Depression, Anxiety and Apathy in Parkinson's Disease: Essential Facts For Patients

Can Parkinson’s Disease Affect Mood?

Yes, Parkinson’s disease (PD) can produce a range of non-motor (i.e. not related to movement) problems in addition to motor symptoms. Mood problems are important and frequent symptoms. They may impair quality of life more than motor difficulties for some patients.

What Are The Common Mood Symptoms In PD?

The most common mood symptoms that may affect PD patients are depression, anxiety and apathy.

Depression is a state of low mood, sadness, hopelessness, sometimes with feelings of emptiness or guilt.
Anxiety is a feeling of nervousness, worry, tension and unease. Patients with anxiety may experience fear or panic attacks.
Apathy is a lack of interest, enthusiasm, or motivation to do things or be with other people.

When Do Mood Symptoms Occur?

Mood symptoms can occur at any time. Some patients may develop mood symptoms even before motor problems start. Others may note them after years of having PD. Some patients also notice changes in mood due to their dopaminergic medication. For example, anxiety often occurs when medication levels are low, during ”off” periods.

How Can I Identify Mood Symptoms?

Depression and anxiety are often accompanied by lack of energy and fatigue, decreased appetite and sleep problems. But these problems can also happen on their own, so having them doesn’t always mean you are depressed. Other symptoms are sometimes more noticeable to your family and friends than to you. These may include:

Increased fearfulness
More irritability
Social isolation
Lack of participation in family events or activities

How Are Mood Symptoms Diagnosed?

Tell your doctor right away about changes in mood, sleep or appetite so you can get a diagnosis and start treatment. Your doctor may want to know:

When the symptoms started
How bothersome they are
Any associated symptoms
Any relation to medication timing

If you have a spouse or caregiver, they may also help by reporting any other changes they noticed in your mood, behavior and/or sleep.

Why Do Mood Symptoms Happen?

PD may cause certain changes in brain areas that control mood. The disease may reduce neuronal messengers such as dopamine, serotonin, and noradrenaline, which may underlie some mood problems. Your response to your illness and some psychosocial factors might also lead to these symptoms.

How Do You Treat Mood Symptoms In PD?

There are different ways to treat mood symptoms including:

Antidepressant and anxiolytic medications can treat depression and anxiety.
Dopamine drugs that improve movement symptoms may also improve depression and anxiety, especially if it changes with the medication schedule.
Psychotherapy can help depression and anxiety.
Programmed activities, exercise and socializing may help in treating apathy.
Getting more sleep and social support while avoiding stress may help.

In Summary

Depression, anxiety and apathy can be symptoms of PD and are quite common.
They can appear early, even before motor problems start, or develop later in the disease course.
It is important to tell your doctor about these symptoms because you have specific treatment options.
Medications, psychotherapy, and social support are the main tools to treat these symptoms.