Depression in Parkinson’s disease: why and what helps

Parkinson’s disease (PD) occurs when dopamine-producing cells in the brain die. Dopamine is a chemical that carries messages between nerve cells. This loss of dopamine causes motor (movement-related) symptoms like uncontrollable tremors and stiffness.

Dopamine depletion in PD is also associated with non-motor symptoms like the Depressiona serious mental health problem that negatively impacts the way you feel and think.

Alright / Paige McLaughlin


Depression is common in PD and is often an early (if not the first) symptom of the disease. If left untreated, depression can have a drastic negative effect on a patient’s quality of life and daily functioning.

This article discusses how depression develops in PD, including the role dopamine plays. You will also learn about the symptoms of depression in patients with PD and how doctors go about treating it.

How does depression work?

Depression is more than just a feeling of sadness. It is a common condition that interferes with your daily functioning, whether at home or at work.

Why depression occurs in some people and not in others remains unclear, although it’s likely that a combination of your DNA and environmental factors play a role.

An interesting theory relating to the development of depression in PD revolves around stress and dopamine, a neurotransmitter (chemical messenger).

We know that psychological stress activates your hypothalamic-pituitary-adrenal axis (HPA axis) and that depression is associated with an overactive HPA axis.

Activating the HPA axis triggers the release of cortisol, which leads to all sorts of inflammatory and hormonal changes in your body, including the possible decrease in dopamine production in your brain.

Since PD is also characterized by the loss of dopamine in the brain, experts believe that low dopamine levels due to early life stress can make a person more vulnerable not only to depression, but also possibly to the PM. Additionally, depression may be a risk factor for developing PD later in life.

Other Effects of Low Dopamine

Besides depression, low levels of dopamine can contribute to the development of certain personality traits in people with PD, such as rigidity or introversion.

Effect on patients with Parkinson’s disease

Depression affects approximately 40% of patients with PD, but its diagnosis is often missed. One reason for this is that the symptoms of PD and depression, such as lack of energy or trouble sleeping, often overlap.

Depression can also go unnoticed, as doctors spend most of their appointment time treating more obvious or “visible” physical/motor symptoms like problems with speech or walking.

Similarly, patients may be reluctant to discuss their feelings or emotions with their doctor. Perhaps they fear they will be a burden on their family or care partner or assume that their depressive symptoms cannot be resolved or are just part of their Parkinson’s disease.

Unfortunately, the unintended effect of not diagnosing and treating depression worsens disability and leads to poorer quality of life for patients with PD.

Other stress-related disorders

Besides depression, two other stress-related mental health problems associated with PD are anxiety and post-traumatic stress disorder (PTSD). Anxiety, in particular, is like depression in PD in that it is often an early but overlooked symptom.

Also, like depression, PTSD and anxiety are linked to brain changes associated with some form of psychological stress or emotional trauma. PTSD and anxiety have also been found separately to increase a person’s risk of developing PD.

Symptoms of depression in Parkinson’s disease

Symptoms of depression in PD can be difficult to distinguish from symptoms of PD itself.

For example, apathy, which is a lack of energy or interest in daily activities, is a symptom of various mental health disorders, including depression. Apathy is also common in patients with PD, whether or not they suffer from depression.

Fatigue is another common and debilitating symptom of PD that can also occur with depression. PD fatigue can make the underlying depression worse or vice versa, creating a vicious cycle that can be difficult to untangle and treat.

Overlapping symptoms

Other overlapping symptoms of PD and depression include difficulty concentrating, eating too little, and sleep problems.

To help screen for depression in patients with PD, doctors often focus on depressive symptoms that don’t normally occur in PD. Among them:

  • Sadness occurring for more than two weeks
  • Guilt
  • Inability to feel pleasure (anhedonia)
  • Feelings of worthlessness
  • Social withdrawal that is not the result of reduced mobility or speech problems

Coping with mental health

Once depression is diagnosed, treating it is key to feeling, functioning and living well with PD. The good news is that there are several treatment options.

Non-pharmacological treatments

Some patients with PD prefer to start with natural or non-pharmacological treatments or use them as complementary therapies to medications.

Some of those that can help with depression in PD include:

  • Cognitive-behavioral therapy has been shown to be a safe and effective therapy for patients with PD and depression. This type of therapy involves talking with a psychologist or therapist to help you change the way you think and act.
  • Socket fish oil with or without antidepressants may be helpful in patients with PD and depression, although more research is needed.
  • An intervention called repetitive transcranial magnetic stimulation (rTMS) has been found to improve depression in PD to a degree similar to taking an antidepressant.
  • Join a support group, virtually or in person, can also be beneficial. PD support groups have been found to help reduce stress, serve as a source of comfort, and improve quality of life.

Self-care

Managing depression and a disease that gets worse over time, like PD, requires care from healthcare professionals and care from within.

Here are some self-care strategies that can help you maintain your overall health and well-being:

  • Stay active, you could try yoga or tai chi.
  • Eat a balanced diet and maintain a healthy weight.
  • Take your medications on time to avoid making your symptoms worse.
  • Regularly practice deep breathing exercises or mindfulness meditation.
  • Practice self-compassion (allowing yourself to be imperfect).
  • Learn to set boundaries and boundaries.

Prescription treatments

The scientific data supporting the benefit of treating depression in PD with medication is still being explored.

The antidepressants with the best evidence include:

Interestingly, Mirapex (pramipexole), a dopamine agonist (a drug that mimics the effects of dopamine), has also been shown to reduce depressive symptoms in patients with PD.

If you and your doctor decide to try an antidepressant, the potential side effects of the drug, particularly as they relate to your underlying Parkinson’s disease, will be a deciding factor when deciding among the various options.

An SSRI is usually tried first, given its low side effect profile. Your doctor will monitor you closely, however, as there is concern that SSRIs may worsen a person’s motor symptoms.

keep in mind

As you sort through treatment options, try to remain patient and committed. You may need to go through a process of trial and error before landing on the single therapy (or combination of therapies) that works for you.

Help as Guardian or Ally

Whether you are a neighbor, friend, family member, or caregiver (or a combination) of someone with PD and depression, know that it is normal to feel helpless and overwhelmed by their condition and your relationship.

Even if you can’t “fix” what’s going on, there’s a lot you can do to provide comfort and support. Among them:

  • Organize a simple outing for coffee or a movie.
  • Prepare a homemade meal or bring their favorite snack or flower to show you are thinking of them.
  • Help with household chores (for example, grocery shopping or caring for pets).
  • Offer to drive them to therapy or doctor appointments.
  • Attend a support group meeting with them.

Summary

Depression is common in people with Parkinson’s disease and can be an early symptom of the disease. It may not be recognized because its symptoms may overlap those of PD. Treatment for depression in Parkinson’s disease may include talking therapy, support groups, self-care, and medication.

A word from Verywell

If you suspect that you or your loved one with PD has symptoms of depression, please contact your neurologist or primary care physician. Although a new diagnosis of depression can be frightening or upsetting, know that a good treatment plan can help manage the condition.

It’s also a good idea if you have PD to have your doctor screen you for depression, because you or your doctor may unwittingly attribute depressive symptoms to PD, stress, or something else.

Frequently Asked Questions


  • How common is depression in patients with Parkinson’s disease?

    Depression is found in approximately 40% of all patients with PD. Research suggests that only a small percentage of people (about 20%) receive treatment. That number may be higher now that more doctors have started screening their patients with PD for depression.


  • What is the relationship between dopamine and depression?

    Dopamine is a chemical in your brain linked to motivation and feelings of pleasure. Low dopamine levels may contribute to depression by making people less interested in engaging in reward-generating activities or goals.

    Parkinson’s disease is also associated with low levels of dopamine in the brain. Depression has been shown to increase the risk of developing Parkinson’s disease.


  • How can you support someone with Parkinson’s disease and depression?

    Supporting someone with Parkinson’s disease and depression can be difficult and can bring up personal feelings of vulnerability or helplessness.

    Start with small, simple steps, like helping with household chores or bringing coffee. Writing a card to let them know you’re thinking of them can also go a long way.

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