Parkinson’s disease (PD), like many chronic illnesses, can change the dynamics of a relationship, particularly when it comes to intimacy and sexuality. Exploring new ways to connect and communicate — whether you have PD or you care for someone who has PD — will help strengthen your relationship. Here are some suggestions for creating a deeper intimacy with your loved one.

Communication

Many couples do not openly talk about sex and intimacy, relying on predictable, nonverbal patterns of sexual expression (such as a look or touch). Given that PD may result in physical or emotional changes that can change these established patterns, maintaining open communication about feelings and emotions is essential.

PD may cause changes in facial expression that can be interpreted as lack of interest. This symptom, called “facial masking,” happens when the same stiffness and slowness that can impact walking and other activities impacts the muscles in the face of someone with PD. Because of this symptom, it is especially important to communicate your needs and listen openly to your partner’s needs.

We all have doubts about our appearance and insecurities about how our bodies may change over time. Express your love and appreciation for your partner regularly. Knowing that your partner still cares and needs you is of great comfort.

A strong friendship, based on caring and communication, is vital for any relationship. Share your thoughts, feelings and concerns, and encourage your partner to do the same. If you can learn to express your frustrations with one another, you will be less likely to build up anger and resentment.

Staying Close

Life and hectic schedules can get in the way of spending quality time together. Remember the things you enjoy doing together and remind one another what you love and appreciate about your loved one.

Parkinson’s can be unpredictable, so do not be disappointed if things do not go as expected. The most important thing is to remain flexible and sympathetic to our partner’s needs.

Patience and Understanding

As we grow older, our bodies may not respond or perform as they used to. Maturing is learning how to be comfortable with who you are and staying open to self-discovery.

Parkinson’s can either help bring you and your loved one closer together or push you apart, depending on how well you are able to cope with challenges. The strength of your bond prior to illness also plays a role. Acceptance and understanding play a large role in helping you both deal with any problems within your relationship.

Be patient. Remember that the goal in sexual intimacy is mutual enjoyment. Emphasize comfort and pleasure, not performance.

Sex

People with PD frequently experience sexual dysfunction. Any combination of Parkinson’srelated symptoms like pain, limitation of movement, fatigue and sleep disorders — coupled with emotional changes such as anxiety and depression — as well as medication side effects can trigger sexual dysfunction. PD symptoms can affect many aspects of sexuality, including intimacy and erotic experiences, thereby adding to a couple’s discord and general dissatisfaction.

People with PD and their partners are typically embarrassed and uneasy when bringing up sex to health care providers, often diminishing the topic because they feel it is not a life-threatening issue. However, when asked to rate a variety of disabling motor and non-motor symptoms, people with PD rated sexual dysfunction as the 12th out of 24 most bothersome Parkinson’s symptoms [Politis et al, 2010].

Expanding the Definition of Intimacy

Intimacy isn’t just about sexuality; it involves mutual respect for each other’s spirit and autonomy. You can still reap the benefits of closeness by sharing time together and using touch in affirming ways that are not reliant on sexual performance. Hold hands, hug or cuddle as an expression of love and intimacy.

Daily routine can be tireless and demanding. Take time for one another outside the required tasks. Simply sharing a meal or watching TV together can be a special event. Consider planning a day trip or a weekend getaway, to a destination that provides care assistance if necessary.

Hypersexuality and Parkinson’s Disease

One out of every six people with PD taking a dopamine agonist drug will develop compulsive behaviors. Known as impulse control disorders, these behaviors may include compulsive gambling or shopping, hoarding or hyper sexuality.

Hypersexuality can include demanding sex, talking about sex and your desire for sex at inappropriate times; cross-dressing; and having affairs outside of your committed relationship.

People living with PD who are taking dopamine agonists and have developed hypersexuality should discuss it with their neurologist. Usually decreasing the dose or complete discontinuation of dopamine agonists resolves impulse control problems.

Tips for Intimacy and Parkinson’s

Never be afraid to ask for help. Sex therapy, couples therapy and behavioral therapy can help you:

• Increase open sexual communication between partners.
• Plan the setting of sexual activity (including time, location, position and roles).
• Learn comfortable positions.
• Adapt new sexual roles.
• Find new solutions for physical limitations (such as, touch, arousal, orgasm).
• Perform intimacy training and erotic tasks.
• Practice sensate focus — a process of re-learning body sensations.
• Practice growing intimacy and satisfaction through sexual stimulation without intercourse, then begin to add it back in, known as the intercourse-outercourse approach.
• Work with medical staff to reduce the effects of medications on sexual function.

Not ready for therapy? Speak with your doctor or social worker about feelings of depression, concerns regarding changes in sexual performance or difficulties with current relationships.

Call our Helpline for more information at 1-800-4PD-INFO (473-4636).

Este video es de la lista de reproducción de la conferencia, “Hacia adelante: Navegando el mar del Parkinson.” 

Descargar Diapositivas

Presentadora

Adriana Gonzalez, MSW, LCSW, University of California San Diego

Everyone experiences changes in mood over the course of any given day, week, month, and year. But “mood changes” is a broad term that can mean different things to different people. This guide explains what mood changes can happen in Parkinson’s disease (PD), why people with Parkinson’s might experience these changes and how to treat and cope with them.

Not everyone develops every symptom of Parkinson’s disease, but if you’re affected, non-motor symptoms including depression, anxiety, anger, and irritability can have a huge impact on your quality of life and those around you. The information, tips, and stories included here will provide answers, help you organize thoughts and questions for your medical team and remind you that you are not alone on this Parkinson’s journey

Listen Now

Like people with other chronic diseases, people with Parkinson’s disease (PD) often struggle with mental health. While the illness is known to impair many aspects of movement, research from the Parkinson’s Outcomes Project has found that two non-motor symptoms — depression and anxiety — play a key role in the disease and on people’s quality of life.

While feeling worried is an understandable reaction to a Parkinson’s diagnosis, when feelings of constant worry or nervousness go beyond a reasonable point, a person may experience anxiety, which is more serious.

Forms of Anxiety

Anxiety is a common non-motor symptom of PD. Anxiety is not simply a reaction to the diagnosis of Parkinson’s, but is instead a part of the disease itself, caused by changes in brain chemistry. Up to 40% people with PD will experience one of these forms of anxiety:

Generalized Anxiety Disorder (GAD) is characterized by feelings of nervousness and recurring thoughts of worry and fear. Physical symptoms that may accompany these feelings include butterflies in the stomach and nausea, trouble breathing or swallowing, racing of the heart, sweating and increased tremors.

Anxiety Attacks, or panic attacks usually start suddenly with a sense of severe physical and emotional distress. Individuals may feel as if they cannot breathe or are having a heart attack. These episodes usually last a few minutes to an hour, particularly when associated with “off” periods, though they can last for longer periods of time.

Social Avoidance, or social anxiety disorder, involves avoiding everyday social situations because of a fear of embarrassment caused by having having Parkinson’s symptoms, such as tremor, dyskinesias, or noticeable trouble walking in public.

Obsessive-Compulsive Disorder (OCD) may cause persistent, unwelcome thoughts or images (obsessions), and the urgent need to engage in certain rituals (compulsions) to try to control or rid themselves of these thoughts. Anxiety can begin before a PD diagnosis or develop much later on. While some people with PD experience anxiety on its own, many are diagnosed with anxiety along with depression. Anxiety is less well-studied than depression, but it may be just as common. If left unchecked, anxiety can worsen a person’s overall health condition.

Causes of Anxiety

Psychological Factors - 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 (the time of day when medication is not working).

Biological Factors - Many of the brain pathways and chemicals affected by Parkinson’s are the same as those affected by anxiety and depression. In some cases, anxiety is directly related to changes in motor symptoms. Specifically, people who experience “off” periods can develop severe anxiety during these states, like anxiety attacks.

How Is Anxiety Diagnosed?

Anxiety is usually diagnosed by a primary care physician, or a mental health professional, who will ask questions about certain symptoms. The doctor usually asks questions about mood changes and behaviors. For people with an anxiety disorder, symptoms can become so intense that they are unable to function normally in life.

In general, symptoms of anxiety may include:

• Excessive fear and worry
• Uncontrollable or unwanted thoughts
• Sudden waves of terror
• Nightmares
• Ritualistic behaviors
• Problems sleeping
• Pounding heart
• Cold and sweaty hands
• Dizziness
• Nausea

In people with Parkinson’s, a diagnosis of an anxiety disorder is made only if the symptoms involve a clear change in a patient’s previous behavior and are not easily confused with motor symptoms. For example, even though there may be a legitimate concern that a tremor or change in walking ability may be noticed in public, a diagnosis of social avoidance is only made if the person realizes that the concern is excessive, the social situation is avoided, and it causes interference in the person’s social or work life.

Treating Anxiety

There are two main types of treatment options for anxiety: medications and psychological counseling (psychotherapy). Depending on the severity of symptoms, psychotherapy can be used alone or combination with medication. Care should be tailored to each person’s individual needs.

Psychotherapy

Psychotherapy or “talk therapy” refers to many varieties of counseling. This treatment can help people diagnosed with an anxiety disorder understand and better manage their symptoms. Psychotherapy offers two advantages: no drug side effects and coping skills that can be used over the long term.

Cognitive behavioral therapy (CBT) is effective at helping people change negative thinking patterns and behaviors to solve their problems and engage in life. CBT encourages people to develop more positive thoughts about themselves, the environment around them and their future: in this case the outcome related to their illness.

Counseling sessions can provide vital support, understanding and education. People with PD may be seen alone, as a couple or family, or in a group.

Non-Conventional Therapies for Anxiety

• Relaxation techniques
• Massage therapy
• Acupuncture
• Aromatherapy
• Meditation
• Music therapy

Tips for Living with Anxiety

• Educate yourself about PD and its symptoms, including anxiety.
• Keep a diary of your moods, medications and PD symptoms.
• Figure out what triggers your anxiety.
• Talk with your doctor about anxiety.
• Tell your care partner and family members how you are feeling, so they can understand your emotions better and help you cope.
• Find a support group for people with PD.
• Be flexible in your approaches to coping with anxiety; try different approaches.
• Understand that symptoms change; if a coping strategy stops working, try a new approach.
• Know that everyone experiences anxiety differently.

Call our Helpline for more information at 1-800-4PD-INFO (473-4626).

This guide takes you through the process of starting, facilitating and maintaining a Parkinson’s support group. Sample meeting guides are included for people with Parkinson’s as well as care partner-only groups. View Appendix A for a full list of resources.

We offer this guide to help first-time support leaders navigate logistics of starting a new group. This guide can also serve as a reference for veteran group leaders looking to improve or adjust how they work with an existing group.

Consider this your practical guide for achieving good sleep health. This book addresses healthy sleep, sleep changes due to aging and sleep problems due to Parkinson’s, as well as diagnosis, treatment and coping strategies.

This book is only available digitally to view, download or print. It is also available in Kindle and audiobook formats.

Así es; añada los trastornos del control de impulsos, como la compulsión patológica por los juegos de azar y la hipersexualidad, a la lista de posibles problemas de tipo no motor que podrían ocurrir a los individuos con la enfermedad de Parkinson (EP, o PD, por sus siglas en inglés). Estudios recientes sugieren que los comportamientos impulsivos seriamente discapacitantes pueden ocurrirle a entre el 3 y el 5 por ciento de los pacientes con EP, afectando a individuos en todas las etapas de la enfermedad. La incidencia exacta de tales perturbaciones en la EP no está completamente clara puesto que estos comportamientos suelen hacerse en secreto, o porque la asociación con la EP parece improbable y por lo tanto nunca se reportan en las visitas médicas. Pero a medida que se vuelve más claro que algunos medicamentos antiparkinsonianos juegan un papel importante en el desarrollo de los trastornos del control de impulsos, es de suma importancia que los profesionales clínicos examinen esta posibilidad, y que los pacientes y sus familiares reporten de inmediato al médico cualquier inquietud o cambio en el comportamiento. El reconocimiento y tratamiento en el momento agudo de los comportamientos impulsivos pueden suministrar la clave para su solución o control, evitando así las devastadoras consecuencias.

Características generales de los trastornos del control de impulsos en la EP

Los trastornos del control de impulsos se caracterizan por la incapacidad de resistirse a un impulso, instinto o tentación dañino tanto para el individuo como para los otros. Los comportamientos suelen ser motivados por la esperanza de placer o gratificación y, en las personas con Parkinson, típicamente involucran el sexo, los juegos de azar y el abuso de medicamentos antiparkinsonianos. Las compras compulsivas, las comilonas patológicas y otros comportamientos por el estilo, también pueden ocurrir. En casi todos los casos, el comportamiento compulsivo que acompaña al Parkinson o a sus medicamentos, no tiene correlación con la personalidad del individuo antes del Parkinson. El problema tiende a ser más serio entre las personas cuya enfermedad de Parkinson está más avanzada y que toman altas dosis de medicación antiparkinsoniana para preservar la función motora. Reportes recientes sugieren que también puede ser intensificado por el uso de agonistas de la dopamina, pero los comportamientos pueden desarrollarse bajo el contexto de cualquier medicamento contra el Parkinson — o después de un tratamiento neuroquirúrgico como la estimulación cerebral profunda.

En la EP, los medicamentos dopaminérgicos reemplazan la pérdida de dopamina que resulta de la degeneración de la región del cerebro denominada “sustancia negra” que controla gran parte de nuestra habilidad para movernos. Sin embargo, este sistema neuronal productor de dopamina no es el único que es afectado por la enfermedad y por los medicamentos dopaminérgicos. Se cree que los trastornos del control de impulsos están relacionados con anormalidades en el “circuito de recompensas” del cerebro, el cual es también un sistema neuronal mediado por la dopamina, y sensible a los medicamentos dopaminérgicos. No está claro aún por qué solo algunos pacientes se ven afectados y otros no, pero una posible respuesta puede hallarse en las diferencias genéticas en el sistema dopaminérgico.

Al igual que en la población general, los problemas de comportamiento parecen ser más comunes en los hombres que en las mujeres con EP, y en pacientes cuyo comienzo del Parkinson es a una edad más joven. Con frecuencia, se presenta más de un trastorno del control de impulsos, algunas veces se acompaña de síntomas psicóticos (es decir, alucinaciones o delirios) o de un trastorno del estado de ánimo (depresión o ansiedad). Los comportamientos impulsivos en las personas con Parkinson también pueden ser una característica de una perturbación maniaca o hipomaniaca, las cuales típicamente se caracterizan por estados de ánimo persistentemente elevados, expansivos, de grandiosidad o de irritabilidad.

Compulsión patológica por los juegos de azar

La compulsión patológica por los juegos de azar se refiere a los comportamientos recurrentes y desadaptados, incluyendo la incapacidad progresiva de resistirse al impulso de jugar a pesar de sus consecuencias destructivas. Los jugadores patológicos tienden a reportar experiencias con muchos tipos de juegos (por ejemplo casinos, loterías, rifas y juegos de Internet o televisión), así como pérdidas que pueden fluctuar entre varios cientos a muchos miles de dólares. La compulsión por jugar persiste a pesar de las súplicas de otros, lo mismo que el deterioro de las cuentas bancarias y la destrucción de carreras y familias. Algunas veces, el impulso de jugar es tan intenso que los individuos hacen engaños o hurtan para satisfacer su urgencia. Las noches de desvelo, los cambios en el estado de ánimo, la irritabilidad y la tensión se suelen aliviar con el juego. Para los jugadores patológicos en general, existe un alto riego de suicidio, pero no se sabe si esta asociación es cierta para las personas con EP.

Hipersexualidad

A diferencia de los temblores de reposo (un claro signo de disfunción en el sistema nervioso), el sexo y la compulsión, tanto en el juego como en las compras, son acciones comunes en la vida diaria. Por lo tanto, los comportamientos problemáticos pueden no ser vistos instantáneamente como anormales, aun cuando empiezan a presentar una desviación del carácter usual de la persona. Los comportamientos hipersexuales varían desde los pensamientos impertinentes, a impulsos o comentarios de tipo sexual, a comportamientos sexuales explícitos, inapropiados y a menudo ofensivos. No es sorprendente que la escala de dichas aberraciones varíe de persona a persona. Puede darse una mayor exigencia de actividad sexual en un contexto establecido o intentos de actividad sexual indiscriminada en contextos al azar. Algunos pacientes continuamente hacen comentarios inapropiados en público, mientras otros — a diferencia de sus comportamientos anteriores — pueden comenzar a usar pornografía, contratar prostitutas(os), engancharse en actividad sexual en Internet o desarrollar parafilias (fantasías sexuales intensas, impulsos o comportamientos tales como el exhibicionismo, el travestismo o el sadomasoquismo). Estas formas de hipersexualidad pueden ir acompañadas de expresiones tan perturbadoras como irritabilidad, ira, inestabilidad del ánimo e interrupción del sueño.

Abuso de los medicamentos antiparkinsonianos

El abuso de los medicamentos antiparkinsonianos es otro trastorno del control de impulsos que puede presentarse en las personas con EP. Consiste en un patrón de uso inapropiado y excesivo de los medicamentos antiparkinsonianos junto con comportamientos de búsqueda de drogas, tolerancia y dependencia psicológica. Aun en las etapas tempranas de la enfermedad de Parkinson, los pacientes afectados insistirán en obtener medicamentos dopaminérgicos para tratar síntomas motores “intolerables” así como ciertos sentimientos psicológicos. Cada vez más, los pacientes tienen una visión distorsionada de los estados motores y mentales intermitentes “on/off” — esto es, describen una sensación de “subidón” y una mayor energía o bienestar en el estado de “on” e irritabilidad, ansiedad, o incluso desesperación o pensamientos suicidas en el estado “off”. A menudo, estos pacientes reportan un historial de trastornos del estado de ánimo antes del comienzo del Parkinson y su tratamiento.

Tratamiento

Aunque el tratamiento de los síntomas del trastorno del control de impulsos en la enfermedad de Parkinson no ha sido formalmente estudiado, es generalmente reconocido que estos problemas son difíciles de manejar. Una razón es sencillamente que a medida que los pacientes requieren dosis más altas de medicamentos antiparkinsonianos para controlar los síntomas motores, estas dosis más altas en sí mismas pueden contribuir a comportamientos anómalos. Estos comportamientos anómalos o autodestructivos pueden tener un impacto inmenso en los familiares y amigos del paciente. Algunas veces, los comportamientos impulsivos dañan las relaciones y corroen la red de apoyo que es tan importante para el cuidado de la persona.

En muchos casos, la aparición de comportamientos impulsivos está asociada con una reciente adición o aumento de medicación dopaminérgica. En tales casos, cuando un paciente exhibe comportamientos descontrolados e impulsivos, el primer paso es informar de inmediato al médico que recetó la medicación, quien deberá ajustar el régimen antiparkinsoniano. Reducir la dosis o eliminar el nuevo medicamento suele ser suficiente. Algunos pacientes toleran un tipo de agonista de la dopamina pero no otro, mientras que otros pacientes solo toleran la terapia con levodopa. En algunos casos, un antipsicótico como la quetiapina (Seroquel®) puede agregarse para controlar mejor los síntomas, especialmente si están asociados con paranoia o alucinaciones.

Este medicamento puede a menudo mejorar el sueño, limitando por lo tanto el tiempo que la persona puede dedicar a comportamientos nocturnos indeseables. Otra clase de medicamentos, incluyendo los antidepresivos tricíclicos, los inhibidores de la reabsorción de la serotonina (Prozac®, Zoloft®, Paxil®, Lexapro® y otros) y los agentes estabilizadores del ánimo, son utilizados para tratar los comportamientos impulsivos en los pacientes que no tienen EP con diferentes niveles de éxito, especialmente si hay trastornos del estado de ánimo asociados.

Las medidas comportamentales también son un aspecto integral del tratamiento, especialmente para los jugadores. Debe eliminarse, o al menos restringirse, la oportunidad de llevar a cabo el comportamiento hasta que haya una mejoría adecuada. Para las familias esto significa confiscar las tarjetas de crédito y bancarias, limitar el efectivo a mano, restringir el acceso a las cuentas bancarias que permitan sacar dinero y limitar el acceso a Internet. Debido a los posibles problemas de no cumplimiento y abuso de medicamentos, algunos pacientes podrían necesitar una evaluación psiquiátrica o hasta un internamiento en un hospital psiquiátrico. Algunos pacientes se benefician de los programas de 12 pasos para adictos o jugadores, pero estos deben estar acompañados de otros métodos, incluyendo ajustes en los medicamentos antiparkinsonianos. También es importante centrarse en el rol de las terapias dopaminérgicas en estos comportamientos y cómo controlar dichos comportamientos — y no en sospechas acerca de una “debilidad del carácter.”

La regla más importante para un paciente o cuidador que está lidiando con un comportamiento impulsivo es: asegúrese de confiar sus inquietudes a su médico. Bien sea que el comportamiento provenga del Parkinson o no, es una inquietud legítima y debe ser discutida. En algunos casos, podría requerirse la pericia de un psiquiatra. Para leer más acerca de la EP y los síntomas de tipo no motor, lea el libro de la Dra. Marsh (coeditado con el Dr. Matthew Menza), Psychiatric Issues in Parkinson’s Disease — A Practical Guide, publicado en el otoño del 2005.

November 2, 2022

Parkinson’s disease (PD) is often thought of as a disease that only involves movement. Yet many people with Parkinson’s experience slowness in thinking, loss of memory, decreased attention span and difficulty finding words. Dementia refers to advanced problems in memory and thinking that interfere with daily activities and quality of life. This webinar will review the various types of dementia, their clinical features as well as ways to manage dementia in Parkinson’s.

Download Slides

Presenter

James Leverenz, MD
Director, Cleveland Clinic Lou Ruvo Center for Brain Health

Everyone experiences changes in mood over the course of any given day, week, month and year. But “mood changes” is a broad term that can mean different things to different people. This guide explains what mood changes can happen in Parkinson’s disease (PD), why people with Parkinson’s might experience these changes and how to treat and cope with them.

Not everyone develops every symptom of Parkinson’s disease, but if you’re affected, non-motor symptoms including depression, anxiety, anger and irritability can have a huge impact on your quality of life and those around you. The information, tips and stories included here will provide answers, help you organize thoughts and questions for your medical team and remind you that you are not alone on this Parkinson’s journey.

This book is only available digitally to view, download or print. It is also available in Kindle and audiobook formats.

It is not uncommon for the stresses of daily life — feeling overwhelmed, under prepared and over stimulated — to cause anxiety and unrest. These psychological issues can impact your health and even exacerbate the symptoms of Parkinson’s disease (PD). That is why it is important to assess what may be causing stress and learn how to deal with the situations that give rise to anxiety. Meditation, yoga or Tai Chi and deep breathing can help restore a sense of calm. Whether you are living with Parkinson’s or caring for someone with PD, finding balance can help you cope with the daily stresses of life. This may mean limiting your exposure to environmental stressors or using complementary therapies. Such approaches are wonderful ways to lower anxiety, lower blood pressure and improve your all-around health.

Managing Stress

Identify stress triggers along with ways to help control your emotions and release anger in a safe way. Try writing in a journal or going for a walk when tension reaches a breaking point. Physical outlets, such as hitting a pillow, can help you vent frustration. If stress triggers are unavoidable, you need reliable ways to reduce and manage them. No method is too silly if it works.

Yoga or Tai Chi

Tai Chi is a moving meditation based on the circulation of “chi,” life’s energy force, believed by the ancient Chinese to be blocked in the presence of disease. It is comprised of continuous, flowing movements. Yoga, which originated in ancient India, can include holding stationary poses or moving into a flowing series of poses and aims to integrate the mind, body and spirit. Both can help with relaxation, which can help with PD symptoms. Additional benefits include:

• Increased awareness of movement and actions
• Better awareness of proper body alignment/ posture and enhanced flexibility
• Improved balance and core strength, which help to reduce fall risk
• Improved breath support and control

Breathing Exercises

Breathing exercises offer a simple and effective way to relax in moments of stress or anxiety. When you are stressed your body goes into a high state of physical arousal. You may notice muscle tension, a faster heart beat or shallow breathing.

3-minute Relaxation Routine

• Select a key word such as relax, calm or peace
• Concentrate on relaxing using your key word. Pay attention to your breathing. Take in one deep breath and hold it.
• While holding your breath, tense up a group of muscles, such as the muscles in your face, arms or legs.
• As you breathe out, relax the tense muscles and let go. Continue using your key word as you drop your shoulders.
• Repeat, alternating to different muscle groups, for 3 minutes.

Consider Massage Therapy

Many people with PD recognize the benefits of massage. Massages are available in a variety of settings, including many local malls. Specific benefits may include:

• reduction in rigidity and tremor
• improvement in sleep
• increase in daily stamina
• reduction in anxiety
• increased feeling of relaxation

In finding a massage therapist, it is important to find someone trained by an accredited school of massage therapy. Tell your medical team, family or friends that you are considering getting a massage. They may be able to provide you with a referral. You can also find a massage therapist by calling toll free 1-888-843-2682 or visiting the American Massage Therapy Association website: www.amtamassage.org/findamassage/.

Distinguishing Between Stress and Anxiety or Depression

Feeling stressed or worried is understandable when managing a chronic illness. It is important to remember that depression and anxiety play a key role in PD and its effect on quality of life. If constant worry or nervousness go beyond what is manageable, a person may be experiencing anxiety, which is more serious.

Remember, anxiety and depression often go together.

Symptoms of anxiety can include:

• feelings of panic
• fear and restlessness
• sleep disturbance
• poor concentration
• palpitations
• shortness of breath
• irritability
• dizziness.

Symptoms of depression can include:

• excessive worrying
• persistent sadness
• crying
• loss of interest in usual activities and hobbies
• increased fatigue and lack of energy
• feelings of guilt
• loss of motivation
• complaints of aches and pains
• feelings of being a burden to loved ones

If you think your stress may be a symptom of depression or anxiety, do not feel embarrassed to seek professional help or counseling. A social worker, psychologist or psychiatrist can help you pinpoint the causes of your distress and provide constructive ways to cope with the situation.

You may find Cognitive Behavioral Therapy (CBT), a non-drug approach to developing the skills and actions that change patterns of thought and behavior related to depression, to be a helpful tool.

Your mood is a critical aspect of living with PD that you can control. Talk to your friends, family and doctor about your feelings of stress, anxiety or depression.

For more resources on managing stress, anxiety or depression, call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).