Anxiety and Parkinson's Disease

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In addition to movement symptoms, many people with Parkinson's disease also experience non-movement symptoms. These symptoms can impact people with Parkinson's in a variety of ways, including causing anxiety. Feeling worried is an understandable reaction to a Parkinson's diagnosis. But when feelings of constant worry or nervousness begin to influence daily life, a person may be experiencing anxiety.

Anxiety is not simply a reaction to a Parkinson's diagnosis. It is a part of the disease itself, caused by changes in the chemistry of the brain. As many as 40% of people with Parkinson's disease will experience a form of anxiety. The four most common forms of anxiety related to Parkinson's include generalized anxiety disorder, anxiety attacks, social avoidance, and obsessive-compulsive disorder.

Generalized anxiety disorder is characterized by feelings of nervousness and recurring thoughts of worry and fear. The worrying is more than what would normally be expected given the situation and can lead to feeling out of control. Physical symptoms that may accompany generalized anxiety disorder include butterflies in the stomach or nausea, trouble breathing or swallowing, racing heart, sweating, and increased tremors.

Anxiety attacks, also known as panic attacks, usually start suddenly with a sense of severe physical and emotional distress. A person may feel as if they cannot breathe or are having a heart attack or a medical emergency. These episodes usually last a few minutes to an hour, particularly when associated with off periods, though they can last longer.

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Social avoidance, also known as social anxiety disorder, involves avoiding everyday social situations because of a fear of embarrassment that Parkinson's symptoms may attract attention. Exposure to social situations can lead to severe anxiety. This goes away when the person is removed from or avoids the situation.

Obsessive-compulsive disorder, often called OCD, this type of anxiety can cause persistent, unwelcome thoughts or images. These are accompanied by an urgent need to engage in certain rituals, also known as compulsions, to try to control or eliminate these thoughts. For instance, someone with OCD may knock on a wall five times before leaving a room. Performing these rituals only provides temporary relief, while not performing them increases anxiety.

Each of these forms of anxiety is not tied to disease progression. Anxiety can begin before a Parkinson's diagnosis or develop much later. Both psychological and biological factors can cause anxiety in people with Parkinson's disease.

Common fears and worries that go along with PD may trigger anxiety. One is a fear of being unable to function independently, particularly during a sudden off period, which is the time of day when medication is not working. This can lead to a fear of being left alone. Many of the brain pathways and chemicals affected by Parkinson's are the same as those affected by anxiety and depression. People with Parkinson's have abnormal levels of the brain chemical GABA. Anxiety and depression are also linked to low GABA and can be treated with a class of anti-anxiety medications designed to boost levels.

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Anxiety is usually diagnosed by a primary care physician or mental health professional who will ask questions about certain symptoms, mood changes, and behaviors. The good news is that there are effective ways to treat anxiety. These include medications and psychological counseling, specifically cognitive behavioral therapy.

Depending on the severity of symptoms, psychotherapy can be used alone or in combination with medication. Care should be tailored to each person's individual needs. Addressing anxiety can help you live better with Parkinson's. These tips may help a person manage their anxiety. Empower yourself by discovering how PD symptoms, including anxiety, can impact you. Keep a diary of your moods, medications, and PD symptoms. Notice what triggers your anxiety symptoms.

Exercise can help reduce anxiety, improve mood, and help manage other Parkinson's symptoms. Talk to your doctor about anxiety. Discuss anxiety with your friends and family, who can help you explore new ways to cope. Find a support group for people with Parkinson's.

Be flexible and try different approaches to coping with anxiety. Understand that symptoms change. If a coping strategy stops working, try a new approach. It's important to remember that you are not alone. If you would like more information on Parkinson's disease and anxiety, please visit Parkinson.org/Anxiety or call the Parkinson's Foundation Helpline at 1-800-4PD-INFO.