At 00:16 20-9-98 -0400, you wrote:
>My father (Innsbruck) is having a LOT of trouble with his drugs and
>ANXIETY. Any advice?
Anxiety may be a symptome of PD, like depression. It may also be a
side effect of dopamine. To learn which of these causes your fathers
anxiety, questions like: does he suffer more anxiety when on than when
off and did he suffer from anxiety before he started to use sinemet, have
to be answered. Because most anti-anxiety meds also influence
PD-symptoms, one needs a neuro who is willing to pay much attention
adjusting the meds in such a way that
your fathers needs are met.
I agree with the advise of someone else to ask the neuro to try
clozapine, but other meds may be tried allso. I add to this some other
possibilities, mentioned in an abstract from the
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NPF REPORT
VOLUME XVI - ISSUE III / 3RD QUARTER, 1995
Anxiety and Parkinson's Disease
By Irene Hegeman Richard, M.D., and Roger Kurlan, M.D., Department of
Neurology, University of
Rochester Medical Center, a National Parkinson Foundation Center of
Excellence
The frequency of anxiety disorders in PD is greater than that which would
be expected for an older-age population . Anxiety usually appears after
the diagnosis of Parkinson's disease but can also develop prior to the
slowness and tremor associated with PD . This suggests that anxiety may
not merely represent psychological difficulties adapting to the illness,
but rather is linked to specific neurobiological processes occurring in
PD. It is even possible that anxiety may represent the first sign of the
illness for some PD patients. Whether antiparkinsonian medications
themselves contribute to anxiety needs to be clarified.
There appears to be a strong relationship between movement difficulties
and anxiety. Most patients with "on-off" fluctuations experience greater
anxiety during the "off" phase (when they are slower and more rigid) . It
remains unclear whether anxiety is an emotional reaction to difficulties
with movement, whether anxiety might worsen these movement difficulties
or whether both anxiety and poor mobility occur together as the result of
common neurochemical mechanisms in the brain.
Anxiety and depression frequently co-exist in PD . It remains to be
determined whether this represents a particular subtype of depression or
whether anxiety occurs as a separate psychatric disturbance. The
association between depression and panic disorder is common in PD
patient, yet is rare in the general older-age population and suggests a
unique relationship in the setting of Parkinson's disease.
There are a number of biological possibilities for the association
between anxiety and PD. Thusfar, a disturbance of a chemical in the brain
called norepinephrine has the most support
The optimal therapy for anxiety in PD patients has not been established
but would likely depend on the nature of the anxiety disorder. Many of
the anxiety disorders improve with antidepressant medications (whether or
not depression is also present). Mild tranquilizers (e.g., diazepam
[Valium], lorazepam [Ativan], aprazolam [Xanax]) may be helpful.
Antidepressant medications that selectively inhibit the re-uptake of the
brain neurochemical serotonin (e.g., fluoxetine [Prozacl, sertraline )
may be particularly beneficial for obsessive-compulsive symptoms, but
these medications may also worsen the
symptoms of Parkinson's disease in some patients [121. Physicians taking
care of PD patients must also choose medications carefully since some
anti-PD medications cannot be safely mixed with some anti-anxiety
medications.
In conclusion, anxiety affects many people with PD and probably reflects
some underlying changes in brain chemistry. Patients should discuss
anxiety symptoms with their doctors because once recognized, the anxiety
can often be effectively treated.
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Hopefully this will help,
Ida Kamphuis
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Vriendelijke Groeten / Kind regards,
Ida Kamphuis mailto: [log in to unmask]
