Woman with anxiety

Parkinson’s disease (PD) can impact you emotionally. While PD is known to influence many aspects of movement, Parkinson's Outcomes Project research shows that two non-motor symptoms — anxiety and depression — play a key role in the disease and have the greatest impact on overall health. Fortunately there are proven strategies, including mindfulness meditation and exercise, that can help manage anxiety.

Feeling worried is an understandable reaction to a Parkinson’s diagnosis. But when feelings of constant worry or nervousness go beyond what is understandable, a person may be experiencing anxiety, which is more serious.

Types of Anxiety

Anxiety is not simply a reaction to a Parkinson’s diagnosis, but is instead a part of the disease itself, caused by changes in the brain chemistry of the brain. As many as two out of five people with PD will experience one of these forms of anxiety:

Anxiety is not tied to disease progression — it can begin before a PD diagnosis or develop much later. Additionally, while some people with Parkinson's experience anxiety on its own, many are diagnosed with anxiety along with depression. If left unchecked, anxiety can worsen a person’s overall health condition.

Causes of Anxiety

Living with Parkinson's and brain changes related to the disease can influence anxiety. Here's how:

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). This can lead to a fear of being left alone. Another is a concern about being embarrassed — often related to interacting with others in public.

Biological Factors

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. In some cases, anxiety is directly related to motor symptom fluctuations. People can experience severe anxiety during “off” periods, sometimes even full-blown anxiety attacks.


of people with PD will experience some form of depression.


of people with Parkinson’s will experience an anxiety disorder.

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, mood changes and behaviors. A person living with anxiety can experience symptoms so intense that it makes daily living difficult.

Symptoms of anxiety can 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

An anxiety disorder diagnosis is made in Parkinson's only if signs are not easily confused with movement symptoms and there is clear change from a person's previous behavior. For example, even though someone may have a legitimate concern that a tremor or change in walking ability may be noticed in public, a social avoidance diagnosis is only made if the concern is excessive, social situations are avoided and the anxiety interferes with social or work life.

Anxiety Treatment Options

The good news is that there are effective anxiety treatments. These include medications and psychological counseling, specifically cognitive behavioral therapy — an evidence-based psychotherapy shown to be effective in the general population that preliminary research shows may also be helpful for people with Parkinson's.

Care should be tailored to each person’s individual needs. Depending on the severity of symptoms, psychotherapy can be used alone or combination with medication.

Tips for Living with Anxiety

Addressing anxiety can help you live better with Parkinson's. Like other PD symptoms, each person experiences anxiety and responds to treatments differently. These strategies can help:

  • Empower yourself by discovering how PD symptoms, including anxiety, can impact you.
  • Keep a diary of your moods, your medications and your PD symptoms.
  • Notice what triggers your anxiety symptoms.
  • Talk with your doctor about anxiety.
  • Share how you are feeling with loved ones and family, who can help you explore ways to cope.
  • Find a support group for people with PD.
  • Be flexible — try different approaches to coping with anxiety.
  • Understand that symptoms change; if a coping strategy stops working, try a new approach.
MY PD STORY: Todd Vogt

"One of the first things I thought was that my days as a competitive rower were over. After several months of dwelling on things, I returned to rowing."

Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson's Foundation Center of Excellence.

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