Barbara Patterson: Following is the complete text of the article by
O'Brien and Watt. It is scheduled to be issued in the Spring 1994
copy of the APDA Newsletter:
DEPRESSION IN PARKINSON'S DISEASE
Christopher F. O'Brien, MD, Director, Movement Disorders Center, Colo-
rado Neurological Institute, Director, APDA Information and Referral
Center, Englewood, CO.
Laura J. Watt, RN, Coordinator, APDA Information and Referral Center,
Englewood, CO.
One of the greatest challenges facing individuals with Parkinson's dis-
ease (PD) is the recognition and treatment of depression. This problem
exists because many of the signs of depression overlap with PD signs--
for example, slowness of movement, sleep difficulty and loss of initiative.
Depression is relatively common in the setting of PD. Some studies sug-
gest that 30-40% of those affected struggle at some point during the ill-
ness with this potentially disabling problem. Recognition is also difficult
because caretakers and health care providers may not be trained to rec-
ognize warning signs early, when treatment can be most effective.
There appear to be three main settings within which depression occ-
urs for parkinsonians
Reaction. It is quite common for someone newly diagnosed with PD or
for someone struggling with the frustration of chronic illness to feel anger,
grief and despair. While usually of short duration, these feelings can be
persistent and overwhelming. Perhaps more than in any other setting, the
PD support groups can help "turn the tide" and be the main resource for
such individuals.
Neurochemistry. Not surprisingly, the same brain chemistry changes
of PD may occur in depression in a slightly altered form. The main neuro-
transmitters in the brain that play a role in each condition are dopamine,
serotonin and norepinephrine. Medications which correct these chem-
ical alterations (just as the levodopa in Sinemet replenishes dopamine)
may result in more rapid resolution of sadness, insomnia, weight loss,
and other signs of depression. Interestingly, depression may be an early
sign of PD predating the motor symptoms several years. Treatment with
antidepressant medications must be supervised by someone knowledg-
able about PD as some medications have beneficial side effects while
others worsen parkinsonism. For example, amitriptyline (Elavil) and nor-
tripty
line (Pamelor) may decrease the parkinsonian tremor and aid sleep.
With these drugs, some people may experience worsening confusion.
Fluoxetine (Prozac) has worsened mobility on occasion and is not a first
choice therapy in PD. Fluoxetine (Prozac) and related medications (e.g.
Zoloft) may cause serious problems if combined with seligiline (Elde-
pryl). Tranylcrypromine (Parnate) and phenelzine (Nardil) cannot be
given with Sinemet due to risk of serious side effects.
Drugs. The many medications used in treating PD may have power-
ful effects on emotions. Fatigue, sleep disruption, agitation, memory dif-
ficulties and other symptoms may occur with too little or too much medi-
cation. Furthermore, commonly used drugs for high blood pressure,
sleeping pills, bladder control agents and many others may produce de-
pression, particularly in the elderly. Of course, drug interactions must be
monitored carefully and offending agents withdrawn under careful
supervision.
Despite the problems presented above, there is good news--treatment
works. Education, addition, removal or adjustment of medication, couns-
eling and support services can result in gratifying resolution of depres-
sion. Often a short course of antidepressant medication, with or without
talk therapy, is all that is needed for a return to active and pleasurable
participation in life. Remember, dedicated researchers continue to un-
ravel the biochemical and psychological basis of depression in PD. You
have an important job--stay informed, read the PD literature, participate
in clinical research, utilize the APDA Information and Referral Centers,
Chapters and Support Groups resources and play an active role in your
treatment.
(Reprinted in its entirety with the permission of The American Parkinson
Disease Association, Inc., 60 Bay Street, Staten Island, New York 10301)
Gaylord Rough ([log in to unmask]). 607-587-9161.
