Depression is a common psychological symptom of Parkinson's disease, occurring in 40% to 50% of patients with Parkinson's Disease. (Murray, 1996) It is the most common psychological problem occurring with ParkinsonÕs. Depression is seen more often in Parkinsonian patients than in patients with similarly chronic, debilitating diseases, suggesting that it may have a biochemical cause in addition to a psychological cause.
Characteristics
The following are characteristics of depression. (Mayberg, 1995) For diagnosis, the DSM IIIR requires that five of the symptoms must be present and that one of them must be depressed mood.
- Depressed mood (anhedonia)
- Significant Weight Change
- Insomnia or Hypersomnia
- Psychomotor Retardation
- Fatigue or Loss of Energy
- Feelings of Worthlessness or Inappropriate Guilt
- Decreased Concentration and Indecisiveness
- Recurring Thoughts of Death or Suicide
Depressed patients are unable to experience pleasure and lose appetite for food or sex. Pacing and crying are two behavioral symptoms of depression. Constipation and decreased salivation are two physiological effects of depression. (Carlson, 1998) 67% of those who have had a depressive disorder also have had an anxiety disorder.
Causes
There are many variables in patients with ParkinsonÕs disease that have been found to be related to severity or existence of depression. It has proved difficult to determine whether the depression is responsible for these factors or these factors are causing the depression. The following are some factors that have been found to be correlated with amount of depression in Parkinsonian patients:
- Early onset of disease
- Duration of disease
- Cognitive impairment (especially in frontal lobe related tasks)
- Inability to participate in normal activities
- Inability to develop effective coping strategies
- Lack of social support
- More severe symptoms on right side of body in comparison with the left side
Most of these factors make psychological sense; the worse the disability is, and the more deleterious the effects it has on oneÕs life, the more intense the depression will be. However, the last factor is hard to account for when considering psychological factors alone. This, and the fact that Parkinsonian patients experience depression of a greater intensity than similarly devastating conditions, suggest that there is a physiological root to the depression in addition to a psychological one. Depression often pre-dates recognizable motor symptoms by several years. (Mayberg,1995)
Recent research has suggested what this physiological cause may be. Abnormal activity of the neurotransmitter serotonin has been implicated as a villain in the depression found in patients with ParkinsonÕs. Research has found that patients with ParkinsonÕs and depression have lower serotonin levels in brain, lower levels of certain metabolites of serotonin (5-hydroxyindoleacetic acid), and less serotonin binding sites in comparison to patients with ParkinsonÕs who are not depressed.
Levodopa levels have not been found to correlate with depression in Parkinsonian patients. Degeneration of dopamine-secreting neurons in the ventral tegmental area has been found to correlate with depressive symptoms. Dopamine appears only to play a minor role in depression in ParkinsonÕs disease.
Treatments
- Serotonin precursors have been found to alleviate depression in some patients with ParkinsonÕs
- Tricyclic Antidepressant medications
- Selective Serotonin Reuptake Inhibitors (SSRIÕs)
increase serotonin activity by blocking the retrieval of serotonin after it is released by the neurons
- Electroconvulsive Therapy (ECT) relieves depression and improves other symptoms of the disease. It has been suggested that its effectiveness is multiplied by dopamine agonists
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The following are characteristics of depression. (Mayberg, 1995) For diagnosis, the DSM IIIR requires that five of the symptoms must be present and that one of them must be depressed mood.
- Depressed mood (anhedonia)
- Significant Weight Change
- Insomnia or Hypersomnia
- Psychomotor Retardation
- Fatigue or Loss of Energy
- Feelings of Worthlessness or Inappropriate Guilt
- Decreased Concentration and Indecisiveness
- Recurring Thoughts of Death or Suicide
Depressed patients are unable to experience pleasure and lose appetite for food or sex. Pacing and crying are two behavioral symptoms of depression. Constipation and decreased salivation are two physiological effects of depression. (Carlson, 1998) 67% of those who have had a depressive disorder also have had an anxiety disorder.
Causes
There are many variables in patients with ParkinsonÕs disease that have been found to be related to severity or existence of depression. It has proved difficult to determine whether the depression is responsible for these factors or these factors are causing the depression. The following are some factors that have been found to be correlated with amount of depression in Parkinsonian patients:
- Early onset of disease
- Duration of disease
- Cognitive impairment (especially in frontal lobe related tasks)
- Inability to participate in normal activities
- Inability to develop effective coping strategies
- Lack of social support
- More severe symptoms on right side of body in comparison with the left side
Most of these factors make psychological sense; the worse the disability is, and the more deleterious the effects it has on oneÕs life, the more intense the depression will be. However, the last factor is hard to account for when considering psychological factors alone. This, and the fact that Parkinsonian patients experience depression of a greater intensity than similarly devastating conditions, suggest that there is a physiological root to the depression in addition to a psychological one. Depression often pre-dates recognizable motor symptoms by several years. (Mayberg,1995)
Recent research has suggested what this physiological cause may be. Abnormal activity of the neurotransmitter serotonin has been implicated as a villain in the depression found in patients with ParkinsonÕs. Research has found that patients with ParkinsonÕs and depression have lower serotonin levels in brain, lower levels of certain metabolites of serotonin (5-hydroxyindoleacetic acid), and less serotonin binding sites in comparison to patients with ParkinsonÕs who are not depressed.
Levodopa levels have not been found to correlate with depression in Parkinsonian patients. Degeneration of dopamine-secreting neurons in the ventral tegmental area has been found to correlate with depressive symptoms. Dopamine appears only to play a minor role in depression in ParkinsonÕs disease.
Treatments
- Serotonin precursors have been found to alleviate depression in some patients with ParkinsonÕs
- Tricyclic Antidepressant medications
- Selective Serotonin Reuptake Inhibitors (SSRIÕs)
increase serotonin activity by blocking the retrieval of serotonin after it is released by the neurons
- Electroconvulsive Therapy (ECT) relieves depression and improves other symptoms of the disease. It has been suggested that its effectiveness is multiplied by dopamine agonists
Back to Home Page
Back to Psychology
There are many variables in patients with ParkinsonÕs disease that have been found to be related to severity or existence of depression. It has proved difficult to determine whether the depression is responsible for these factors or these factors are causing the depression. The following are some factors that have been found to be correlated with amount of depression in Parkinsonian patients:
- Early onset of disease
- Duration of disease
- Cognitive impairment (especially in frontal lobe related tasks)
- Inability to participate in normal activities
- Inability to develop effective coping strategies
- Lack of social support
- More severe symptoms on right side of body in comparison with the left side
Most of these factors make psychological sense; the worse the disability is, and the more deleterious the effects it has on oneÕs life, the more intense the depression will be. However, the last factor is hard to account for when considering psychological factors alone. This, and the fact that Parkinsonian patients experience depression of a greater intensity than similarly devastating conditions, suggest that there is a physiological root to the depression in addition to a psychological one. Depression often pre-dates recognizable motor symptoms by several years. (Mayberg,1995)
Recent research has suggested what this physiological cause may be. Abnormal activity of the neurotransmitter serotonin has been implicated as a villain in the depression found in patients with ParkinsonÕs. Research has found that patients with ParkinsonÕs and depression have lower serotonin levels in brain, lower levels of certain metabolites of serotonin (5-hydroxyindoleacetic acid), and less serotonin binding sites in comparison to patients with ParkinsonÕs who are not depressed.
Levodopa levels have not been found to correlate with depression in Parkinsonian patients. Degeneration of dopamine-secreting neurons in the ventral tegmental area has been found to correlate with depressive symptoms. Dopamine appears only to play a minor role in depression in ParkinsonÕs disease.
Treatments
- Serotonin precursors have been found to alleviate depression in some patients with ParkinsonÕs
- Tricyclic Antidepressant medications
- Selective Serotonin Reuptake Inhibitors (SSRIÕs)
increase serotonin activity by blocking the retrieval of serotonin after it is released by the neurons
- Electroconvulsive Therapy (ECT) relieves depression and improves other symptoms of the disease. It has been suggested that its effectiveness is multiplied by dopamine agonists
Back to Home Page
Back to Psychology
- Serotonin precursors have been found to alleviate depression in some patients with ParkinsonÕs
- Tricyclic Antidepressant medications
- Selective Serotonin Reuptake Inhibitors (SSRIÕs)
increase serotonin activity by blocking the retrieval of serotonin after it is released by the neurons
- Electroconvulsive Therapy (ECT) relieves depression and improves other symptoms of the disease. It has been suggested that its effectiveness is multiplied by dopamine agonists
Back to Home Page
Back to Psychology