What are the Symptoms of Anxiety Disorders and Treatments ?

There are many different ways in which a person with Parkinson’s can experience anxiety. The following is a list of common anxiety disorders and a description of symptoms associated with each form. As many as two out of five people with Parkinson’s will experience one of these forms during the course of their illness.

1. Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by feelings of nervousness and recurring thoughts of worry and fear. This worrying is in excess of what would normally be expected given the situation and often leaves the person feeling out of control. Physical symptoms that may accompany these feelings include butterflies in the stomach, trouble breathing or swallowing, racing of the heart, sweating and increased tremors.

2. Anxiety Attacks

Anxiety, or panic, attacks usually start suddenly with a sense of severe physical and emotional distress. Individuals may feel as if they cannot breathe or are having a heart attack. They may feel they are experiencing a medical emergency. These episodes usually last less than an hour, particularly when associated with “off” periods, though they can last for longer periods of time.

3. Social Avoidance

Social avoidance, or social anxiety disorder, involves avoiding everyday social situations because of a fear of embarrassment at having Parkinson's symptoms, such as tremor, dyskinesias, or trouble walking noticed in public. Exposure to social situations can lead to severe anxiety in these individuals, which goes away when the person is removed from the situation.

4. Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD ) may be plagued by persistent, unwelcome thoughts or images (obsessions), and by the urgent need to engage in certain rituals (compulsions) to try to control or rid themselves of these thoughts. As an example, they may be obsessed with germs or dirt, and wash their hands over and over. Performing these so-called rituals, however, only provides temporary relief, and not performing them markedly increases anxiety.

What are the Treatment Options for Anxiety?

There are two main types of treatment options for anxiety:  medications and psychological counseling (psychotherapy).  Depending on the severity of symptoms, psychotherapy can be used alone or combination with medication. NPF recommends a holistic, comprehensive strategy for the treatment of mental health problems, meaning that care should be tailored to each person’s individual health needs and preferences.

The following are treatment options for anxiety disorders:

Medication Therapy

SSRIs (antidepressants)

A newer class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically the first-line treatment for depression and anxiety disorders. All of these medications have been shown to be helpful for one or more anxiety disorder. They include:

• fluoxetine (Prozac®)
• sertraline (Zoloft®)
• paroxetine (Paxil®)
• citalopram (Celexa®)
• escitalopram (Lexapro®)

For patients with anxiety attacks, very low dosages should be used at first, as there is evidence that these medications can actually increase attacks when first started at higher dosages. An added benefit of using SSRIs is that they also work for depression, which often occurs simultaneously. 

Benzodiazepines (anti-anxiety medications)

An older class of medications called benzodiazepines is used to treat anxiety disorders and target the brain chemical GABA. Most of these medications have been around for many years.  They include:

• diazepam (Valium®)
• lorazepam (Ativan®)
• clonazepam (Klonopin®)
• alprazolam (Xanax®)

These medications can be very effective for anxiety, sometimes working better than antidepressants. They take effect very quickly, often providing some relief after a single dose, though they have to be taken regularly for a lasting effect. Also, they can help with other symptoms of Parkinson’s, including certain types of tremor, muscle cramping and sleep changes. Major drawbacks of using benzodiazepines include memory difficulties, confusion, increase in balance problems and tiredness. These medications should not be stopped suddenly, as patients can have serious withdrawal symptoms.

NOTE: Benzodiazepines should be used with caution in older patients with Parkinson’s or in those with dementia. If used regularly, they should never be stopped suddenly to avoid serious withdrawal symptoms.

Psychotherapy

Psychotherapy or “talk therapy” is a term used to refer to the many varieties of counseling available today. This type of treatment can help people diagnosed with an anxiety disorder understand their illness and better manage their symptoms. Mental health professionals who provide therapy include psychologists, social workers, psychiatrists, licensed professional counselors, and specially-trained nurses. Importantly, the first step is to find a compatible therapist. Here are ways that quality therapy can be beneficial.

• Cognitive behavioral therapy (CBT) is a popular technique that has been shown to be very effective at helping people change negative thinking patterns and behaviors in order to solve their problems and engage in life.
• Counseling sessions can provide vital support, understanding and education. Patients may be seen alone, as a couple or family, or in a group.
• For those who do not want to take medication, psychotherapy offers two advantages: no drug side effects and coping skills that can be used over the long term.