News ArchivesRead News

Depression Takes a Toll on Parkinson's Patients

Tuesday December 04, 2012

Kathleen Doheny

WebMD - For many people with Parkinson's disease, depression affects quality of life more than the symptoms such as shaking, according to new research.

"At least 50% of people with Parkinson's have depression," says Michael S. Okun, MD, national medical director of the National Parkinson Foundation and professor of neurology at the Center for Movement Disorders at the University of Florida, Gainesville.

That was a main finding of the Parkinson's Outcomes Project, a report released today by the National Parkinson Foundation.

"The big news is how large of a role depression plays in Parkinson's disease, how under-diagnosed and under-treated it is," says Joyce Oberdorf, CEO and president of the foundation.

The impact of depression on the health of people with Parkinson's is nearly twice that of movement problems, the researchers found.

About 1 million people in the U.S. and more than 4 million worldwide have the disease. It is marked by tremors and difficulty with walking, movement, and coordination.

Tracking Parkinson's Patients

Beginning in 2009, the researchers evaluated the care of more than 5,500 patients, ages 25 to 95. They went to 20 Centers of Excellence in the U.S., Canada, Israel, and the Netherlands.

About 9,000 clinic visits were included.

The researchers looked at information about medications, referrals to specialists, and rates of depression and anxiety, among other information. The study will be ongoing.

Based on the results, the researchers made some recommendations.

Depression & Parkinson's Disease Details

Mood disorders are common among people with Parkinson's, the researchers found. Besides widespread depression, anxiety is common.

"We have become more acutely aware over the last few years that these non-movement factors are impacting people's quality of life," Okun says.

Doctors should screen people with Parkinson's for depression at least once a year, the foundation says. Patients are encouraged to report mood changes to their doctors. Family members are also encouraged to accompany them to doctor’s visits and to discuss any changes in patients’ mood.

Treatment with medications and talk therapy, as well as getting regular exercise, can help, according to the researchers. "People's quality of life can significantly improve," Oberdorf says.

It's important to realize, Oberdorf says, that the depression is part of the disease, a chemical phenomenon. "It's not, 'Oh, I have Parkinson's disease and I'm depressed,'" she says.

The depression, she and others say, is related to changes inherent in the disease, such as a decline in the brain chemical dopamine. It helps control the brain's reward and pleasure centers.

Tracking Parkinson's Disease: Other Findings

After depression, mobility issues affected a patient's health status the most, the researchers found.

Mobility problems can affect balance, walking ability, and everyday tasks.

Exercising more than 2.5 hours a week is linked with fewer mobility problems and less difficulty in doing everyday activities, according to the researchers.

While all the centers were considered expert at caring for Parkinson's disease patients, the care itself varied, the research found.

There were different referral rates, for instance, to physical, occupational, and other therapists.

Depression & Parkinson's: One Man's Story

Jeff Mackey of Melrose, Fla., is one of the 50% of Parkinson's patients who knows all too well about depression.

The 60-year-old Episcopal priest was diagnosed with Parkinson's disease five years ago, after noticing a hand tremor first thought to be harmless.

He had struggled with mild depression starting in his teen years, he says. It was kept under control, sometimes with low doses of medication, he says.

But when his neurologist diagnosed Parkinson's, he also told Mackey the depression had gotten worse.

Mackey is now on a mood stabilizer and another drug for the depression. "My mood now is much higher; it's stable," he says. "I am able to kind of float above the depression."

Depression still brings him down a day or two a month -- much less than before, he says. "It's gone from almost constant to rare," he says.

Parkinson's Patients' Challenges: Perspectives

The study findings, especially those about depression, ring true with neurologists who treat people with Parkinson's.

"I am not surprised at all by the depression findings," says Michele Tagliati, MD, director of the movement disorders program at Cedars-Sinai Medical Center, Los Angeles. "It's something we see all the time," he says.

"The depression really colors the experience of these patients in a dramatic way," he says. "It's not the sadness of someone looking in the mirror [and saying, 'I have Parkinson's']. It is an integral part of the disease."

Others agree.

"There is a strong link between psychological symptoms and Parkinson's," says William Buxton, MD, medical director of neurodiagnostics at the UCLA Medical Center, Santa Monica, and associate clinical professor of neurology at the UCLA David Geffen School of Medicine.

"Many patients have generalized anxiety for a year or two before symptoms," he says, citing anecdotal and published reports.

The new report, he says, "reinforces what we know, that Parkinson's is not only a disease that just affects walking and motor function, but impacts a patient's sense of well-being and psychological state."

For patients, he says, "the message ... is to stay on top of how they are feeling emotionally" and to keep their doctors informed.

Recent News

Jul 14 - Cancer drug shows early promise for Parkinson's disease
Jul 13 - Opinion: Dividing the Caregiving Responsibilities Between Siblings
Jul 12 - Researchers make advance in possible treatments for Gaucher, Parkinson’s diseases
Jul 11 - Parkinson’s Head Trauma Link Looks Even Stronger
Jul 7 - Penn students’ start-up XEED puts wearables to work against Parkinson’s disease
Jul 5 - Last Patient Enrolled in Pivotal Phase 3 Parkinson’s Disease Trial, Cynapsus Therapeutics Says
Jun 29 - Exoskeleton Could Quell the Tremors of Parkinson's Disease Patients at Crucial Moments
Jun 28 - Parkinson's disease: New protein discovery could fuel new treatments
Jun 27 - Study finds direct evidence linking Parkinson’s to autoimmune disease; 2 genes that are key regulators of immune system discovered
Jun 27 - Blocking key enzyme halts parkinson's disease symptoms in mice
Jun 23 - Parkinson's Research Might Benefit from Novel Discovery of Zinc Transport Protein Structure
Jun 23 - Parkinson's disease breakthrough 'could lead to cure'
Jun 20 - More American men diagnosed with Parkinson's
Jun 15 - First monkey genetically engineered to have Parkinson’s created
Jun 14 - Fighting Parkinson's in the lab
Jun 9 - A New Gene Has Been Linked to Parkinson's Disease
Jun 6 - A neurologist weighs in on Muhammad Ali's battle with Parkinson's disease
Jun 5 - Michael J. Fox: How to honor Muhammad Ali
Jun 3 - Singing improves speech of people with Parkinson's, but more research needed
Jun 1 - San Diego Parkinson’s Research Sparks Ethical Discussion