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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.

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. Joseph Jankovic 00:00:05
We really don't know yet what causes Parkinson's disease, and we suspect there are many different causes. There's more and more evidence to suggest that many causes of Parkinson's disease are of genetic origin. Some individuals are genetically predisposed to develop Parkinson's disease, even though we don't necessarily know what specific gene or genes cause the disease in that particular individual.

The loss of nerve cells in the substantia nigra, in the part of the brain that produces dopamine, is due to a complex interaction between genetic factors on one end of the spectrum and environmental factors on the other end of the spectrum. We still have a lot to learn about how this complex interaction actually results in cell death and eventual loss of dopamine, which is the biochemical hallmark in the brains of patients with Parkinson's disease.

Dr. Rajesh Pahwa 00:00:05
The way Parkinson's disease is diagnosed is a clinical diagnosis. By which I mean that the physician usually takes a history and performs an examination. We usually don't do any tests, such as a brain scan like an MRI of the brain, unless there is a certain reason the physician feels an MRI is needed.

To make an assessment that they have features of parkinsonism, a patient has to have at least two out of these three present: tremor, slowness or bradykinesia, or rigidity. Once that is established, a physician usually assesses that there are not any other reasons or other neurological findings. In addition, the physician usually will assess that the presentation is not atypical, by which I mean that the symptoms did not begin with an atypical symptom such as falling.

Dr. Rajesh Pahwa 00:01:09
Finally, we look at certain other characteristics, such as: Did the symptoms begin on one side? Did the patient have a tremor when they were just resting, which is called a resting tremor? A resting tremor starting on one side is the most common presentation for Parkinson's disease. We often assess: Have the symptoms progressed over time? We assess if they have been on medications, not only whether they have responded well to the medications, but if a patient has developed any involuntary movements due to their medications.

Taking all this together, a physician will come to a clinical diagnosis of Parkinson's disease.

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.