Anxiety

Anxiety is a common but often overlooked symptom in Parkinson’s disease (PD). While PD is most often associated with movement problems, research shows that non-movement symptoms like anxiety can significantly impact overall well-being. Fortunately, there are proven strategies, including medication adjustments, therapy, mindfulness practices and exercise, that can help manage anxiety and improve quality of life.

Anxiety is more than a reaction to the stress of living with a chronic condition, it is connected to the same brain changes that cause movement symptoms such as tremor and stiffness, and it is a treatable part of PD.

Understanding Anxiety in Parkinson’s

For some people with PD, anxiety can be one of the earliest signs — sometimes appearing years before a diagnosis. For others, it may start around the time they learn they have Parkinson's, often intertwined with the emotions of facing something new and uncertain. In some cases, anxiety doesn’t appear until later. It is also common for anxiety to occur alongside depression, as both are affected by changes in brain chemistry caused by PD.

There is no single cause for anxiety in Parkinson’s, but several factors can play a role:

Brain Changes — In PD, dopamine-producing cells are damaged and gradually die. Since dopamine is a brain chemical that helps regulate mood as well as movement, its loss can contribute to anxiety. PD also affects brain chemicals like GABA and serotonin, which are linked to anxiety and depression.
"Off" Periods — As PD medications wear off in between doses, movement symptoms often return or worsen. During these periods, some people may experience anxiety or other non-movement symptoms.
Coping with Parkinson’s — Life with PD means managing symptoms and facing many unknowns. Worrying about how symptoms might change during the day or over time can lead to anxiety.
Isolation — PD can make it more challenging to stay active or socially connected, which can lead to isolation and increase anxiety.
Other factors — Family history, health issues and everyday life stressors can also influence the development of anxiety.

50%

of people with PD will experience some form of depression.

40%

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

Recognizing and Diagnosing Anxiety in Parkinson’s

Anxiety can take many forms, including ongoing worry, sudden panic, racing thoughts or a sense of impending doom or fear without any obvious trigger. It might make everyday tasks feel overwhelming and even cause physical symptoms like a pounding heart, sweating or shortness of breath.

Signs of anxiety include:

Ongoing worry or fear
Unwelcome, repetitive thoughts
Sudden feelings of panic or terror
Difficulty falling or staying asleep, often due to racing thoughts or worry
Avoiding situations because of fear
Irritability or restlessness
Feeling overly alert or constantly on guard
Racing heartbeat, dizziness or nausea
Excessive sweating

Feeling stressed or worried from time to time is normal, and might even seem like an unavoidable part of living with PD. But if these feelings become constant, intense or begin interfering with daily life, they could be a sign of anxiety.

To diagnose anxiety, your healthcare team will review your PD symptoms, along with any anxiety symptoms you are experiencing and how they are affecting your daily life. Your doctor may refer you to a mental health professional for further evaluation.

Managing Anxiety in Parkinson’s

Talking to your healthcare team is often the first step in managing anxiety. They can help identify triggers and recommend strategies. You do not have to face anxiety alone — it is treatable and often managed with a combination of approaches, such as:

If your anxiety is linked to medication timing or “off” periods, your doctor may suggest several strategies for more consistent symptom management, including:
- Switching to longer-acting medications, such as controlled or extended-release levodopa.
- Using medications that provide a quick burst of dopamine, such as inhaled levodopa or injectable apomorphine.
- Adding medications that boost dopamine, like dopamine agonists, MAO-B inhibitors or COMT inhibitors.
Psychotherapy, or talk therapy, involves working with a trained therapist to explore your thoughts, feelings and behaviors. It can help you understand your anxiety and explore ways to manage it.

There are different types of therapy, including cognitive behavioral therapy (CBT), which focuses on changing negative thinking patterns and behaviors. You might meet with a therapist one-on-one, with a loved one or in a group. Some benefits of psychotherapy include:
- Gaining a better understanding of your thoughts and emotions
- Developing a more positive outlook on yourself or your journey with Parkinson’s
- Getting support, understanding and education
- Building lasting coping skills
Antidepressants

Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and other types of antidepressants are commonly used to treat depression and anxiety in Parkinson’s. These medications help balance the brain chemicals that affect mood and anxiety.

Doctors usually start with a low dose, especially for people who are prone to anxiety attacks, since higher doses can sometimes worsen anxiety initially. It often takes 4 to 6 weeks to feel the full effects. Keep in mind that finding the right medication and dose can take time.

Like all medications, antidepressants have potential side effects. In some cases, these side effects may be helpful. For example, a medication that increases appetite could be useful for someone who experiences weight loss in relation to PD.

Benzodiazepines (anti-anxiety medications)

Benzodiazepines, such as clonazepam (Klonopin) and alprazolam (Xanax), are sometimes used for short-term relief of anxiety. They affect a brain chemical called GABA, which plays a role in calming the nervous system.

While benzodiazepines can provide temporary relief, they are usually avoided because of risks like drowsiness, confusion, falls and dependence.

Important: Stopping benzodiazepines suddenly can lead to withdrawal symptoms, so it is important to consult your healthcare team before making any changes.
Managing stress is key to coping with anxiety. Look for ways to simplify your day, set boundaries and ask for help when needed to lessen daily pressures. Activities like yoga, meditation and breathing exercises can also help relax your body and mind.

Join our PD Health @ Home weekly virtual Mindfulness Monday sessions for guided relaxation techniques to reduce stress and improve mental clarity.
Regular physical activity can help manage PD symptoms, ease anxiety and improve overall well-being. Find activities you enjoy, whether it is going for a walk, stretching, gardening or something else that gets you moving. Before starting a new exercise program, check with your healthcare team to ensure it is safe and targets your needs.

Join weekly virtual Fitness Friday sessions to get moving with PD-tailored fitness videos.

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:

Understand how PD symptoms, including anxiety, impact you.
Keep a journal to track any triggers that might contribute to your anxiety symptoms.
Discuss your anxiety with your healthcare team.
Share your feelings with loved ones so they can support you.
Consider joining a support group for people with PD.
Know that symptoms can change. If one coping strategy stops working, be open to trying something else.

Page reviewed by Louise Marasco, PhD, Clinical Psychologist and Joseph Quinn, MD, Movement Disorders Specialist at Oregon Health and Science University, a Parkinson's Foundation Center of Excellence.