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/