Anxiety is feelings of fear or worry. It is normal to experience anxiety when faced with new, challenging or stressful situations, however such feelings usually subside over time. Some people feel anxious for long periods of time. Anxiety may make you lose sleep or lose your appetite. In extreme cases, it may lead to a panic attack, which can make you dizzy and short of breath. Anxiety may lead to avoiding situations where – even if only imagined – this feeling may occur. Non-specific anxiety can also be a sign of depression.
Anxiety is a natural reaction to unfamiliar or threatening situations. However, beyond a certain level, it can affect your wellbeing and ability to cope with daily life. At this point anxiety would then be diagnosed as a ‘disorder’ according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V©) or the International Classification of Diseases (ICD-10 F).
There are several different kinds of anxiety disorders. Some people may experience more than one type:
- Generalised anxiety disorder (GAD)
This common form of anxiety involves excessive and uncontrollable anxiety about everyday matters but is not focused on a particular object or situation. Being anxious about the future is normal, but anxiety can become disabling if stops you from doing everyday activities and pursuing your goals.
- Panic attacks
These are usually brief attacks of intense fear and anxiety. You may experience a racing heart, shortness of breath, trembling, confusion, dizziness, sweating and nausea. Some panic attacks last more than an hour. They may be triggered by stress, fear or even exercise, or the cause may not be clear. Freezing, although very disturbing, is not experienced as a panic attack when it occurs in Parkinson’s.
An intense but irrational fear of a situation or thing that is not actually dangerous, such as spiders or the sight of blood.
- Social anxiety disorder or social phobia
A fear and avoidance of everyday social situations because of fear of embarrassment, humiliation or social interaction. Many people who experience this form of anxiety often try to avoid social situations, which may lead to isolation.
Anxiety and Parkinson’s
People with Parkinson’s may experience anxiety, either because of worries about living with their condition, or because of possible changes in brain chemistry. Anxiety is likely to reduce quality of life, both for the person with Parkinson’s and their carer.
General social anxiety (below the level of a ‘disorder’) can range from mild to severe and is often related to a fear on being negatively judged in public due to your visible symptoms. Such fear can cause stress which in turn immediately worsens motor symptoms, particularly tremor.
People with Parkinson’s may also experience depression simultaneously, although you may experience one without the other.
Taking Parkinson’s medications, particularly levodopa, may also cause anxiety. When levodopa is working (‘on’) you may be optimistic and cheerful, but when it is not working (‘off’) you may become anxious, particularly as your symptoms may no longer be well controlled. These ‘on-off’ mood swings may occur several times a day.
Some people with Parkinson’s experience a condition called akathisia – an inner restlessness and inability to keep still. This is common in Parkinson’s and should not be confused with anxiety.
Anxiety can be difficult to diagnose in people with Parkinson’s. This is partly because a number of symptoms associated with anxiety – sleep problems, difficulty concentrating, tiredness and reduced libido –may occur even if you are not anxious. Your doctor will usually diagnose anxiety by asking questions about your symptoms, mood and other factors. The assessment may involve carefully chosen questions found in recognised questionnaires or Rating scales, for example the Hamilton Anxiety Rating Scale. Responses are measured using a points system to evaluate the severity of the anxiety and to assess whether clinical diagnosis as a disorder might be appropriate. These tests may be repeated to monitor the effects of any treatment. However, rating scales or questionnaires can offer indications but cannot provide a clinical diagnosis of anxiety. 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).
How can I help myself?
It is important to remember that anxiety is common and anxiety disorders can be effectively treated. Don’t be afraid to say if you feel anxious – this is the first step to getting help and overcoming your worries.
One of the most important ways in which you can help yourself is by staying positive. Below are some suggestions that might 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.
- Confront difficult situations rather than avoiding them, but try not to be disheartened if things don’t turn out the way you hoped.
- Keep socially active to avoid social isolation.
- Let people know you have Parkinson’s when asking for help.
- Be open with your doctor and other healthcare professionals – mention if something is worrying you.
- Keep doing the activities you enjoy – 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 – some complementary therapies such as Yoga and Tai Chi may help.
- Accept help when you need it.
- Contact your local Parkinson’s organisation or other support groups.
Your carer, friends and family can also help by encouraging you to practise relaxation techniques. They may also suggest that you discuss anxiety with your doctor if they feel that it is affecting your quality of life.
What treatment is available?
There are many things you can do that may help to reduce feelings of anxiety. Learning how to relax, recognising triggers that make you anxious and regular exercise can all help to control anxiety. Reducing your intake of alcohol and caffeine (found in coffee, tea and certain fizzy drinks), particularly late in the evening, may also help, as these can intensify anxiety symptoms.
Relaxation techniques can be very effective in relieving anxiety, particularly in mild cases which are the most common. These techniques include therapies such as massage, meditation, acupuncture, breathing techniques, yoga, aromatherapy and Tai Chi. Always talk to your doctor before starting a new therapy to make sure that it is safe for you to do so. For more information on these see Complementary Therapies.
Anxiety related to motor fluctuations is best managed by adjusting your Parkinson’s medications. Talk to your doctor about altering your medication.
Your doctor may also discuss whether other antidepressant medications could help. A wide range of these are available, and the choice will depend on their benefits and side effects, how they interact with other medications and how they suit you as an individual. Long-term use is not generally recommended. When you no longer need to take antidepressants you should reduce the dose slowly to prevent the return of anxiety and symptoms such as headache and irritability.
Counselling and psychotherapy
Talking about your worries with close friends or family will often help reduce feelings of anxiety. You will be able to share experiences and explore solutions. If your anxieties concern Parkinson’s, it may help to talk to another person with the condition, as you can share problems and strategies for overcoming them.
If you prefer to talk to a professional counsellor, discuss it with your doctor. Individual counselling can help you recognise worries and underlying issues, and work out a strategy to deal with them. Your doctor may be able to refer you to a counsellor, psychiatrist, psychologist or psychotherapist. This can be particularly effective in more severe cases when used together with medication. Sometimes it may be useful if your partner or carer is included in consultations.
Cognitive Behaviour Therapy (CBT) has been shown to offer effective psychological treatment for anxiety disorders. Major strategies used in the behavioural treatment of anxiety include confronting stressors, cognitive restructuring (i.e. analysing the situation that causes fear and elaborating alternative thoughts) and relaxation in critical situations. CBT confronts thoughts or behaviours that produce or anxiety or make it worse. Your therapist will help you learn to change such thoughts or behaviours so that they are no longer ‘unhelpful’.
CBT, either in a group or individually, may help to tackle anxiety.
Various groups and organisations such as telephone helplines offer emotional support and/or practical help. Even if you have close family and friends, you might want to talk with an outsider, and such organisations can be very helpful. Your doctor or social worker will be able to help you identify such organisations, or you may find contact details on the Internet.