Anxiety

Feeling worried is an understandable reaction to a Parkinson’s diagnosis. But when feelings of constant worry or nervousness go beyond what is understandable, a person may be experiencing anxiety, which is more serious.

Anxiety is a common nonmotor symptom of PD. It is important to note that anxiety is not simply a reaction to the diagnosis of Parkinson’s, but is instead a part of the disease itself, caused by changes in the chemistry of the brain. Estimates show that between 25 and 45 percent of people with PD experience an anxiety disorder at some point.

Anxiety is not tied to disease progression — it can begin before a PD diagnosis or develop much later on. Additionally, while some people with PD experience anxiety on its own, many are diagnosed with anxiety along with depression.

Anxiety and depression can be even more disabling than the movement symptoms of PD. It is important to recognize and treat both of them.

Symptoms

Anxiety shows itself in many different ways for people with PD. The following are common ways people with PD experience anxiety:

  • Continuous anxiety: a constant general feeling of being anxious and overwhelmed; excessive worry, anticipation, concern with details, emotional reactivity or fearfulness. This may include symptoms such as restlessness, trouble sleeping or trouble concentrating, which overlap with symptoms of Parkinson's disease.
  • Anxiety about PD medications “wearing off”: Anxiety may improve or worsen depending on how well a person’s PD medications are working.
  • Panic attacks: Episodes of intense fear, with symptoms of rapid heartbeat, shortness of breath, sweating or dizziness.
  • Phobias: A phobia is an overwhelming fear of an object or situation, for example, fear of embarrassment in social situations.
  • Worsening of movement symptoms: Anxiety and depression can make a person’s movement symptoms more disabling, regardless of how much PD has advanced. For example, when a person is anxious, his or her tremor may return, or stiffness may worsen— even while medications are working.
  • Perception of health: those with anxiety also may perceive their health as worse than it is based on test results. This affects quality of life.
  • In addition, a person with anxiety may experience more:
    • Movement symptoms in general
    • Freezing episodes when walking
    • On-off fluctuations with their medications
    • Dyskinesias—involuntary movements that are common with advanced PD and long-term levodopa use
    • Gait difficulties

Therapies

How can you ease anxiety in PD? First, discuss symptoms with your doctor. There are many ways to cope with anxiety, including:

  • With your doctor, evaluate your PD medications. Are they causing anxiety as a side effect? Do you have anxiety with “wearing off”? Are you taking other medications that may cause anxiety? Adjust them if needed.
  • With your doctor, identify and treat any other medical problems besides PD that can cause anxiety, such as thyroid problems or an infection.
  • Be aware of depression and ensure it is treated, since it is so often diagnosed alongside anxiety in PD. But be aware that some medications for depression may interact with PD medications.
  • Understand that anti-anxiety medications, while very effective, may cause confusion or balance problems. Discuss these issues with your doctor.
  • Consider psychological counseling, in particular an approach called cognitive behavioral therapy (CBT), which helps people to develop ways of modifying thinking and behavior to ease anxiety.
  • Exercise. Walking, yoga, or any exercise that appeals to you, can help to ease symptoms of anxiety.
  • Try relaxation techniques or meditation.

Tips for Living with Anxiety

  • Educate yourself about PD and its symptoms, including anxiety.
  • Keep a diary of your moods, your medications and your PD symptoms.
  • Figure out what sets off anxiety for you.
  • Talk with your doctor about anxiety, so you can get medical help.
  • Tell your care partner and family members how you are feeling, so they can understand your emotions better and help you find ways to cope.
  • Find a support group for people with PD.
  • Be flexible in your approaches to coping with anxiety; try different approaches.
  • Understand that symptoms change; if a coping strategy stops working, try a new approach.
  • Like other PD symptoms, each individual experience anxiety differently.
  • Find treatments and techniques that work for you.