Depression is one of the most common emotional challenges of Parkinson's disease (PD). It affects approximately 40% to 50% of people with PD, and is associated with a poorer quality of life (QoL), greater disability, greater decline in cognitive abilities, and greater caregiver distress. Now studies are pointing the way toward effective treatments of depression in PD.
Although almost of half of all people with PD struggle with depression, few studies have been designed to create effective treatments for the depression of PD. It made sense to assume that the depression of PD was no different than depression in non-PD cases but this assumption was wrong. We now know that depression of PD has unique features that may require unique forms of treatment as well.
Treatment approaches for depression of PD have included drugs, psychotherapy, and cognitive-behavioral therapy. To date, only a few drug studies have been conducted. Some promising findings have included treatment with nortriptyline and a controlled release form of paroxetine. Nortriptyline was associated with a significantly larger improvement in mood than did the inert placebo pill in at least one study. Nortriptyline was also more effective on some measures of mood than was paroxetine. Side effects of these drugs were not as severe as expected.
Psychotherapy for depression of PD typically focuses on attainment of insight, overcoming denial of the limitation the disease imposes, dealing with the anger and grief associated with losses occasioned by the disease and maintaining and repairing relationships and the social support network of the person with PD. It is becoming clear that another benefit of psychotherapy for people with PD is that the person with PD is less likely to focus anger and frustration on caretakers if anger and frustration can be discussed in the therapeutic situation. Many psychotherapists also contend that discussion and venting of anger and rage over the disease allows the person with PD to better confront the emotional challenge of depression if depression exists.
Cognitive-behavioral therapy for depression of PD involves short-term therapeutic encounters with a therapist. The therapist in this case, however, spends a lot of time teaching you to confront negative self-talk, to cease self-attacks, to use cognitive tips to handle strong emotions and to re-label internal feelings as non-catastrophic or at least as manageable feelings and experiences. 'Cognitive tips' are easy to use mental strategies that help you to think more positively about your emotional challenges. These mental strategies often involve 're-labelling' an even or feeling. For example if you say to yourself: "That was a disaster!" it just intensifies your distress. But if you realable the event as follows: That was a setback but I will do better next time!" you often find that you feel better that you can actually do better as well. All this helps put you back in control of your reactions to the disease rather than allowing the disease to control you. Existing cognitive behavioral approaches to depression of disease all suggest that these techniques effectively help the person with PD to cope with it.
Weintraub D, Morales KH, Moberg PJ, et al. Antidepressant studies in Parkinson's disease: a review and meta-analysis. Mov Disord 2005; 20: 1161-1169.