Depression is one of the most common non-motor symptoms of Parkinson’s. It involves long-lasting feelings of deep sadness. People who are depressed feel low, unable to enjoy things, and generally pessimistic or hopeless about the future, or emotionally empty.
If you are depressed, you may also feel:
- lacking in energy. You may find it hard to make plans
- worthless or helpless. You may feel guilty and blame yourself
- less interested in sex (reduced libido)
- restless and irritable
- tired, because of difficulties with sleeping.
It is very rare to have all of these symptoms, but if you are depressed you may also experience:
- changes in appetite or weight
- difficulty in concentrating or memory problems
- feelings that life is not worth living.
Most of these symptoms are not exclusive to depression, so having one symptom does not mean you are depressed. Depression is when people experience a number of these symptoms every day for at least two weeks.
We all feel down from time to time and many people experience temporary depression, for example after losing a loved one. But if you feel sad or low over a long period and cannot shake these feelings off either by yourself or with the support of others, you may be depressed. Major or clinical depression can occur at any time for any number of reasons, and it is important that it is recognised so that you can get help and support. An experienced professional will make a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V©) or the International Classification of Diseases (ICD-10 F).
Older people who are depressed may experience memory problems. Prolonged depression can itself result in lasting memory problems, so it is important to get it treated.
Parkinson’s and depression
Some doctors believe up to half of all people with Parkinson’s experience depression, but estimates vary and depression is very hard to measure.
We do not know for sure why people with Parkinson’s get depression. Research has suggested that a lack of the chemical dopamine, which causes symptoms of Parkinson’s, can be a trigger for depression. Doctors believe depression can also be genetic, so if you have a family history of depression, you are more likely to experience it yourself.
Being diagnosed with Parkinson’s can be very stressful and upsetting, and the condition can have an impact on every aspect of life. As Parkinson’s progresses, you may have to give up activities that are important to you. This can lead to sadness or depression. If your Parkinson’s makes it harder to socialise, it can make you lonely, which can increase your risk of depression.
People with Parkinson’s react in many different ways to the condition, partly depending on their personality, general attitude and personal circumstances. But it’s completely understandable that some people will experience feelings of depression because of Parkinson’s. And in some cases, people may have experienced depression for months before they notice any Parkinson’s symptoms.
Am I depressed?
Some of the symptoms of depression are also common in Parkinson’s. For example, many people with Parkinson’s have difficulties with sleeping. This would make you tired and lacking in energy, but wouldn’t necessarily mean that you are depressed. Fatigue (overwhelming feelings of tiredness) can also be a symptom of both Parkinson’s and depression.
You may experience ups and downs in mood because of the changing nature of your Parkinson’s symptoms through the day. These feelings may be related to changes in your Parkinson’s medication, and not a sign of depression.
Whether or not you have Parkinson’s, depression can also be related to other physical conditions, such as thyroid problems, deficiencies in diet (such as low vitamin B12 and folate levels) or anaemia. Speak to your doctor, specialist or Parkinson’s nurse about any concerns.
It may be that you are under-medicated for the physical symptoms of Parkinson’s, or alternatively, depression could be a side effect of medication. Again, it is best to speak to your doctor about this.
Alcohol can be a depressant, so drinking too much can cause low moods and disrupt your sleeping pattern.
Whatever the cause of your depression, it is important to try not to get too upset about exactly why you feel the way you do.
Like any other illness, depression can affect anyone at any time. It is not your fault or a sign of weakness. The important thing is that you speak to a doctor or specialist as soon as possible, so that a diagnosis can be made and you can get the treatment that is right for you.
For carers, family and friends
It’s important to realise that the effects of depression can spread beyond the individual, affecting the emotions of family, friends and carers. If untreated, depression may continue for years, so it is vital to recognise the condition and seek help.
Often the person with depression may not recognise their symptoms, so it is important that those around them raise their concerns with the person or with his or her doctor, so that depression can be treated.
Further information on how carers and family can look after themselves so that they can continue to care effectively may also be found in the Caring and Parkinson's section of this website.
Diagnosis can be difficult for people with Parkinson’s. Depression is sometimes wrongly diagnosed in people who are not depressed, and not detected in those who are. Depression and apathy are also sometimes confused.
If you have Parkinson’s and experience speech and communication difficulties, you may appear sad or unresponsive, but may not be depressed.
Sometimes people assume that those with Parkinson’s are depressed because they are less willing or physically able to take part in social activities, but again, this does not mean that you are depressed.
Parkinson’s symptoms such as slow movements, sleep problems, difficulty in concentrating, tiredness and reduced libido can also be considered signs of depression.
Your doctor or Parkinson’s specialist will usually reach a diagnosis by asking questions about your mood, symptoms, and other signs. These questions relate to depressed mood, loss of interest, reduced energy and decreased activity, as well as to reduced self-esteem, ideas of guilt and unworthiness, pessimistic thoughts or thoughts about self-harm. Symptoms such as disturbed sleep or diminished appetite may occur in depression as well as in Parkinson’s.
Rating scales for depression are ideally used, such as the Hamilton Depression Rating Scale. These involve asking carefully chosen questions and assessing the responses according to a points system which helps to distinguish between mental difficulties and the physical effects of Parkinson’s. Scales are also used to determine the severity of depression. These tests may be repeated to monitor the effects of any treatment. However, these rating scales or questionnaires can offer indications but cannot provide a clinical diagnosis of major depression. Even a high rating scale score cannot replace an experienced professional making a diagnosis according to the criteria laid down in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V©) or the International Classification of Diseases (ICD-10 F).
Depression that begins suddenly, perhaps as a reaction to an event such as losing a loved one, early retirement or having to move home, is far easier to diagnose and generally responds well to treatment.
Choosing the right medication, reducing stress levels and taking regular exercise can all play a vital role in managing depression. Psychological approaches and counselling can also be important.
Your doctor needs to make sure that your Parkinson’s medications are controlling symptoms as effectively as possible. Symptoms such as pain and fatigue can contribute to depression, so effective symptom control is very important.
Certain Parkinson’s medications - levodopa infusions, dopamine agonists and selegiline - appear to improve mood for some people with depression. However, they may not always be appropriate or sufficiently beneficial, and they may have side effects.
If the above medications are not effective or appropriate, your doctor may prescribe an antidepressant. A wide range of these is available. The choice will depend on possible benefits and side effects, how the drug interacts with other medications and how it suits you as an individual. Your doctor may need to try more than one to find the best treatment for you.
Most antidepressants take four to six weeks to be effective, and some need to be taken for several months, sometimes with a decreased dose over time. Everyone is different, so discuss the effects with your doctor so he or she can monitor progress.
If you no longer need to take antidepressants, doctors generally recommend that you reduce the dose slowly to prevent rebound symptoms such as anxiety, headache and irritability.
Other forms of treatment
It is important to remember that depression is quite common, and can be effectively treated. The following treatments and therapies can be effective in dealing with depression alongside or instead of medication.
A psychiatrist, psychologist or psychotherapist may help you to feel more positive and overcome feelings of depression. This can be particularly helpful when used alongside medication, particularly in more severe cases. Sometimes it may be useful if your partner or carer is included in consultations.
Cognitive behavioural therapy (CBT)
This can be helpful in breaking the circle of negative thoughts, emotions and behaviour patterns that surround depression. CBT is currently the most often applied psychological therapy for depression, and many studies have shown it to be effective.
A trained therapist will encourage you to talk about how you feel about yourself, those around you and the world in general, and to understand how your behaviour affects your feelings and thoughts. He or she can help you to make sense of what may seem overwhelming problems. An important element in CBT is to systematically and consciously expand pleasant activities. This is often quite difficult for a depressed person with Parkinson’s. But being active and doing pleasurable things, even on a low level, helps to improve mood. This can help you deal with problems and break the patterns of behaviour linked to depression.
CBT can take place on a one-to-one basis or in a group, usually with a course of 12-20 sessions. The therapist may set homework to help you practise changes in thinking and behaviour. He or she may suggest a thought diary for noting links between what you do and how you feel. These techniques can help you to learn new skills that will be useful in the long term.
Interpersonal therapy (IPT)
This can help to improve communication skills and relationships. People with depression often find interacting with others difficult and lose both the desire and the skills needed to sustain good relationships. IPT focuses on the way people interact with others, how they communicate and express themselves. It can provide practical help in overcoming difficulties with social skills and teach useful ways of dealing with challenging relationships or social situations. A specific communication task for people with Parkinson’s is to talk and inform others about the condition and also to be proactive in asking for help.
The therapist will work with the person to agree the causes of depression and how to treat it. The partnership will typically last for 12-16 one-hour sessions.
Individual counselling from an experienced and qualified counsellor can be very helpful in recognising worries and underlying issues, and working out strategies to deal with them. Just talking about concerns often improves mood and can also help to strengthen channels of communication at home.
Electroconvulsive treatment, which involves passing an electrical current through the brain, is used occasionally in treating severe states of major depression, but to date, has not been systematically applied or tested in people with Parkinson’s.
Support groups and telephone helplines can offer emotional support and/or practical help and advice. Support groups also offer activities which may help to counteract depression. Even if you have close family and friends, it can be useful to talk to an outsider. Your doctor or a social worker may be able to help identify such organisations, or you may find contact details in a telephone directory or online.
St John’s wort, a herbal medicine, has been shown to help with depression in general. However, it is thought to interact with some Parkinson’s medications, so it should be taken only after consulting your doctor.
How can I help myself?
If you think you may be depressed, the first step is to talk to your doctor or another healthcare professional. But you can also help yourself. The most important thing is to try to stay active and positive. Below are some suggestions that may be helpful:
- Educate yourself about Parkinson’s, its cause and treatment. Being informed generally helps you to feel more in control.
- Take an active role in managing your illness.
- Keep doing the activities you enjoy if possible. Research has shown that keeping active can improve mood.
- Pace yourself – know and accept your limitations and accept that these may change with time.
- Try to stay relaxed. Complementary therapies such as yoga and tai chi or meditation tapes or classes may help.
- Accept help when you need it.
- Contact your local Parkinson’s organisation or other support groups.
Other self-help measures include:
Research has shown that exercising two to three times a week, especially as part of a group, can help with depression. Swimming, walking and cycling are low-impact sports that can be done alone or with a friend.
A structured exercise programme may be helpful. Exercise referral schemes may be organised in your local area through your local council or sports centre. Speak to your doctor about getting a referral. Talk to your doctor, specialist or Parkinson’s nurse about what may be suitable for you.
If you experience problems with sleeping, make sure your bedroom is quiet and comfortable, and go to bed at the same time each night. Avoid extended afternoon naps which may further disrupt night-time sleep. Try not to eat or drink too much before going to bed. Also, try to have a regular routine for getting up in the morning. Avoid smoking. Regular exercise may also help you to sleep better.
Our thanks to Parkinson's UK for permission to use the following source(s) in compiling this information: