When Parkinson’s Disease Affects Mood

When people think of Parkinson’s disease, what comes to mind are the physical effects — the rigid muscles, the tremors, the difficulty with movement.

But Parkinson’s disease is a disorder of the brain and nervous system and, as such, also can have an effect on the patient’s emotional state. Mood changes can arise from biochemical changes wrought by the disease, but they may also be related to the medications used to counter Parkinson’s or be a natural reaction to the patient’s loss of control over his own body.

Caregivers of people with Parkinson’s disease need to understand these potential mood changes and be ready to adjust to them. There is a lot a caregiver can do to help, either by determining the source of the problem or by responding to the patient’s feelings with care, compassion, and thoughtfulness.

Emotional Responses to Parkinson’s Disease

Some of the emotional responses that have been associated with Parkinson’s disease include:

• Depression. Up to half of all Parkinson’s disease patients end up dealing with depression. It is so prevalent that some doctors believe depression may actually be a symptom of Parkinson’s, possibly rooted in the way the disease affects the brain.
• Denial. Many patients with Parkinson’s disease react to the initialdiagnosis by refusing to accept the reality of their situation. That denial could be accompanied by feelings of anger, fear, and anxiety.
• Fatigue. Parkinson’s disease can transform the simplest body movements — standing up, walking around — into draining experiences. Because of this, patients might end up becoming withdrawn and introverted, making them less interested in socializing with others.
• Anxiety. Doctors believe Parkinson’s patients experience feelings of anxiety for a couple of reasons. They become anxious when they think about the future and what the disease holds in store for them. Patients also have been shown to experience anxiety before they are ready to receive their next dose of medication, when some of their symptoms begin to resurface, or when they have an “off” period in which their symptoms re-emerge. Up to 40 percent of Parkinson’s patients may experience anxiety at some point.
• Apathy. About one in three patients with Parkinson’s disease experience feelings of apathy. They might find it hard to care about anything, or hard to get up and get things done.

Parkinson’s Disease Meds Can Change Moods

The medications people take for Parkinson’s disease can cause some emotional problems as well.

“Medications can cause some psychotic symptoms, some hallucinations and paranoia. Oftentimes it’s benign and not too upsetting, but other times it can become very uncomfortable,” said Linda Pituch, a patient services manager for the Parkinson’s Disease Foundation.Parkinson’s Disease: On the Lookout for Depression

Depression is the most common mood disorder linked to Parkinson’s disease, so caretakers need to keep an eye out for warning signs. These include:

• Being indifferent to activities the person once enjoyed
• Having a sharp decrease or increase in appetite
• Having trouble focusing attention or concentrating
• Making statements about feeling worthless, or showing a general lack of hope for the future
• Feeling constant sadness
• Having recurring thoughts of suicide or death

Pituch recommends bringing a depressed Parkinson’s disease patient to the doctor as soon as possible. “Determine if that person is getting help for their depression,” she said. “That’s very important. If they’re not getting help, it’s going to be a very difficult battle to win.”

Parkinson’s Disease: Helping With Mood Issues

Some of the ways that caregivers can help Parkinson’s disease patients with emotional problems or mood changes include:

• Therapy. Getting your loved one into psychotherapy can be an important step in dealing with anxiety, depression, or apathy. The therapist can help the patient understand their moods and what is causing them, and can teach that person how to better guide and control their emotions.
• Medication. Some Parkinson’s medications help with these mood problems; others make them worse. Parkinson’s medications and antidepressants can help improve feelings of depression, fatigue, or anxiety. On the other hand, some of these medications can bring on hallucinations or psychosis, so medication levels may need to be adjusted or a new Parkinson’s medication may need to be considered if effects like those occur.
• Socializing. Re-establishing a person’s ties to the outside world can do much to lift his spirits, Pituch said. “Get them out socializing, and support them when they feel uncomfortable,” she suggests. “Help them come up with ways of framing the situation when they’re having an embarrassing moment, like if there’s a bit of drool or some food on their shirt, by coming up with a quip to say when these things happen.”
• Reassurance. Caregivers can help tremendously just by maintaining a calm, loving, and reassuring manner, Pituch said. This is particularly true if the patient is having hallucinations or psychosis. “Caregivers should not debate that what they’re seeing is wrong or not true,” she says. Instead, “they want to say things like, ‘You’re okay, I’ve checked and everything’s okay. This could be a side effect of the medication.'”

Parkinson’s is a complicated disease. Read as much as you can about it. Beyond Everyday Health, two good places to start are the Michael J. Fox Foundation for Parkinson’s Research and the Parkinson’s Disease Foundation.

By Dennis Thompson

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