Depression/Anxiety

Depression

Depression can impact up to 50% of people with PD at some point during the condition, especially in early stages upon diagnosis. Common signs of depression include:

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• Insomnia or excessive sleeping

• Loss or reduction of energy levels

• Loss of interest or pleasure

• Diminished attention spans

• Decreased participation in social or recreational activities

• Sexual dysfunction

• Loss or gain of appetite / weight

• Feelings of guilt or self-pity

• And in extreme cases, even thoughts of suicide or death

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Antidepressants are medications used to treat depression, and there are several different classes of medications that may help, including:

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• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (TCAs)

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Anxiety

People with PD often describe feelings of anxiety that can include unease, jitteriness, worry and even panic. Anxiety can also cause physical symptoms such as difficulty breathing, heart flutters, shaking or cold sweats. Anxiety is especially common and can be related to motor symptoms in social situations if the person feels embarrassment - which can create additional motor symptom aggravation. Additional anxiety symptoms may include:

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• Excessive worry

• Obsessive-compulsiveness

• Social avoidance

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Some of the medications utilized to treat Parkinson's motor symptoms can enhance anxiety, requiring additional medications for treatment. SSRIs commonly used to treat depression can often be used for anxiety as well. General anxiety can also be treated by Benzodiazepines to help reduce symptoms of panic and worry. Sometimes, they can even help to control tremor.

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Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most prescribed antidepressants for Parkinson's-related depression because of their tolerability. These medications can also be used to treat anxiety and obsessive compulsive disorder (OCD). It often takes four to six weeks of a therapeutic dose for full effect. SSRIs are sometimes combined with other medications such as SNRIs and TCAs, but such combinations should be used with caution due to a potential for serotonin syndrome. Possible side effects include headaches, nausea, insomnia, jitteriness, sexual dysfunction, and weight gain.

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Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another class of antidepressants that can treat depression, anxiety, and OCD like SSRIs. It often takes four to six weeks after reaching a therapeutic dose for them to take effect. SNRIs can raise blood pressure and have other side effects, including headache, nausea, sexual dysfunction, and dizziness. All SSRIs and SNRIs should be used with caution in conjunction with other serotonergic medications due to a potential for serotonin syndrome.

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Tricyclic Antidepressants (TCAs)

TCAs are another class of medications used to treat depression, anxiety, and OCD. They are prescribed less often than SSRIs and SNRIs due to higher likelihood of side effects. Possible side effects include dry mouth, constipation, orthostatic hypotension, urinary retention, and confusion. People with heart conditions should use TCAs with caution. It often takes four to six weeks after reaching a therapeutic dose for them to take effect. These medications should also be used with caution in conjunction with other serotonergic medications due to potential for serotonin syndrome.

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Other Antidepressants

These medications can also have benefits for depression, anxiety and OCD. Like SSRIs, SNRIs, and TCAs, it often takes four to six weeks after reaching a therapeutic dose for these drugs to take effect. Some of these medications should be used with caution in conjunction with serotonergic medications due to the potential for serotonin syndrome.

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