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Depression in Parkinson's Disease

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Updated June 11, 2009

Depression in Parkinson's Disease
HAAP Media Ltd

Everyone with Parkinson’s disease (PD) at one time or another gets the ‘blues’ and at least 40% of people with PD experience a major bout of depression. Depression of PD, however, has some unusual characteristics, and these unusual characteristics require special efforts to shed the depression. But it can certainly be done.

Depression in PD occurs for long periods of time in approximately 40% of persons with PD and it can occur for short bouts at one time or another in almost all persons with PD.

Beside the unpleasant mood characteristic of depression, depression can make all the other symptoms of PD much worse. When you are depressed, the motor symptoms seem worse, thinking becomes more difficult, relationships with others seem more strained and doing the daily chores become that much more difficult. When you have PD its simple: You can’t afford to get depressed.

Depression in Parkinson‘s Disease?

Distinctive characteristics of depression in PD (as opposed to depression in people without PD) include more intense worrying, brooding, loss of interest, pessimism, hopelessness, suicidal tendencies, social withdrawal, self-depreciation, ideas of reference, and anxiety. There is the usual sadness but little guilt or self-reproach, a high rate of anxiety symptoms, a relative lack of delusions and hallucinations, and a low suicide rate though thoughts of suicide are not uncommon.

Causes of Depression in Parkinson‘s Disease?

You would think that this question would be a ‘no-brainer’ right? What causes depression in PD, you say, is the condition PD itself: Its relentless course and ever continuing taking, taking, taking from you. But there is a problem with this simple answer. Not all people with PD experience long-lasting depression. When you get depression, it is not necessarily related to the severity of your symptoms or duration of the disease.

When we compare brain activity patterns of PD patients with depression versus PD patients without depression who are at equal disease severity levels, we find that the PD patients with depression exhibit lower brain activity levels in a portion of the brain known as the orbitofrontal cortex. This pattern of low activity in the orbitofrontal cortex was strongly related to the degree of depression experienced by patients with depression. Now the orbitofrontal cortex is that area in the brain where we experience and evaluate pleasurable rewards of various kinds from the mundane rewards of a good meal to the highly abstract rewards of prestige and influence. Dopamine fibers normally regulate operations in the orbitofrontal cortex. When these dopamine fibers degenerate, as they do in SOME, not all, persons with PD, the ability to normally experience pleasure and the ability to anticipate future rewards becomes difficult.

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