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Parkinson's, Depression and the Wintertime Blues

Originally published in the Winter 2006-2007 issue of PDF News & Review

Depending upon what study you read, anywhere from 30 to 80 percent of people with Parkinson's suffer from depression - and for many, it remains undiagnosed and untreated.  The post-holiday months can make coping with depression more difficult than usual to manage.  In this article, we suggest some ways to make it easier. 

For many people with Parkinson's, feeling sad may seem natural.  After all, living with a chronic disease alone is a valid reason to have such feelings.  But when these emotions go beyond occasional sadness, they could be signs of depression … and this depression, in many cases, could be related to Parkinson's. 

To recognize depression, keep a look out for the primary signs.  These can include experiencing anger out of proportion to the situation, sleeping too much or too little, losing interest in things that used to be exciting, feeling anxiety or finding that you are focusing almost exclusively on the negative aspects of day-to-day existence.  If you or a loved one with Parkinson's has experienced two or more of these problems for two weeks or longer, it may be depression.  It is essential to speak with a doctor for a professional assessment of the situation. 

At its most severe, depression can generate thoughts of worthlessness or despair and sufferers may become withdrawn and isolated.  People may feel that they are becoming a burden to loved ones, and that life is no longer worth living.  Depressive symptoms of this degree require immediate medical attention.

Treating depression may need to be approached from more than one direction.  The first step should be a visit to a doctor (either your primary care doctor or your neurologist).  The doctor may prescribe an antidepressant at this time.  If you are already taking medication to treat depression but are still experiencing symptoms of depression, talk to your doctor about making adjustments in the dosage or type of medication.  All of the doctors who treat you should communicate regularly with each other to avoid any possible drug interactions between Parkinson's medications and those that are used to treat depression.

Unfortunately, antidepressants - by themselves - do not smooth out all of life's problems.  They cannot repair relationships, teach more effective communication skills, or help a person cope with chronic illness - all of these problems can potentially lead to depression or worsen it. 

To address these issues, ask the doctor for a referral to a therapist who will recommend treatment that can range from therapy to lifestyle changes.  Experts agree that the most effective treatment for depression is usually a combination of antidepressant medication and counseling.  A trained therapist - that is, a psychologist, licensed clinical social worker, licensed clinical professional counselor or family therapist - can work with you to change negative behaviors and thought patterns.  Your physician may be able to refer you to a therapist who is familiar with chronic illness. 

There are also a variety of daily practices that you can try.  The first is developing and maintaining a regular schedule.  Try to wake up at the same time every day.  Once out of bed, bathe and dress and plan to stay up for the rest of the day.  It is very hard for a person to feel energized if they stay in their pajamas, no matter how comfortable they may be.  If a nap is required, make it a short one of 30–60 minutes.  This will help assure a better sleep the following night.

People who are depressed should also eat balanced meals at regular times.  If you are not very hungry, eat small meals with high nutritional content.  Look for foods with high fiber content (this will help ease constipation, which can also worsen when you are depressed) and drink plenty of fluids. 

Exercise is another vital key to effectively combating depression.  Cold weather in many parts of the country may make it difficult to exercise out of doors, but lots of substitutes are available, from the gym to enclosed shopping malls.  PDF offers two exercise programs for home use.  For more information or to purchase these programs, visit www.pdf.org or call (800) 457-6676. 

Of course, not everyone may feel like getting up, eating healthily or exercising.  Some experts suggest the approach of trying to overcome these feelings and "do what needs doing" - in other words, making an effort to go about your daily routine even when you lack motivation. 

In Parkinson's disease, depression may not be limited to the person who has the diagnosis.  It can afflict care partners as well.  Many of the methods described above for people with Parkinson's will also be helpful for care partners.  In fact, individual counseling is one of the most effective methods for managing caregiver strain.  Care partners also should discuss the situation with their doctor if they think they may be depressed.

Recovery from depression takes time.  Depression affects people differently, and response to treatment will vary from person to person.  Working with your therapist to provide feedback on how you are feeling and how well your treatments are working can be an important step on the road back to feeling "like yourself."  And remember - it is your commitment to taking steps to feel better and making changes in your life that will ultimately help you successfully treat depression. 

For more information or questions about depression and Parkinson's disease, call our Parkinson's Information Service (PINS) toll-free at (800) 457-6676.