When we think of Parkinson’s disease, we think of the motor symptoms, of course. But, the “non-motor symptoms” of Parkinson’s disease are also very important, e.g., depression, anxiety, cognitive impairment, apathy, psychosis.
Why this is important
The topic of depression in Parkinson’s disease is very important because (Timmer et al., 2017):
– Depression is very common in these patients
– It greatly affects the quality of life of these patients—and of their caregivers.
– Unfortunately, it often goes undiagnosed and untreated.
How common is it?
The prevalence of depression in persons with Parkinson’s disease differs from study to study and varies depending on whether the study is done in the community or in a specialty clinic. But, here are two statistics that give us at least some idea of how common depression is in persons with Parkinson’s disease (Timmer et al., 2017):
– About one-third have clinically-significant depression
– About 10% to 20% have major depression
When is depression more likely to be seen?
There tend to be periods in the course of Parkinson’s disease when depressive symptoms are more likely to appear. These are two opposite ends, both of which are understandable:
1. Early on—when the impairments first appear and the diagnosis is made.
2. Late in the course of the illness—when the illness has progressed and the symptoms and impairments are more severe.
Tips on diagnosis
Like I said above, even clinically-significant depression often goes undiagnosed and treated in persons with Parkinson’s disease. Let’s resolve to do something about this!
The problem: Many of the symptoms of depressive disorders can also occur in Parkinson’s disease. For example, reduced facial expressions, fatigue, weight loss, psychomotor slowing, impaired sleep, early morning awakening, impaired cognition, decreased speech, sexual difficulties, etc. Also, the masked face that many persons with Parkinson’s disease have makes it harder to identify a depressed affect (Timmer et al., 2017).
Keep it in mind: When evaluating a person with Parkinson’s disease, the possibility of depression should always be kept in mind, especially if there are some symptoms that seem unexpected or out of place (Timmer et al., 2017; Lattoo et al., 2012).
Past or family history? We should ask about a past history of depressive disorder (before the symptoms of Parkinson’s disease became apparent), and about a family history of mood disorders. Both of these make it more likely that the person with Parkinson’s disease will develop depressive symptoms.
Focus on the emotional symptoms: To decide whether or not the person with Parkinson’s disease has a depressive disorder, we should focus mainly on the emotional symptoms, These patients can present with either depressed or dysphoric/ irritable mood (Agüera-Ortiz et al., 2021).
Anhedonia may or may not indicate depression: Diagnostically, we should be careful to note that, in persons with Parkison’s disease, anhedonia can be present even without a depressive syndrome (Agüera-Ortiz et al., 2021).
Also focus on the negative cognitions: The presence of ideas of hopelessness, worthlessness, self-blame, and suicide can help identify depression in these patients.
Depression versus apathy: Persons with Parkinson’s disease may also have apathy but this is not the same as depression. The difference is that a person with apathy doesn’t care and isn’t suffering as much, while the person with depression has a high degree of suffering (Timmer et al., 2017).
Next, please see the following article on this website:
How should depression be treated in persons with Parkinson’s disease?
Related Pages
How should depression be treated in persons with Parkinson’s disease?
Pramipexole for depression in Parkinson’s disease?
MAO-B inhibitors and antidepressants
Parkinson’s disease psychosis: Introduction
Clinical tips on managing Parkinson’s disease psychosis
Pimavanserin (Nuplazid®): Efficacy for Parkinson’s disease psychosis
Punding in Parkinson’s disease: An overview
References
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Rating scales
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Treatment
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