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Treatment of Mood Disorders in PD

Much like any of the symptoms of Parkinson’s Disease, management of mood disorders like depression and anxiety which are more prevalent in those with this illness, requires a comprehensive approach. It’s not a simple solution and you may have to try a whole complement of things before you notice an improvement.

First of course is recognition of the problem – you can’t treat what remains undiagnosed. Sometimes it’s you the patient that recognizes a change in how you feel as well as the host of physical symptoms that accompany the change in your mood. And in other cases it may be a loved one or a health professional involved in your care that becomes concerned.

Regardless of how it is identified, it is important that the potential diagnosis of a mood disorder comes to the attention of the physician managing your Parkinson’s. This is because once clinically diagnosed, there may need to be adjustments in the current medication dosing or the addition of specific mood modifying medications.

For example in the case of nonmotor fluctuations where anxiety and / or depressive symptoms increase during “off” periods, mood may be improved by increasing “on” times, that is those periods when the Parkinson’s medications are working. Optimizing overall effects of Parkinson’s medications is very important.

Or perhaps the mood symptoms are more persistent and concerning in which case specific medication may be warranted. In the case of anxiety this may include the use of very occasional anxiety medications such as benzodiazepines although they are used rather sparingly due to their addictive potential. Antidepressants are used for both depression and anxiety and can be beneficial when either of these is diagnosed. There are a variety of classes of these medications and usually with the help and supervision of your physician, you can find one that works for you with tolerable or few side effects. Part of the difficult nature of these types of medications however is that they can take weeks to become effective and may not relieve all your symptoms or tackle any of the issues that are affecting your mood. That is, they don’t do anything about the stress you are facing in your life.

But what about you? What can you do to help yourself? The answer to this question is not necessarily a quick one but is based on establishing a routine of self-care that includes a healthy diet (avoiding caffeine which can aggravate anxiety and alcohol which acts as a depressant), regular exercise, adequate sleep and stress reduction among others.

In fact you must make stress management a priority as it can have detrimental effects on both how you feel physically as well as emotionally. A consistent self-care routine is highly beneficial and should include reflective and meditative practices aimed at relaxing your mind, body and breathing. (Consider relaxing your breathing (6 – 10x/min) instead of normal 14x/min or 18x/min in someone who is anxious. Doing it for 10 minutes at a time, combining it with tensing and then relaxing different muscles of the body can be helpful.) Tai chi, yoga, meditation and massage can also help achieve this goal.

It’s also important to reach out to those in your family, social circle or other support people. Discussing your anxieties or frustrations can at times be therapeutic.

This can be particularly true when you turn to support groups either online or in person. There’s a particular insight that can only be shared by those that are living through similar life experiences and that level of support should not be underestimated.

Or in fact you may benefit from speaking with someone more objective such as a counselor. Someone trained in counseling may in fact be able to assist you in Cognitive Behavior Therapy – this is a therapy that is designed to change a person’s everyday thoughts and behaviors thereby improving their emotions. This change in perspective can be quite helpful in treating mood disorders.

Mood disorders unfortunately are a fairly common issue face by those of us with Parkinson’s disease and their treatment can be challenging. However based on their negative impact on quality of life, a comprehensive routine of self-care, support and medical intervention when necessary is well worth the effort by all those involved.

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