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Anxiety and sadness: Parkinson's symptoms often ignored.

Parkinson's symptoms are associated with movement-related disorders

Let's find out why we neglect mood disorders and how to manage them every day.

Parkinson's disease requires dealing with problems mainly related to movement. Not surprisingly, among the most common and also most well-known symptoms are tremor, stiffness or slowness in walking. Yet there are several so-called symptoms non-motors that often end up being given little consideration even though they have a significant impact on patients' quality of life.

Among these, anxiety, depression, and apathy are particularly common and are a non-random aspect of the disease course. Understanding and addressing them is critical to taking care of each patient's well-being in a comprehensive manner.

The causes of mood disorders in Parkinson's disease.

Some researchers believe that depression and anxiety in those with Parkinson's disease can be attributed to certain changes in brain chemistry caused by the disease itself.

Neurotransmitter imbalance, in fact, not only causes movement-related difficulties but is one of the causes of mood disorders. Reduced dopamine is often associated with symptoms such as anxiety and depression, while loss of serotonin contributes to mood swings, insomnia, and reduced appetite.

At the same time, levodopa therapy, used to relieve motor symptoms, can cause emotional swings known as non-motor fluctuations. This phenomenon requires careful monitoring to balance the benefits of treatment with the emotional stability of the patient.

The most common symptoms, not to be underestimated.

Mood disorders may manifest differently in patients with Parkinson's disease.

Anxiety can lead to a constant feeling of worry, often accompanied by restlessness, muscle tension, difficulty concentrating, and insomnia.

Depression is often associated with a state of apathy, with a loss of interest in daily activities and a general sense of sadness that results in feelings of emptiness and guilt.

In some cases the mood can vary rapidly from sadness to anger, with irritability and very sudden mood changes the most noticeable symptoms in the eyes of family and friends.

Diagnosis of mood disorders as a challenge.

Identifying mood disorders in Parkinson's is complex, as some symptoms may overlap with those of the disease itself. For example, tremors and muscle restlessness may be mistakenly attributed to Parkinson's instead of an anxious state.

These symptoms can occur years before the onset of motor problems, which in turn occur long before Parkinson's disease is diagnosed. Those who are already living with motor difficulties, on the other hand, often notice mood changes especially during so-called moments off, which also correspond to lowered dopaminergic levels.

As early as the 1970s, researchers Marsden and Parkes pointed out as. the off period could be accompanied by marked anxiety, redness, sweating, and pain in the limbs.

At the same time, however, more recent studies have shown that depression in those with Parkinson's disease may not be closely correlated with the severity of motor symptoms or the degree of disability of the affected individual

For example, Drs. Menza and Mark's study done in 1994 showed that mood disorders are more common in patients with Parkinson's than those with disabilities caused by other diseases.

This evidence underscores how identifying mood swings in those with Parkinson's disease is a complex challenge and how important an integrated approach is to recognize and treat these symptoms.

Pharmacological and nonpharmacological management and treatment strategies.

Managing mood swings in Parkinson's requires a personalized approach, combining pharmacological solutions and nonpharmacological strategies.

Medications for anxiety and depression can be helpful, but their use requires care.

SSRIs (selective serotonin reuptake inhibitors) are effective but can cause side effects such as insomnia or nausea. MAO inhibitors, on the other hand, can improve both mood and motor symptoms, but require a controlled diet to avoid dangerous interactions.

Dopaminergic drugs, when dosed correctly, can also help stabilize mood, especially in patients with symptoms related to therapeutic fluctuations.

In parallel, nonpharmacological interventions can offer great support.

Yoga and meditation are practices that reduce levels of cortisol, the so-called stress hormone, and improve emotional regulation, helping to achieve greater serenity.

Music therapy promotes relaxation, generates pleasant feelings and awakens positive memories by stimulating the release of dopamine, serotonin, endorphins and oxytocin while the use of essential oils such as lavender and chamomile help calm the mind and relieve tension.

Exercise, planned activities, and socialization also play a crucial role in counteracting apathy and improving psychological well-being.

Socialization as an antidote.

Social isolation is one of the most insidious consequences of Parkinson's disease. The limitations imposed by the disease can lead to gradual withdrawal from social life, increasing the risk of depression.

Keeping relationships active is crucial. Even small gestures, such as a walk to meet neighbors or a chat with a friend, can have a positive impact on mood and self-esteem.

Undertaking innovative pathways, such as AMPS therapy delivered by the Gondola® Home device, can improve mobility and reduce motor blocks, facilitating participation in social life. Connecting with others is a key element in combating loneliness and curbing mood swings.

Taking care of the nonmotor symptoms of Parkinson's is critical to improving quality of life. Don't ignore these signs: addressing them with awareness and support can make all the difference.

Sources:

  • Depression and Parkinson's disease: current knowledge, Curr. Neurosci. Rep. L. Marsh, 2013
  • Parkinson's disease and depression: the relationship to disability and personality.
    J Neuropsychiatry, Menza MA, Mark MH, 1994.
  • Bromocriptine in parkinsonism. Lancet Aug, Marsden CD, Parkes JD, 1976.
  • Anxiety: An ignored aspect of Parkinson's disease lacking attention. Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER). Dharmendra Kumar Khatri, Mamta Choudhary, Anika Sood, Shashi Bala Singh. Biomedicine & Pharmacotherapy, 2020
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