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©2015 Davis Phinney Foundation

The Victory Summit® – San Antonio, TX | November 14, 2015 1

Navigating Mood & Depression in Parkinson’s Disease

Navigating Mood & Depression in Parkinson’s Disease

Walt N. Mercer, Ph.D.Ursula Alford, M.S., M.A.Walt N. Mercer, Ph.D.Ursula Alford, M.S., M.A.



Depression and Parkinson’sDepression and Parkinson’sWhy is this important to YOU?• Patients rank depression as

2nd greatest negative impact to overall function (Weintraub et al., 2004)

• Depression in Parkinson’s is the single best predictor of patient perception of quality of life (Kadastik et al., 2015)

Why is this important to YOU?• Patients rank depression as

2nd greatest negative impact to overall function (Weintraub et al., 2004)

• Depression in Parkinson’s is the single best predictor of patient perception of quality of life (Kadastik et al., 2015)



Depression and Parkinson’sDepression and Parkinson’sWhy is this important to YOU?• An estimated 40 – 49% of Parkinson’s patients

have depression (Chaudhuri et al., 2010; Koerts et al., 2008)

• Depression in Parkinson’s frequently goes undiagnosed (Dyduch & Zaluska, 2015)

• Risk factors include past history of depression, younger age of onset, and more functional decline

Why is this important to YOU?• An estimated 40 – 49% of Parkinson’s patients

have depression (Chaudhuri et al., 2010; Koerts et al., 2008)

• Depression in Parkinson’s frequently goes undiagnosed (Dyduch & Zaluska, 2015)

• Risk factors include past history of depression, younger age of onset, and more functional decline



Definition of DepressionDefinition of DepressionSymptoms:• Depressed mood

• Decreased interest or pleasure in most or all activities

• Significant weight loss or gain

• Changes in sleep (too much or too little)

Symptoms:• Depressed mood

• Decreased interest or pleasure in most or all activities

• Significant weight loss or gain

• Changes in sleep (too much or too little)



Definition of Depression Definition of Depression Symptoms:• Changes in physical activity

(slowing of activity or increased restlessness:pacing, fidgeting)

• Decreased energy/ fatigue

• Excessive feelings of guilt or worthlessness

Symptoms:• Changes in physical activity

(slowing of activity or increased restlessness:pacing, fidgeting)

• Decreased energy/ fatigue

• Excessive feelings of guilt or worthlessness



What can YOU do?What can YOU do?• Focus on your OVERALL health,

not just physical symptoms

• Consider physical symptoms you may be experiencing and possible relationship to depression

• If you think you might be depressed, do not ignore it! Talk to your doctor!

• Focus on your OVERALL health, not just physical symptoms

• Consider physical symptoms you may be experiencing and possible relationship to depression

• If you think you might be depressed, do not ignore it! Talk to your doctor!



• Decreased production of brain chemicals(neuro transmitters)

• Coping reaction to disease

• Changes in roles and support network

• Decreased production of brain chemicals(neuro transmitters)

• Coping reaction to disease

• Changes in roles and support network

Causes of Depression in PDCauses of Depression in PD



When Should You Seek Help?When Should You Seek Help?When symptoms begin to interfere with your daily life

– Irrational fear or worry– Internal agitation– Repetitive concern (rumination)– Loss of sleep– Change in appetite– Loss of concentration due to worry– Shakiness

When symptoms begin to interfere with your daily life– Irrational fear or worry– Internal agitation– Repetitive concern (rumination)– Loss of sleep– Change in appetite– Loss of concentration due to worry– Shakiness



When Should You Seek Help?When Should You Seek Help?When you feel like this for most of the time:

– Sadness– Loss of interest / inability to feel pleasure– Fatigue– Change in appetite / sleep– Hoplessness / worthlessness / guilt– Thoughts of suicide– Agitation or slowness of movement / thought

When you feel like this for most of the time:– Sadness– Loss of interest / inability to feel pleasure– Fatigue– Change in appetite / sleep– Hoplessness / worthlessness / guilt– Thoughts of suicide– Agitation or slowness of movement / thought



Warning Signs for Serious Suicidal ThoughtsWarning Signs for Serious Suicidal Thoughts

• Talking about death and dying often• Thinking about methods of suicide• Acquiring guns, pills, etc.• Planning for your death• Giving away precious things• Thinking or saying “I wish I wouldn’t wake up”National Suicide Hotline: (800) 237-TALK (8255)

• Talking about death and dying often• Thinking about methods of suicide• Acquiring guns, pills, etc.• Planning for your death• Giving away precious things• Thinking or saying “I wish I wouldn’t wake up”National Suicide Hotline: (800) 237-TALK (8255)



Treatment of Depression in PDTreatment of Depression in PDPharmacotherapyPharmacotherapy



Types of MedicationsTypes of MedicationsSelective Serotonin Reuptake Inhibitors (SSRIs)• Studies show reduced depression in patients

with Parkinson’s disease (Weintraub et al., 2005; Devos et al., 2008)

• Effects on motor symptoms have been variable (Meerwaldt, 1986; McCane-Katz et al., 1992; Hauser & Zesiewicz, 1997).

• Fluvoxamine (Luvox®), Fluoxetine (Prozac®), Sertraline (Zoloft®), Citalopram (Celexa®)

Selective Serotonin Reuptake Inhibitors (SSRIs)• Studies show reduced depression in patients

with Parkinson’s disease (Weintraub et al., 2005; Devos et al., 2008)

• Effects on motor symptoms have been variable (Meerwaldt, 1986; McCane-Katz et al., 1992; Hauser & Zesiewicz, 1997).

• Fluvoxamine (Luvox®), Fluoxetine (Prozac®), Sertraline (Zoloft®), Citalopram (Celexa®)



Types of MedicationsTypes of MedicationsDopamine Replenishing Strategies • Selegiline improves motor symptoms & affect in

Parkinson’s (Lees et al., 1977; Mann et al., 1989)

• Some studies demonstrate levodopa is initially effective for improving depression(Barbeau, 1969 ; Tringer et al., 1971; Fetoni et al., 1999)

• Others show prolonged use of levodopa can cause other psychological problems(Maricle et al., 1995; Beaulieu-Boire & Lang, 2015)

Dopamine Replenishing Strategies • Selegiline improves motor symptoms & affect in

Parkinson’s (Lees et al., 1977; Mann et al., 1989)

• Some studies demonstrate levodopa is initially effective for improving depression(Barbeau, 1969 ; Tringer et al., 1971; Fetoni et al., 1999)

• Others show prolonged use of levodopa can cause other psychological problems(Maricle et al., 1995; Beaulieu-Boire & Lang, 2015)



Treatment of Depression in PD Treatment of Depression in PD PsychotherapyPsychotherapy



PsychotherapyPsychotherapy• Recent studies have shown significantly

reduced depression in people with PD with as few as 10 – 14 sessions of individual Cognitive-Behavioral Therapy(Dobkin, Allen, & Menza, 2007; Dobkin et al., 2011)

• Therapy is even more effective when as few as 3 – 4 care partner education sessions are included

• Recent studies have shown significantly reduced depression in people with PD with as few as 10 – 14 sessions of individual Cognitive-Behavioral Therapy(Dobkin, Allen, & Menza, 2007; Dobkin et al., 2011)

• Therapy is even more effective when as few as 3 – 4 care partner education sessions are included



PsychotherapyPsychotherapyFocus topics of effective therapy include:• Increased participation in meaningful activities• Relaxation techniques• Sleep hygiene techniques• Reducing negative thoughts about self:

– “I’m helpless”– “I’m a burden”– “I have no control”

Focus topics of effective therapy include:• Increased participation in meaningful activities• Relaxation techniques• Sleep hygiene techniques• Reducing negative thoughts about self:

– “I’m helpless”– “I’m a burden”– “I have no control”



Other Ways to Reduce DepressionOther Ways to Reduce DepressionStay ACTIVE• Physical activity boosts brain

chemicals that protect against depression

• People with PD reportimproved quality of life whenparticipating in exercise

(dePaula et al., 2006)

Stay ACTIVE• Physical activity boosts brain

chemicals that protect against depression

• People with PD reportimproved quality of life whenparticipating in exercise

(dePaula et al., 2006)



Other Ways to Reduce DepressionOther Ways to Reduce DepressionStay Connected / Stay Engaged• Don’t withdraw• Lack of engagement

frequently worsensdepression, & may negatively impact family and caregivers

• Don’t be afraid to talk to family and friends; make accommodations and participate in social functions

Stay Connected / Stay Engaged• Don’t withdraw• Lack of engagement

frequently worsensdepression, & may negatively impact family and caregivers

• Don’t be afraid to talk to family and friends; make accommodations and participate in social functions



Tips for Care PartnersTips for Care Partners• Report changes in mood and behavior to care

providers

• Recognize that depression maycause irritability

• Be patient

• Report changes in mood and behavior to care providers

• Recognize that depression maycause irritability

• Be patient



Tips for Care PartnersTips for Care PartnersSELF CARE!• Recent studies suggest that depression in care

partners frequently equals that of patients(Martinez-Martin et al., 2008)

• Pay attention to increasingphysical & emotional demandswith disease progression

• ASK FOR HELP

SELF CARE!• Recent studies suggest that depression in care

partners frequently equals that of patients(Martinez-Martin et al., 2008)

• Pay attention to increasingphysical & emotional demandswith disease progression

• ASK FOR HELP



• Consider alternatives like home care providers a few days per week; know your own limitations

- Ask your friends to come stay at your house while you do something for yourself – don’t feel guilty!

- You can’t take care of a loved one if you don’t take care of yourself!

• Consider alternatives like home care providers a few days per week; know your own limitations

- Ask your friends to come stay at your house while you do something for yourself – don’t feel guilty!

- You can’t take care of a loved one if you don’t take care of yourself!

Tips for Care PartnersTips for Care Partners



• Care partner burden in PD is frequently associated with decreased social contact, so it’s important to make time for friends and family(Rowland et al., 2010).

• Care partner burden in PD is frequently associated with decreased social contact, so it’s important to make time for friends and family(Rowland et al., 2010).

Tips for Care PartnersTips for Care Partners



Action Steps – People with PDAction Steps – People with PD• Participate in an active exercise that you enjoy• Engage with friends and family to stay

connected within your social circles• Take note of your daily mood and document

significant changes in a journal for your doctor• Talk with your doctor about medication, therapy

and other treatment options• Tell someone or call the hotline if you are having

suicidal thoughts à (800) 237-TALK (8255)

• Participate in an active exercise that you enjoy• Engage with friends and family to stay

connected within your social circles• Take note of your daily mood and document

significant changes in a journal for your doctor• Talk with your doctor about medication, therapy

and other treatment options• Tell someone or call the hotline if you are having

suicidal thoughts à (800) 237-TALK (8255)



Action Steps – Care PartnersAction Steps – Care Partners• Record your loved one’s significant changes in

mood for their health care providers• Continue social contact with your friends and

family to stay connected within your social circles

• Know your limits and consider respite care from friends or home care providers

• Tell someone or call the hotline if you are having suicidal thoughts à (800) 237-TALK (8255)

• Record your loved one’s significant changes in mood for their health care providers

• Continue social contact with your friends and family to stay connected within your social circles

• Know your limits and consider respite care from friends or home care providers

• Tell someone or call the hotline if you are having suicidal thoughts à (800) 237-TALK (8255)

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