Parkinson’s Disease and Anxiety
Anxiety is normal when anticipating a difficult or threatening situation and it allows us to take the necessary precautions to avoid risks. Most of the time, anxiety is useful and disappears once the anticipated situation is over. Some anxiety episodes are associated with a decreased effectiveness of Parkinson’s medications.
Anxiety is very common in the general population, and three times as common in people with Parkinson’s disease. Episodes can also be 10 times more intense.
Mild anxiety can be characterized by a feeling of nervousness and premonition disproportionate to the circumstances. In more severe cases, anxiety can induce panic attacks without direct cause.
In most cases, anxiety episodes are justified, but chronic anxiety and a lack of direct triggers can be an impediment to accomplishing daily tasks and activities.
Anxiety is expressed through psychological symptoms (constant worry, excessive nervousness, feelings of fear, avoidance of social situations, difficulty concentrating) and physical symptoms (pounding heartbeat, sweating, increased shaking, dizziness, difficulty breathing).
Of people with Parkinson’s disease,
30% to 40% have episodes of anxiety.
For people with Parkinson’s disease, anxiety has a strong reactive component. The diagnosis and progression of symptoms, including unpredictable fluctuations and freezing, are triggering factors that contribute to uncertainty about the future.
Anxiety also has functional causes. Neurodegeneration causes an imbalance of neurotransmitters in areas of the brain responsible for regulating emotions and mood, as well as in the areas that manage episodes when you shouldn’t be thinking about anything. For many people, anxiety episodes are early manifestations of the disease and can appear in the decade before diagnosis.
Finally, anxiety episodes can be directly caused by a decreased efficacy of antiparkinsonian medication (off periods). They therefore mainly appear before taking the next dose.
Differences in anxiety disorders lie in the triggers, intensity and duration of symptoms. Not everyone with Parkinson’s disease experiences all symptoms, but knowing how to identify them helps better adapt treatment.
These are specific fears of objects, animals, or situations. The anticipation of the unpleasantness associated with the situation will lead to anxiety and avoidance (ex. freezing before crossing the street).
Panic disorders do not have an identifiable trigger. The anticipation of unpredictable unpleasant moments leads to avoidance in an attempt to escape crises in vain. The fear of being afraid becomes most disabling.
Panic attacks are short episodes of intense fear that usually result in an overwhelming sense of terror, as well as typical physical symptoms of anxiety. They are usually harmless but traumatic.
Generalized anxiety disorder
This involves an excessive, chronic and uncontrollable anxiety about daily life events. This excessive worry consumes a large part of the day and reduces the ability to function. It is an inability to deal with uncertainty that is an integral part of life.
Obsessive Compulsive Disorder (OCD)
This often occurs when anxiety takes the form of a haunting idea that cannot be silenced. Repeated rituals or gestures are then implemented to release anxiety. In most cases, OCD is a side effect of dopaminergic agonist drugs. You must therefore inform your neurologist or a healthcare professional as quickly as possible.
If you are overly worried about everyday situations or overly preoccupied with the events of the day, you may have anxiety.
Anxiety is not the same as stress, which is also common when subjected to external pressures. Anxiety’s trigger is often broader and less identifiable.
Both anxiety and stress are necessary human reactions because they help us adapt and prepare for future situations.
Everyone therefore alternates between rest and stress or anxiety periods in order to cope with different life events. These states appear and disappear on their own.
If you have chronic anxiety, restlessness or the inability to perform daily tasks, you should seek professional help. Anxiety is not a sign of weakness or something to be ashamed of, it is a medical condition.
Anxiety and its consequences are largely underestimated by people living with the disease and therefore under-diagnosed. Talk to your doctor.
Talking about your uncertainties and fears with loved ones you trust can help relieve anxiety. You may also need to consult a professional, such as a psychologist, or join a Parkinson’s disease support group.
You can also implement concrete actions into your daily life to help manage your anxiety:
- Focus on the positive things in your life (your children, hobbies, etc.)
- Try to improve the quality of your sleep
- Do things you enjoy (ex. read, listen to music, take a walk, etc.)
- Stay active: regular exercise releases hormones and neurotransmitters that promote well-being
- Eat a healthy and balanced diet
- Reduce your consumption of coffee, tea and other stimulants
- Avoid avoidance: ironically, it can increase your anxiety
- Do breathing exercises several times a day for a few minutes to manage the first symptoms of anxiety episodes (inhale for four seconds, hold the air for four seconds, exhale slowly for four seconds and finally, keep your lungs empty for four seconds before starting again)
Anxiety episodes that fluctuate with levodopa use generally respond well to a levodopa treatment adjustment.
Your anxiety may not be caused by low dopamine levels if the optimization of medication doses does not make a difference, and other strategies may be required. The most common anxiety medication for people with Parkinson’s disease are serotonin reuptake inhibitors, which are generally used to treat depressive episodes. Anxiolytic medications can also be prescribed but side effects may include drowsiness, loss of balance, and cognitive impairment.
Therapy is often a complementary approach to medication. It aims to change thought processes in order to reduce negative thoughts. It can help the person organize themselves and gradually resume activities that have been neglected. Cognitive-behavioural therapy is one of the most common forms of therapy and can help you reduce your anxiety levels.
Friends and family play an important role in anxiety prevention and management. Encourage your loved one to stay active, maintain a social circle and consult a doctor of psychologist if their anxiety interferes with daily life.
You may also feel anxiety, fatigue and/or fears for the future. You must take care of yourself, both physically and psychologically. This will help you to take good care of your loved one.
Finally, we suggest joining a Parkinson’s disease support group with your loved one. Talking with people who are in similar situations can be very helpful.
Progressive neuron degeneration of Parkinson’s disease usually increases the frequency and intensity of anxiety episodes. Furthermore, the progressive onset of symptoms and uncertainty about the future are anxiety-provoking factors. Anxiety can impair mobility, balance and even cognitive functions.
You need to address your anxiety before it significantly affects your daily life. You should ask those around you and professionals for help.
Parkinson’s Quebec is proud to announce the appointment of Ms. Joannie Daly as Assistant to the Executive Director and Director of Philanthropic Development. Recognized for […]
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