3.7 Depression
It can be common for people with Parkinson’s to experience depression. Symptoms can feel overwhelming, but with the right help, support and treatment, individuals can manage depression and enjoy a good quality of life.
Depression is usually diagnosed when you have feelings of extreme sadness or a sense of emotional ‘emptiness’ for a long time. It’s more than temporary feelings of sadness, unhappiness or frustration.
Other symptoms of depression may include difficulties concentrating, low energy and tiredness, trouble sleeping or excessive sleeping, a loss of appetite and decreased interest in sex. In severe cases, some people may have thoughts of death, suicidal ideas and thoughts of self-harm.
Some symptoms of depression, such as fatigue, are also common symptoms of Parkinson's. It is important to understand the cause of the symptom – is it a symptom of Parkinson's in its own right, or is it a symptom of depression?
‘I’d been a social butterfly. I was very outgoing. Now I didn’t want to go out at all. These feelings were totally alien to me.’
Causes of depression in Parkinson’s
Depression can have a number of contributory factors, one of which is neurobiological with the chemical changes occurring in the brain. However we also need to consider significant psychological and social factors as well, such as changes in identity, grieving process along with changes in relationships and expectations of the future.
Some people may be more prone to depression at times when their Parkinson’s symptoms suddenly worsen or new problems emerge, perhaps as a drug begins to become less effective. Sometimes stressful life changes such as having to stop driving or give up a much-loved hobby, may result in a period of depression.
If you notice any of these changes in a person with Parkinson’s, you may wish to suggest a medical review. It is very important to make sure that Parkinson’s symptoms are as well controlled as possible.
Other causes of depression-like symptoms
Whether a person has Parkinson’s or not, depression could also be related to other physical conditions, such as thyroid problems, nutritional deficiencies (such as low vitamin B12 and folate levels) or anaemia.
Some people may be under-medicated for the physical symptoms of Parkinson’s – or depression could be a side effect of other drugs.
Treating depression
'Medication, such as antidepressants, can help treat moderate to severe depression within Parkinson's. They can be prescribed alone or alongside a course of talking therapy. The prescriber will need to take a full medical history, including symptoms of Parkinson's and current Parkinson's medication, to ensure that the antidepressant is not contra-indicated.
Not a lot is known about treating depression in Parkinson’s, but there are some things people can try. The treatment of depression has to be tailored to each person with Parkinson’s, because some medications for depression have the potential to make symptoms of Parkinson’s worse. Treatments should be introduced step by step, starting with the simplest measures.
It is very important to first make sure that a person’s Parkinson’s symptoms are as well controlled as possible. This may mean making changes to their medication regime.
Other recommendations for the treatment of depression include complementary therapies, regular sleeping times, gentle exercise, counselling.
Find out more in the Parkinson’s UK complementary therapies information [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .
Sometimes you may recognise the symptoms of depression more clearly than the person themselves. If this is the case, share your concerns with your manager or recommend an appointment with their GP, specialist or Parkinson’s nurse.
Find out more in the Parkinson’s UK information sheet on depression.
Actions to take
- Be aware of changes in emotions and any link with communication problems.
- Report any changes in mood to your manager and organise an appointment with the person’s specialist or Parkinson’s nurse. The person may need a change in drug treatment, but if they are regularly unhappy or negative, they may need further treatment.
- Encourage people to take part in activities and ensure that you take time to talk to them as much as you can.
- Remember the treatment of depression has to be tailored to each person with Parkinson’s. Medication for depression may be difficult to combine with their other drug treatment.
3.6 Cognitive problems and their management