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.
