Depression Requires Recognition & Treatment

DEPRESSION REQUIRES RECOGNITION & TREATMENT

by Jim Messerschmidt, LCSW

Depression can strike anyone, but those with Parkinson's disease appear to be at greater risk. The prevalence of depression among those with Parkinson's is difficult to determine since there is no "quick and easy" tool designed to assess depressive within the context of Parkinson's disease.

Studies indicate that 40-90% of those with Parkinson's may suffer from depression.  Although there have been enormous advances in brain research the past 20 years, depression in Parkinson's continues to under-recognized, undiagnosed, and ineffectively treated.  Depression can happen at any stage and can appear even before the physical symptoms of Parkinson's appear. For this reason it generally believed to be part of the illness and not only a "to a potentially disabling and chronic illness. Chemical changes the brain that are a part of Parkinson's may lead to a form of depression.

Diagnosing depression in Parkinson's can be challenging because symptoms of depression may overlap with those of Parkinson's and other physical illnesses. Many people with Parkinson's have weight loss, sleep disturbance, a sense of lethargy and a lack of interest in pleasurable or meaningful activities. But people with depression who have Parkinson's disease have a different symptom profile than those without Parkinson's. The Parkinson's profile includes higher rates of anxiety, sadness without guilt or self-blame, pessimism, irritability, and lower suicide rates despite higher rates of suicidal thoughts. Treating depression can help people feel better and cope better with their Parkinson's treatment. For some, a combination of a positive attitude, support, and education about Parkinson's can be helpful in managing the disease. Yet for many others, "pulling oneself up by one's bootstraps" is simply not enough, in the same way that one cannot rid oneself of diabetes by thinking happy thoughts. Some people may benefit from a combination of psychotherapy or counseling and antidepressant medication. Psychotherapy can focus on strategies to identify vulnerable times, stress reduction, breaking the spiral of negative self-defeating thoughts, and coping with change and loss. Prescription antidepressant medications are generally well tolerated and safe for those with Parkinson's. The need and choice of medication is best individualized based on the individual's mood disorder, physical and emotional status, consideration of current medication taken, and concurrent medical conditions. Treatment for depression should be managed by a mental health professional (psychiatrist, psychologist or clinical social worker) who maintains close communication with the primary physician providing Parkinson's treatment. Recovering from depression will take time. Antidepressant medication may take several weeks to "kick in" and reach its full effect. Dosing may need to be adjusted and alternate medication may need to be prescribed. Nevertheless, treatment for depression helps people manage both diseases better, thereby improving the quality of life.

Jim Messerschmidt is a Licensed Clinical Social Worker (LCSW) and Director of Community Relations at the Wealshire, a long term care facility in Lincolnshire, Illinois.

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