Depression

Depression is usually diagnosed when you have feelings of extreme sadness or a sense of emotional ‘emptiness’ for a long time. It’s more than temporary feelings of sadness, unhappiness or frustration. These feelings may affect your ability to carry out day-to-day activities.

You may be depressed if you have one or more of these symptoms:

• A lack of interest in, or pleasure from, usual activities.
• Feeling down or hopeless nearly every day.
• Feeling anxious, or feeling constantly worried or afraid.

If you’re depressed you might also experience:

• difficulty concentrating
• low energy and tiredness
• trouble sleeping (waking in the early hours of the morning can be a typical sign) or excessive sleeping
• a loss of appetite, usually connected with weight loss
• increased appetite and weight gain
• feelings of worthlessness or guilt
• in severe cases, thoughts of death or self-harm, and suicidal ideas

Like any illness, depression can affect anyone at any time. It's no one’s fault, and it's not a sign of weakness.

Some of the symptoms of depression are also common in Parkinson’s, which means it's often difficult to diagnose.

For example, many people with Parkinson’s experience sleep and night-time problems. These can make you feel tired and lacking in energy, but they don't necessarily mean you’re depressed.

Fatigue, an overwhelming sense of tiredness, can also be a symptom of both Parkinson’s and depression.

Your mood may go up and down because of the fluctuating nature of your Parkinson’s symptoms throughout the day. These changes in mood aren’t necessarily a sign of depression. Sometimes, these feelings may be related to changes in your Parkinson’s medication.

If you think you may be depressed it’s very important to speak to your GP, specialist or Parkinson's nurse. They can make an accurate diagnosis and discuss your medication with you.

Severe depression may result in suicidal thoughts or plans. It may also disrupt a person’s sense of reality or make it much harder for them to function on a day-to-day basis. It requires specific treatment by a mental health specialist. Speak to your GP, specialist or Parkinson’s nurse if you have any concerns.

Apathy is being increasingly recognised in Parkinson’s. It's described as a lack of enthusiasm and emotion for everyday activities. This can feel like depression. 

Unlike depression though, apathy is not linked to low self-esteem or a negative outlook on the future. So just because you experience apathy, it doesn't mean you have depression. 

Apathy needs to be diagnosed so it can be treated. Speak to your GP, specialist and Parkinson's nurse. If necessary, they can refer you to a mental health specialist or counsellor.

We don’t know for sure why people with Parkinson’s get depression. There are several possible explanations.

Some research suggests that a lack of dopamine, which causes the symptoms of Parkinson’s, can be a trigger for depression, worry and anxiety.

Being diagnosed with Parkinson’s can be very stressful and upsetting for many reasons and the condition can have an impact on every aspect of life. So it’s completely understandable that you might sometimes experience feelings of depression because of Parkinson’s.
 
For example, as Parkinson’s symptoms progress, some people may find they have to reduce  certain activities like socialising. This could lead to loneliness and isolation, which may increase the risk of depression.

In some cases people have experienced depression months before they notice any Parkinson’s symptoms.

Depression can also be part of non-motor fluctuations. This is linked to the effect of levodopa ‘wearing off’ before the next dose is due. This type of depressed mood or anxiety usually gets better after the next dose of levodopa starts working.

More generally, depression can also be related to genetics. So if you have a family history of depression, you are more likely to experience depression yourself.

With the right treatment and support, many people who experience depression can get better. 

The first step is to talk to your GP, specialist or Parkinson’s nurse to make sure your Parkinson’s drugs are working well. 

Treatment will depend on how severe your symptoms are and what's helped in the past. Treatments should be introduced step by step, starting with the simplest self-help measures.

There is some limited evidence to suggest that some dopamine agonists – for example, bromocriptine or pramipexole (Mirapexin) – may improve a person’s mood as well as any mobility problems. But there can be side effects, so this treatment might not be an option for everyone. 

How can I help myself? 

One way of helping mild depression is to understand it better. Many organisations in the useful contacts section produce guides or books about how you can help yourself to manage depression. Others have helplines where you can share your feelings. 

Other types of self-help include:

Exercise and physical activity – if you have Parkinson's, being active for 2.5 hours a week can help manage Parkinson’s symptoms, and has a positive impact both physically and mentally. Research has also shown that exercising two to three times a week, especially as part of a group, can help with depression. It can also boost your mood and help you sleep well. 

Find something that suits you and go for it. This could be as simple as chair-based exercise or a brisk walk that gets your heart rate up.

To get started, a physiotherapist can recommend an activity that is right for you. Also, your GP, local council or sports centre may organise exercise referral schemes in your local area.

Sleep – to help improve the amount and quality of your sleep, make sure your bedroom is quiet and comfortable, and go to bed at the same time each night.

Relaxation – you may find relaxation therapies, such as aromatherapy, useful. You could also try complementary therapies, such as massage, meditation, or exercises such as tai chi or yoga. 

Self-help computer programmes – some GPs provide access to computerised cognitive behavioural therapy (CBT) courses. Examples include ‘Beating the Blues’ and MoodGYM. If you're interested in any of these activities, speak to your GP.

If self-help measures don't improve your symptoms, or if your depression is severe, your GP may suggest a course of talking therapy. This includes counselling and cognitive behavioural therapy (CBT).

Cognitive behavioural therapy (CBT)

For persistent or significant depression, group or individual therapy using cognitive behavioural techniques can be useful. 

It's a therapy designed to change your emotions and lift depression. It looks at how you think about yourself, your environment and the people around you, and how these thoughts affect your mood  and behaviour. 

Your therapist will try to teach you new skills to help deal with negative thoughts and problems more effectively. They may use techniques including relaxation, distraction and goal setting.

Counselling

A counsellor can work with you to understand any underlying issues that may be contributing to your depression.

Some GP practices have a counsellor, or your GP, specialist or Parkinson's nurse can refer you. 
 
You can also find your own counsellor. To find one in your area, contact the British Psychological Society or the British Association for Counselling and Psychotherapy.

Anti-depressants

Antidepressants are drugs that can be used to treat moderate to severe depression. There are 3 main types of antidepressant, and they work by stimulating chemicals in the brain. They may be prescribed alone, or alongside a course of talking therapy.

It’s important to remember that some antidepressants will be more suitable for you than others – it depends on your symptoms and what other medications you’re taking. If your GP or specialist thinks that antidepressants are right for you they can talk through your options. 

Your specialist will also be able to advise you on how to take antidepressants alongside your Parkinson’s medication. Taking antidepressants won’t always improve your mood immediately, and it may take 2 to 4 weeks before you notice any change in your symptoms.

As with most medications, antidepressants can have side effects, but they are generally safe. Speak to your GP, specialist or Parkinson's nurse if you have any concerns about the potential side effects. 

There is no evidence that antidepressants are addictive, although some people may experience symptoms, such as irritability or nausea, when they stop taking them.

It is very important that you take antidepressants as prescribed, even if you feel better. Treatment will normally continue for 6 months after your symptoms improve, but may be be longer, depending on your health professional’s advice.

St John's Wort

St John’s Wort, a herbal remedy that can be used for depression, is not recommended for people with Parkinson’s. This is because it can interact with your Parkinson’s drugs. 

St John’s Wort is also often mixed with other components to create different brands of the herbal remedy. This could increase the possibility of side effects and interactions.

Some people find it useful to talk to others who may understand how they feel because they have been in a similar situation.

People in support groups tend to share problems or experiences, and can offer understanding based on what has helped them in the past, which you may find useful.

Parkinson’s UK has local groups across the UK that offer friendship and support. Parkinson’s UK can provide information on these local groups and how to contact them. Call our helpline on 0808 800 0303 or email [email protected]

Sometimes, a carer, or someone close to a person with Parkinson’s, may recognise the symptoms of depression more clearly than the person themselves. If this is the case, you should share your concerns with the person and encourage them to talk to their GP, specialist or Parkinson’s nurse.

It’s important for family, friends and carers to recognise that the mood of someone with Parkinson’s can negatively affect their own emotions. If you care for someone who has Parkinson’s and depression, you may want to think about support for yourself too.

It's quite normal for a loved one to feel many of the same feelings as the person with Parkinson’s. These feelings may include difficulty accepting the diagnosis, fear about the future, anxiety, depression and fatigue. 

You might also experience confusion about the changes to your role and relationship with the person you care for.

Because of this family, friends and carers should also try to look after their physical and mental health as much as they can. This can be difficult, but it's important to remember that by taking care of your own health you will be better able to care for the person with Parkinson’s and not burn out. 

If you are worried about your own mental health, you should talk to your GP. Many carers also find it helpful to join a support group where they can meet other people in a similar situation.

National organisations

• British Association for Counselling and Psychotherapy - you can find contact details for local counsellors and psychotherapists on their website.
• British Psychological Society - contact the society to find a clinical or counselling psychologist in your area.
• Carers Trust - provides support, information and centres for  carers in England, Scotland and Wales.
• Carers UK - provides information and support to people who are caring at home. 
• Mind - the charity provides support and advice on all kinds of mental health problems, including depression.
• Samaritans - provides a place for you to explore your feelings in confidence and without prejudice.

Northern Ireland

• AWARE - provides support to people living with depression in Northern Ireland.
• Inspire - this organisation works together with people living with mental illness to ensure they reach their full potential.

Scotland

• Breathing Space - a free confidential phone and web-based service for people (especially young men) experiencing low mood, depression or anxiety.
• Scottish Association for Mental Health - for people living in Scotland, the organisation provides information and support.

Wales

• Mind Cymru - dedicated to improving the lives of people with a mental illness in Wales.