Moodiness

Everyone experiences changes in mood over the course of any given day, week, month, and year. People with Parkinson's might experience mood changes, including depression, anxiety, anger, and irritability which can have an impact on the quality of life for them and the persons around them.

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Mood refers to a temporary state of mind or generalized state of feeling. A mood- be it happy, sad, frustrated, relaxed, cranky, surprised or any other mental emotional states - can last a few minutes, or a few weeks, and changes based on exposure to different stimuli. Generally, your mood changes in a manner appropriate to the situation.

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Mood changes happen to everyone, but in people with PD, mood can become disordered, with changes that are extreme and persistent or inappropriate to the social context. Mood disorders can be greatly improved with medical treatment, so that you can keep living your best possible life with PD.

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While it is understandable, and normal to feel sad upon receiving a diagnosis of Parkinson's, for many people the sadness is more serious, and is not just a reaction to learning you have a progressive disease. Parkinson's is also called a neuropsychiatric disease. This means it is a disease of the nervous system ("neuro" that may involve changes in mental health).

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Emotional and behavioral changes are common in people with chronic diseases, but these changes are even more common in PD. The same neurotransmitters (e.g., dopamine) that regulate movement also regulate our mood.

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Treatments

Psychotherapy is the treatment of a mental or emotional disorder by talking. In general, it offers the opportunity to reflect on your situation and what you are feeling. A therapist can help focus your attention to resolve some of the issues that concern you.

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Medications can also be used to treat moods. There is no antidepressant created specifically for us in people with Parkinson's. As with many other treatments, finding the right drug and the right dose can take time. It might take several tries, and antidepressants can take weeks or even months to work. Be patient and communicate with your physician. Antidepressants can cause side effects like dry mouth, constipation, cognitive dysfunction, blurred vision, drowsiness, and sexual dysfunction. Medications work best when their effects are regularly evaluated, about every six weeks in the beginning. For those reasons, it is helpful for your primary care provider and mental health specialist to work together to determine the best treatment plan for you and monitor your status.

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There is no single rule for how to start or stop antidepressants, though in general, both should be done gradually and under the direction of a physician. When starting an antidepressant, the goal is to achieve a therapeutic dose as quickly as possible while minimizing side effects. Typically, side effects are less of a problem the more slowly dosage increases occur.

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Do not stop taking your medication without speaking to your doctor. Finding the antidepressant that works best for you may take time. Suddenly stopping the drug can cause a "rebound effect" and make your depression worse. Report any concerns to your physician.

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Electroconvulsive therapy (ECT) is a standard treatment option for people with severe or non-responsive depression, meaning no other treatments have worked. ECT is generally not to be used for people with DBS. Complementary therapies could include:

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• Nutritional supplements and multivitamins

• Meditation and Mindfulness

• Music Therapy

• Massage Therapy

• Light Therapy

• Tai Chi

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Apathy, anxiety and depression each have their own symptom management categories on this website. But there are a few additional mood disorder symptoms listed below that may impact some people living with Parkinson's. They include Anger/Irritability, Bipolar Disorder, Pseudobulbar Affect (PBA) and Personality.

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Anger and Irritability

Like depression and anxiety, anger and irritability can be normal responses to the disease journey. Anger can express itself in several ways and at different times in the PD progression. However, if these emotions are pervasive, it could be symptomatic of an untreated or under-treated mood disorder, such as major depression or bipolar disorder. In this case, mood changes are not just a response to the disease, but a part of the disease process itself: chemical or biological changes that distort the normal range of emotion. Therefore, it is important to pay attention to what makes you angry or what is triggering your irritability. If symptoms are triggered by something specific, they might be the result of poor coping strategies, stress, or a breakdown in emotional  processing. In this case, a therapist can teach you techniques to help anticipate and effectively manage mood changes when they occur.

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A second possibility is that anger is a side effect of medication. Dopamine agonists have been anecdotally linked to continual outbursts of rage, which subside when the medication is reduced or removed. If you are taking a dopamine agonist and having issues with anger or irritability, talk to your doctor about adjusting your medications and dosing. If you cannot identify a pattern, and you feel constantly angry or irritable, a combination of psychotherapy and medication is likely to be the best approach.

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Bipolar Disorder

Bipolar disorder, formerly called manic depression, is a condition for extreme mood swings and its effects on energy and activity levels. Manic episodes - when you are persistently elated and energized - usually last at least a week and involve many of the following:

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• Inflated self-esteem

• Decreased need for sleep

• Being more talkative than usual

• Racing thoughts and being easily distracted

• Increased goal-directed activity

• Increased involvement in activities that have a high potential for adverse consequences

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Depressive episodes - when you feel generally "down" and "hopeless," with a loss of interest or pleasure in activities - can occur, and usually can last up to two weeks. People with bipolar disorder can experience problems with work, relationships, and cognition.

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Bipolar disorder affects about 1% of people in the U.S. Little is known about bipolar disorder in Parkinson's disease, but evidence indicates that bipolar disorder in PD has a more rapid cycling pattern: people go from manic to depressive states more quickly than the usual one to two weeks. Treating manic states in PD is also complicated, as several of the best anti-mania mood stabilizers can worsen motor symptoms. For example, divalproex sodium (Depakote) may worsen overall parkinsonism, and lithium often worsens tremor.

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Pseudobulbar Affect (PBA)

Pseudobulbar affect (PBA), previously referred to as emotional incontinence or emotional lability, is characterized by uncontrollable bouts of laughing or crying that do not match your feelings or the situation you're in. This condition can occur when brain injuries or neurologic disorders, including Parkinson's, damage the areas of the brain that control normal expression of emotion. PBA is sometimes confused with depression, but PBA episodes are brief, and spontaneous, compared to the prolonged symptoms of depression. It is possible to have both conditions, and it is important for each condition to be diagnosed and treated separately.

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Personality

Personality is the combination of characteristics that form your distinctive character, including both what others observe and your inner experience. Personality is usually fixed by early adulthood, about the time the brain finishes developing, in your 20s or 30s.

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Neurodegenerative disorders are sometimes thought to cause changes in what are otherwise stable traits. Some research suggests that there is a "Parkinson's personality," which may be a prodromal symptom -- one that appears before the onset of PD motor symptoms - like depression, constipation, and sleep problems, among others. These personality traits include caution, single-mindedness, industriousness, and seriousness. If that sounds familiar, you are not alone.

Sources:

Parkinson's Foundation. Mood. A Mind Guide to Parkinson's Disease. "Booklet."​

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