Living with Parkinson’s disease can stir up a range of emotions. From receiving a diagnosis to managing the chronic symptoms of PD, it’s normal to experience impacts on your mental health.

Depression, in particular, is a common non-motor symptom of Parkinson’s disease. Unfortunately, it is still largely unacknowledged and untreated despite occurring in roughly 50% of people with PD.

There is plenty of hope on the horizon, though! Armed with the right information and resources, you can manage and significantly reduce symptoms of depression.

Here are the causes and symptoms of depression for people living with PD and the next steps for treatment and management.

Depression vs. Sadness

It’s important to note that it’s common for people to feel sad now and then. You may experience sadness from time to time due to personal circumstances or general changes in mood.

Depression, however, is different. While sadness is temporary, depression may drag on for weeks to months. It’s not just circumstantial — it’s a direct side-effect of Parkinson’s disease, stemming from actual changes to brain chemistry.

Just like other symptoms of PD, depression may manifest differently from person to person. While one person may struggle with sleep, another may become more irritable. It’s an individual experience, but knowing the symptoms is an essential first step in identification and diagnosis.

Causes of Depression in PD

The links between Parkinson’s and depression involve various biological, psychological, and social factors.

Here are the main factors that play a role in depression for people with PD.

Neurological Links

Parkinson’s disease primarily affects the neurons in the brain that produce dopamine, a neurotransmitter crucial for both movement and mood regulation.

The progressive loss of these dopamine-producing neurons can lead to an imbalance in brain chemicals — specifically neurotransmitter levels, not just of dopamine but also of serotonin and norepinephrine, which are directly linked to mood and commonly associated with depression.

Inflammatory Processes

Research has shown inflammation and the immune response may play a role in Parkinson’s disease and depression.

Chronic inflammation, oxidative stress, and subsequent neuronal damage are common features of Parkinson’s disease and may also be involved in the pathophysiology of severe depression. This suggests a potential common biological mechanism underlying both conditions.

Genetic Factors

There’s evidence to suggest certain genetic factors may predispose individuals to both Parkinson’s disease and depression. While the genetic links are unclear, certain genetic variations might increase the risk for both conditions, indicating a potential shared genetic susceptibility.

Social and Psychological Factors

Living with a chronic, progressive neurological disorder like Parkinson’s disease can have a significant psychological impact.

People living with PD often experience worry, fear, or hopelessness about their future and the possibility of progressive motor function loss. Thoughts surrounding the potential gradual loss of independence and daily functioning can also contribute to a decreased sense of self-worth and increased vulnerability to depression.

Medication Side Effects

Some people with Parkinson’s may experience depression as a side-effect of their Parkinson’s medications.

Likewise, some medications might have mood-elevating effects. The complex interplay of various medications and their impact on a person’s neurochemistry can play a role in the development of depression.

Symptoms of Depression

Depression in people with Parkinson’s disease manifests with symptoms similar to those experienced by individuals with depression who do not have PD. Still, there can be nuances due to the overlapping symptoms of both conditions.

Here are the common symptoms of depression in people with PD:

• Persistent Sadness or Low Mood: Continuous feelings of sadness, emptiness, or hopelessness may be more pronounced in individuals with PD due to their chronic health condition.
• Loss of Interest or Pleasure: Diminished interest in activities once enjoyed, including socializing, hobbies, or sexual activity. This symptom, known as anhedonia, can be particularly impactful for individuals with PD, who may already be experiencing a reduced ability to engage in activities due to physical limitations.
• Fatigue or Loss of Energy: Individuals may feel physically drained or mentally tired, which can be compounded by the energy it takes for those with PD to manage their motor symptoms and perform daily activities.
• Change in Appetite or Weight: Unintentional weight loss or gain, or changes in appetite, often a decrease in appetite. These changes can be complicated by difficulties in eating due to PD-related motor symptoms.
• Sleep Disturbances: Insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleepiness). Sleep problems are also common in PD due to other symptoms like restless legs or nighttime movements, so it can be hard to distinguish whether they’re related to depression or PD.
• Feelings of Worthlessness or Guilt: Individuals may experience harsh self-criticism or excessive guilt over past actions, compounded by a sense of guilt or burden due to their illness.
• Difficulty with Concentration or Decision-making: Trouble focusing, remembering things, or making decisions is common in depression and can be exacerbated in PD, especially in those experiencing cognitive decline.
• Slowed Thinking or Physical Movements: Depression may cause individuals to think and move slower than usual. This symptom can be particularly challenging to identify in people with PD, as slowness of movement, or bradykinesia, is a primary symptom of the disease itself.
• Suicidal Thoughts or Behaviors: Thoughts of death, suicide, or suicide attempts. These thoughts require immediate attention and intervention.
• Anxiety: It’s common for depression to co-occur with anxiety, presenting as excessive worrying, nervousness, or agitation.
• Physical Symptoms: Sometimes, depression can manifest as physical pain or discomfort, headaches, or digestive problems that don’t ease even with treatment.

Managing & Treating Depression in PD

The first step to managing depression with Parkinson’s disease is talking to your healthcare provider. A doctor helps navigate a depression diagnosis by asking detailed questions about changes in your mood and symptoms.

While it’s becoming more common for doctors to ask about depression symptoms, know it is never a sign of weakness to bring it up yourself.

Depression in Parkinson’s disease is often underdiagnosed and undertreated. The overlap of some physical Parkinson’s symptoms (like fatigue and slowness of movement) can make it challenging to distinguish depression from the progression of PD itself. That’s why having these conversations with your doctor is essential so they can assign the proper treatment as quickly as possible.

Further, there are a variety of ways to treat depression depending on your individual experience. Because depression manifests differently from person to person, treatment options vary and can include the following:

Physical Activity

Research shows regular physical activity helps reduce symptoms of depression. Exercise can be particularly beneficial for individuals with PD, as it also helps with mobility and motor symptoms. Activities like Tai Chi, yoga, and dance are popular and impactful options.

Medication

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are often the first line of treatment because they tend to have fewer side effects. They’re also generally safer for older adults and people with chronic conditions.

Sometimes, adjusting the medications used to treat Parkinson’s may help improve mood, particularly if the medications are contributing to depression. It’s also crucial to monitor for interactions between antidepressants and PD medications, as some combinations can cause complications.

Psychotherapy

Psychotherapy is a broad term encompassing various counseling or talk therapy options.

A particularly effective therapy option is Cognitive Behavioral Therapy (CBT), which helps people identify negative thought patterns and teaches strategies to challenge and change these thoughts and behaviors.

Support Groups and Social Support

Engaging with peers who face similar challenges can be incredibly therapeutic. Support groups, whether in person or online, provide a platform for sharing experiences, learning from others, and receiving emotional support.

Strengthening personal relationships and maintaining social activities can also help alleviate feelings of isolation and depression.

Lifestyle Modifications

Ensuring a healthy diet, regular sleep patterns, and reducing alcohol intake can positively affect mental health.

Mindfulness meditation and relaxation techniques can also help manage stress and reduce depressive symptoms.

Neuromodulation Therapies

Treatments like electroconvulsive therapy (ECT) may be considered for severe, treatment-resistant depression. However, doctors typically reserve these for cases where medication and therapy haven’t been successful, and their use in people with PD requires careful consideration.

Each treatment plan should be individualized, considering the severity of the depression, the stage of Parkinson’s disease, the person’s overall physical health, and personal preferences. Ongoing communication with healthcare providers is crucial to monitor and adjust treatment as necessary.

Coping with Depression & PD

Depression is a common symptom of Parkinson’s disease, but that doesn’t mean you should endure it alone.

There are many effective ways to manage Parkinson’s-related depression. Many people living with PD have found success in countering depression through medication, exercise, and lifestyle changes as directed by a doctor.

Check out PCLA’s support groups and programs for more resources on managing depression with PD. We have some great options for in-person and virtual support groups and regular virtual events covering various topics, including mental health and Parkinson’s disease