Dear Listfriends,
Dr. Lieberman has requested that the following text be passed on. The
website for NPF is:
http://www.parkinson.org/
===============

Depression and Anxiety in Parkinson's Disease-Under-recognized Symptoms

        Depression is present in approximately 40% of Parkinson's
disease
(PD) patients. It's usually an integral or intrinsic part of PD,
unrelated
to the degree, duration, or severity of the accompanying physical
symptoms.
In 20% of PD patients who are depressed, the depression precedes the
onset
of physical symptoms. Obviously, this is something appreciated only in
retrospect-after the patient's been diagnosed with PD.
In addition to an integral, intrinsic, or endogenous depression, PD
patients may suffer from an exogenous depression, a depression related
to external or outside events such as job loss, retirement, or knowledge
of a relative or friend with advanced PD with fear of becoming as
disabled as the relative or friend with advanced PD.
      Spouses and care-givers of PD also become depressed.
       In many PD patients depression is associated with anxiety. In
some of these patients the anxiety is overwhelming and may result in an
agitated depression. Anxiety may be accompanied by feelings of
light-headidness, dizziness, increased sweating, a pounding or racing
heart. In many of these patients it's difficult to tell whether the
symptoms are related to anxiety or something else. Thus a PD patient
experiencing dizziness, shortness of breath, and tightness of his
chest-may be having a heart attack-or an anxiety attack.
      In some patients, PD is complicated by impairment of the autonomic
nervous system symptoms. The autonomic nervous system controls or
regulates activities such as blood pressure, heart rate, breathing,
swallowing, bowel movements, and bladder function. Some PD patients with
an impaired autonomic nervous system may complain of symptoms such as
light-headidness, dizziness, increased sweating, a pounding or racing
heart. In many of these patients it's difficult to tell whether the
symptoms are related to impairment of the autonomic nervous system,
anxiety--or something else.
      In some patients PD is complicated by a sleep disorder. The
patient
may have trouble falling asleep, or after they fall asleep they may
trouble remaining asleep. In some patients the drugs they're taking for
Parkinson disease may cause they to have trouble falling asleep, or
after they fall asleep cause them to have trouble remaining asleep. Many
depressed patients and many anxious patients have trouble falling asleep
or after they fall asleep they have trouble remaining asleep. In these
patients it's difficult to tell whether the symptoms are related to the
sleep disorder or some of their drugs.
      In some patients PD is complicated by selective intellectual (or
cognitive) impairment. Patients may have difficulty completing tasks
they
previously performed effortlessly. Thus patients may have difficulty
balancing a check-book, completing a cross-word puzzle or playing cards.
Many depressed patients and many anxious patients may also have
difficulty
balancing a check-book, completing a cross-word puzzle or playing
card-they just can't concentrate. In these patients it's often difficult
to distinguish these symptoms from symptoms associated with selective
intellectual or cognitive impairment.
      In some patients PD is complicated by combinations of autonomic
nervous system impairment, a sleep disorder, and selective intellectual
impairment. In such patients it may be difficult to diagnose depression
and anxiety. Some PD patients, perhaps 20%, suffer from a syndrome, a
symptom complex consisting of ANERGIA (lack of energy, perpetual
tiredness or fatigue), ANHEDONIA (an inability to receive or experience
pleasure from activities from whom they previously received or
experienced pleasure), APATHY, and PASSIVITY. Although these symptoms
resemble symptoms of depression, these patients DENY they're depressed.
Moreover, when questioned closely, they deny their symptom complex of
anergia, anhedonia, apathy, and passivity are accompanied by feelings
that traditionally accompany depression such as gloom, guilt,
hopelessness, pessimism, remorse, or sadness. These patients
are usually not anxious. The symptoms complex of anergia, anhedonia,
apathy and passivity which is separate from depression probably has a
different basis than depression. This symptom complex does not usually
respond to conventional treatments for depression.
      A patient reading the above may be bewildered. How does one
distinguish among depression, anxiety, autonomic nervous system
impairment, sleep disorders, drug effects, selective intellectual
impairment, and the sym ptom complex of anergia, anhedonia, apathy, and
passivity? Indeed, are they distinct? A doctor trained in Parkinson
disease can attempt to distinguish among these disorders. As with
everything we need more information.
       To determine the prevalence of depression and anxiety the
National
Parkinson Foundation created a Depression/ Anxiety Questionnaire as part
of "askthedoctor." The responses to the Depression/Anxiety Questionnaire
is confidental - they're not publically posted-only Dr. Lieberman reads
them.

Hundreds of patients have completed the Questionnaires for Tremor and
Parkinson Disease--few have completed the Depression/Anxiety
Questionnaire.
Why?

1. The information in the Depression/Anxiety Questionnaire is too
sensitive?
Patients and care-givers are afraid of completing them.
2. Patients and care-givers are in denial-they won't acknowledge they're
depressed or anxious.
3. Depression and anxiety aren't as prevalent as we think.
4. It's none of  your business.

We welcome your comments. Remember it's your disease-the more we know
about it-the sooner we'll cure it.


Copyright © 1996-99 The National Parkinson Foundation, Inc.
--
Kathrynne Holden, MS, RD
Medical nutrition therapy for Parkinson's disease
Author: "Eat well, stay well with Parkinson's disease"
"Parkinson's disease: assessing and managing unique nutrition needs;"
"Risk for malnutrition and bone fracture in Parkinson'sdisease,"
J Nutr Elderly. V18:3;1999.
http://www.nutritionucanlivewith.com/