown that 20 to 40 percent of people with Parkinson's disease may suffer from depression that is caused by the condition itself, according to Dr. Julie Pilitsis, a neurosurgeon at Albany Med. Other lesser-known symptoms of the disease include pain and anxiety, she said.
The discoveries make sense to Tassinari.
"The Parkinson's does lower dopamine, which people call the pleasure center of the brain," he said. "When it's affected, it's going to make you feel not so good."
Doctors at Albany Med's Movement Disorders Center said they try to temper patients' emotional setbacks with hope about their treatment options, which include medication, surgery and talk therapy when needed. Exercise and support groups also help patients maintain high quality of life over more than a decade.
Tom Stephany, a retired 57-year-old Delmar resident who was diagnosed with Parkinson's three years ago, said his mood dips at least once a day over his struggles with the illness. Like Burek, he exercises and gets support from family and friends. He is also participating in the testing of a new drug, which helps him focus on the future and on making a contribution to research.
"It's quite possible within the next few months, I may actually experience some benefits," Stephany said of the drug trial. "But I think it's just important that medications be researched. To me, that's very important."
Uncommon to Parkinson's patients is suicide, according to Dr. Eric Molho, an Albany Med neurologist. Suicide is often impulsive, and lowered dopamine levels reduce impulsiveness, Molho said.
Thinking about suicide, however, is a symptom of deep depression, Tassinari said. So doctors should ask Parkinson's patients about such thoughts, even if a patient seems unlikely to act on them.
Emerging research and treatments provide hope for the future, doctors said.
Some Parkinson's patients, especially those not getting sufficient relief from medication, opt for deep brain stimulation. At Albany Med, Pilitsis inserts a pacemaker-like battery in the patient's chest and attaches it with a thin metal wire to the brain; it controls abnormal rhythms and electrical signals.
Evidence is mounting that deep brain stimulation lessens some non-motor symptoms of Parkinson's, but it's not clear whether depression and anxiety are among them, Pilitsis said.
The illness may one day be controlled through prevention, Molho said. Researchers are working on identifying genes that will determine someone's risk for getting Parkinson's disease. The goal is to intervene with medication or surgery before the worst effects are felt, to protect the dopamine-producing cells. "Once the process of cell death has started, that's a very hard thing to undo," Mulho said.
chughes@timesunion.com • 518-454-5417 • @hughesclaire
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