Dr. Michael Aminoff 00:00:05
Depression is a very common disorder that many patients with Parkinson's disease suffer with. Many of those patients don't recognize that they have depression, and this leads to a problem because they suffer really unduly because they haven't sought treatment for their disorder. It's a problem that is probably misdiagnosed or not recognized in many instances. The reason for that is that some of the symptoms of depression are similar to the symptoms of Parkinson's disease.

Therefore, the physician does not recognize that depression is a problem in addition to Parkinson's disease. In most cases, it's mild. But certainly in some patients, it can be much more severe or even disabling. What are the symptoms of depression? Well, they are very variable. They include feelings of sadness, of being unhappy with life, an inability to make decisions, a certain apathy, and a constant feeling of fatigue. It may include disturbances of sleep and changes in appetite.

A lot of patients who are depressed have really no interest in going out or enjoying life. They may have difficulty communicating with other people, and that makes it much more difficult, of course, for physicians or other healthcare providers to help them. We all have ups and downs in life, but it's when these symptoms interfere with the ability of the patient to live a normal, satisfying life that they really merit a lot of medical attention. Because these symptoms can be increasingly overpowering, and some people may eventually feel that life is not worth living. Occasionally, patients may even try to harm themselves because life seems so wretched.

Dr. Michael Aminoff 00:02:07
People have often wondered why patients with Parkinson's disease become depressed. Parts of the brain that are concerned with our emotional state are involved in patients who have Parkinson's disease. So there may be disturbances of function in the brain in those very areas that affect how we feel. What can we do about depression? There are a lot of things that we can do. They include, for example, various medications, various antidepressants. There are antidepressants that have been used for many years, and they are known to be effective in people with Parkinson's disease who are depressed.

There are other medications that have been developed more recently, and these medications are also very effective. The issue with all these antidepressant medications is that they don't work instantly. So when we start a patient on medication, there's going to be a delay before the treatment will kick in. There's no one dose of any particular medication that fits everyone. The typical approach would be for us to start a patient on a small dose of the selected antidepressant, and then gradually build that dose up until there's a beneficial response.

Now, in addition to medication, there are other things that we can do. Meeting, for example, regularly with a psychotherapist, who could be a psychologist or a psychiatrist, can be very valuable. And the combination of such meetings for psychotherapy and taking medication is generally more effective than one or the other approach alone. Another approach is to really keep people very active.

Dr. Michael Aminoff 00:03:48
Now, the problem is that when patients are depressed, they don't want to be active. But if they can be encouraged to be active, if they can go out to the gym every day or go for a brisk walk an hour or so a day, that is really very helpful in helping depression. There are very effective treatments for depression, and the only problem, really, is knowing when to prescribe or give those treatments.

Dr. John Nutt 00:00:12
What I recommend is an exercise program that has four parts. One of the components of an exercise program is aerobic fitness. This is bicycling, rowing, doing things like this. The second one is strengthening, and a lot of this is either weight machines or small weights. The third is stretching.

And yoga can be really good for this. And the fourth part, and I think this is really important, is agility. Looking for things that will help you with your balance and help prevent falls.

The recommendations are that you exercise for 30 minutes a day, at least five days a week. More is better. That should really be a minimum. And you don't have to try to have all four components in each day.

Dr. John Nutt 00:01:06
One or two days could be cardiovascular fitness. Other days could be strengthening, and other days could work on balance and stretching.

Well, this is not known for certain. There are some studies that suggest that exercise may either help repair the dopamine system that's damaged in Parkinson's disease or prevent further damage.

What is known is that exercise changes what happens in your brain, and it actually has a lot of beneficial effects on the basic chemistry in the brain. And this is sometimes referred to as neuroplasticity.

Dr. John Nutt 00:01:52
So even though it may not directly combat Parkinson's disease, it helps the brain compensate. And there's no doubt that people do better if they are exercising, and it does prevent consequences of Parkinson's disease from being as severe as they might be without exercise.

Another thing that can be very helpful to people to either reduce the number of falls or prevent any further falls are exercise programs such as Tai Chi or Pilates.

Simply walking in a straight line or getting out and walking around the block is not going to challenge the balance system as much as trying to dance, doing Pilates, doing Tai Chi.

Dr. John Nutt 00:02:41
The other benefit is if they're done in a group, there's great social interaction, and it's really fun. People really enjoy that as well. In many parts of the country now, there are classes that are specifically for people with Parkinson's disease.

Can't emphasize enough that we think it's very important for people to keep moving and moving in a way that helps improve their balance and their agility.

Dr. Joseph Jankovic 00:00:07
Parkinson's disease is certainly one of the diseases where a cure has not yet been found. That does not necessarily mean that Parkinson's disease is not a treatable disease. It clearly is a treatable disorder, and we can treat it in different ways. We can treat the symptoms of Parkinson's disease. There are many medications that have been proven to be very effective and safe in the treatment of symptoms of Parkinson's disease, particularly the dopaminergic drugs, drugs that stimulate the dopaminergic system. Levodopa is the best example. It replaces dopamine, which is the neurotransmitter that is missing in the brains of patients with Parkinson's disease. Then there are drugs, so-called dopamine agonists, that stimulate the dopamine receptors.

Dr. Joseph Jankovic 00:00:55
They can also improve the symptoms of Parkinson's disease. There are certain medications that we have found delay the progression of the disease and may in fact be disease-modifying drugs. These medications include, for example, monoamine oxidase inhibitors such as selegiline or rasagiline. It has been shown that early introduction of these medications in the initial phase of the disease may delay the need for levodopa, which is the main medication that we use for Parkinson's disease.

Dr. Joseph Jankovic 00:01:34
Our goal in the therapeutics of Parkinson's disease, of course, is to develop truly neuroprotective drugs, drugs that actually protect the dying neurons and protect the brains from developing the dopamine deficiency.

Dr. Joseph Jankovic 00:02:15
Another form of therapy that is very important in more advanced stages of Parkinson's disease involves surgery, particularly deep brain stimulation. This is usually reserved for patients who respond to levodopa but, as a result of chronic levodopa therapy, have developed side effects such as motor fluctuations and involuntary jerking movements, called dyskinesia.