{"id":149905,"date":"2022-01-07T15:01:24","date_gmt":"2022-01-07T15:01:24","guid":{"rendered":"https:\/\/effectsofanxiety.net\/archives\/149905"},"modified":"2022-01-19T23:44:07","modified_gmt":"2022-01-20T04:44:07","slug":"depression-anxiety-and-parkinsons-season-2-episode-1-3","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/149905","title":{"rendered":"Depression, Anxiety, and Parkinson’s: Season 2, Episode 1"},"content":{"rendered":"– Hi, and welcome to ParkinsonTV. An educational series that brings you diverse perspectives of Parkinson’s, and its many possible symptoms. Season one focused on the basics\r\nof living with Parkinson’s. In season two, we’re\r\nexploring an important topic that’s not discussed often enough: mental health. In this, our first episode of season two, we’ll discuss two frequent\r\ncompanions to Parkinson’s: depression and anxiety. (violin music) Joining us is the series\r\ncreator and neurologist Dr. Bas Bloem, from the Netherlands. Bas and his team started\r\nParkinsonTV in Dutch, and they’ve now released\r\nclose to 40 episodes that have reached hundreds\r\nof thousands of viewers. Bas, it is so nice to have you today. – And it’s a pleasure to be here, Patrice. – Thank you. We are also delighted\r\nto introduce our guests, Dr. Roseanne Dobkin, and Bob Pearson. Roseanne is a clinical psychologist and associate professor of psychiatry at the Robert Wood Johnson Medical School at Rutger’s University in New Jersey. Welcome. – Thank you, Patrice. I am honored to be part\r\nof this important work. – Thank you so much. And we’re also joined by Bob Pearson. Bob has Parkinson’s, and\r\nhe’s experienced anxiety and participated in\r\nseveral research studies investigating new treatments.\r\n\r\nThank you all for joining us today. It’s such a pleasure to see\r\nyou, and to learn from you, and to share this with our viewers. And I guess, to you, Bas, first of all, tell us a little bit about your research, and just these very important first symptoms that we’re discussing, depression and anxiety. – Yeah, I think this is a critical season, for ParkinsonTV. We long thought that Parkinson’s\r\nwas just a motor disease. It’s maybe good for the viewers to know that James Parkinson described the disease based on people he literally\r\nsaw walking on the street.\r\n\r\nAnd if you start to\r\nspeak to people like Bob, you will hear that there are\r\nlots of non-motor symptoms, including depression and anxiety, which are actually very common\r\nin patients with Parkinson’s. And I know that you have\r\nexperienced this firsthand. – Yes I have, Patrice. I think I’ve had Parkinson’s\r\nfor maybe 20, 25 years, but my first clinical treatment was for general anxiety,\r\nnot for Parkinson’s. That was about eight years ago. I was misdiagnosed, I think. And the anxiety was pretty severe, I was put on medication for it, and now I’m getting the proper treatment, and it’s made a world of difference to me. – And I know, Roseanne,\r\nyou treat patients, you see how these symptoms\r\nmanifest themselves. And it’s not always the same. – Everybody is different. And just like Bob said,\r\noftentimes we will see depression or anxiety present, 5 years, 10 years, 20 years before the onset of the physical symptoms of Parkinson’s disease. This means that people with\r\nParkinson’s have been living with these very distressing\r\nnon-motor symptoms for quite some time, and they can be very impairing.\r\n\r\nYou know, there isn’t\r\nthat much of a difference in the specific mood or\r\nanxiety symptoms per se, that people with Parkinson’s present with compared to the general population, but the way in which\r\nThe present fluctuates, it varies. Sometimes the presentation is chronic, sometimes it’s intermittent, sometimes it’s both, so it looks very different\r\nperson to person. And oftentimes, these\r\nmood symptoms get missed because they overlap with some of the physical symptoms\r\nof the disease process, and doctors, the healthcare team, people living with Parkinson’s,\r\nand their family members, might not recognize, you know, there are two\r\nseparate phenomena at play that really require\r\nattention and treatment.\r\n\r\n– And I know that just\r\nin talking to people, the first thing they usually say is, oh, I remember, like you said, 30 years ago I had this\r\ndepression, this anxiety. Never, in their mind, realizing that it could be Parkinson’s. Because maybe they didn’t have\r\nany of the motor symptoms. And that’s exactly what happened to you. – Sure was, yeah. It’s kind of a baffling disease. And that’s why I’m so glad we have these experts with us today to help explain this to everybody. Because it is treatable. That’s the important\r\nmessage, it’s treatable. – It is. And people need to know, Bas, that these are normal symptoms. I think sometimes people\r\nthink that it’s just them, but, quite common. – It’s quite common. And, so, two things. One is, many patients who\r\nhave the disease today can become depressed, or have anxiety. Bob’s example is one where patients have the non-motor symptom,\r\nin his case, anxiety, but also frequently depression, as the very first symptom of what later becomes full-blown Parkinson’s.\r\n\r\nYou can’t turn things around; not everybody with depression will later get Parkinson’s. But in hindsight, we\r\nnow know that depression can be the very first manifestation of what later becomes Parkinson’s. – And it’s so important for people to ask questions, isn’t it? – You have to ask questions. And as Roseanne was already alerting, in order to identify\r\ndepression and anxiety, you have to speak to people.\r\n\r\nSo that’s why James\r\nParkinson missed the boat when he was just observing\r\npeople walking on the street. You have to speak to people. And what I always say is, you\r\nhave to look behind the mask. Patients with Parkinson’s have the mask face, or the poker\r\nface, as it’s sometimes called. This is a core motor\r\nsymptom of the disease. And it complicates matters in two ways. One is, sometimes the mask face\r\nis mistaken for depression. So people feel cheerful, but\r\npeople think they are depressed because they have this\r\nlack of facial expression. But in other cases, the\r\ndepression is missed because you literally have\r\nto dig behind the mask and listen to patients\r\nand find their depression. – And I know people will learn\r\nso much from these episodes. What do you hope comes out of this one, the depression, and anxiety? Because I know you’ve\r\nexplored so many topics, and you were just telling me\r\nthat there are so many more. It’s such a complex disease. – Yeah, as we were saying when we were preparing the episodes, the fact that we’ve done\r\n40 episodes in Dutch says everything about Parkinson’s, and what a complex disease it is.\r\n\r\nAnd we still keep finding new topics. What I hope that today will achieve is, first and foremost, recognition. Recognition that Parkinson’s\r\nis not just a motor disease. It’s a disease with lots\r\nof mental health issues, including depression and anxiety. And the second thing\r\nis, the moment people, listeners, viewers, see and hear this, don’t just sit it out. But it’s a treatable condition. I’m sure Roseanne will\r\nsay a lot more about that. It’s a treatable condition. – I was just gonna ask you, I know that you specialize in this, in recognizing this. What are the treatment options? – So, there are several treatment options. And I always like to share that there’s no cookie-cutter approach, there’s no one-size-fits-all, everybody with Parkinson’s\r\nis a unique individual. In general, as first-line therapies for depression and anxiety, we may look to anti-depressant medications or anti-anxiety medications.\r\n\r\nI do a type of psychotherapy called cognitive-behavioral therapy, which really focuses on coping skills, what people are doing or not doing in response to the symptoms and life stressors they’re experiencing, how they’re thinking about themselves, their life, their future, their ability to handle the challenges in front of them, and this type of therapy,\r\ncognitive behavioral therapy has a growing evidence base suggesting that it can be very helpful for people with Parkinson’s,\r\nwith depression and anxiety, not just in terms of alleviating some of those non-motor symptoms, but enhancing their\r\nthe overall quality of life, and in some cases, enhancing\r\ntheir physical functioning. – And I know, 50% of\r\nDo people with Parkinson’s have some form of depression? – That’s a rough estimate, but it’s probably close to the target. And I think one of the interesting issues with both depression and anxiety is that, in Parkinson’s especially,\r\nit doesn’t always look like the type of mood disorder\r\nor anxiety disorder that’s portrayed on a TV commercial.\r\n\r\nSo there are a lot of people out there that have very distressing symptoms, but maybe they don’t\r\nsay anything about it, or those symptoms don’t get detected, because they’re not on the\r\nsuper-severe end of the spectrum, but they’re still very impactful. So I think we always have\r\nto be on the lookout, not only for severe symptoms, but even symptoms that come and go, but are very distressing, bother us and really change the\r\nlandscape of the day. – So, one thing, if I may,\r\njust to add to the treatment. One thing that I always\r\nfind very effective is simple dopaminergic therapy.\r\n\r\nSo, the depression in\r\nParkinson’s is sometimes a reaction to just having an illness. You could lose a leg and become depressed. In Parkinson’s, it’s more complex, because the lack of dopamine in the brain can also be, itself, responsible for both depression and anxiety. And treating Parkinson’s symptoms with dopaminergic treatment, levodopa or a dopamine agonist, works in both ways. It corrects the dopamine deficiency and thereby treats the\r\ndepression and anxiety directly, and people feel better, they can move, they can achieve things again, and thereby feel more cheerful. – And I’m really glad\r\nthat you brought this up. We want to make sure that the Parkinson’s treatment\r\nregimen is optimized. That there aren’t any\r\nbig misses in that area. Get that under control first, and then layer on additional\r\ninterventions as needed. And for some people, just getting the Parkinson’s medication\r\nright can make a big difference.\r\n\r\nOther times, more is needed, and it’s not so straightforward. – And we’re going to be talking\r\na lot more about this as we continue, but so\r\ninsightful, thank you all. We had a chance to\r\nspeak with Rocco Romano, who also has Parkinson’s. We talked to him about his experience and strategies for coping with depression. Let’s take a look at that now. (violin music) – [Patrice, voiceover] Rocco Romano lost his sense of smell\r\nwhen he was in his 30s. And he also suffered deep depression. But he was shocked to\r\nlearn, a decade later, he had Parkinson’s disease. – When I heard it from the first doctor, I just, I felt like … I felt like my heart just\r\ndropped to the floor. It was awful. It’s like a sudden loss. You’re like, “oh my God, what’s\r\ngonna happen to my life?” Well, I found out when I was 43 years old, so that was five years ago. And I had these symptoms, probably, as I said,\r\n15 years beforehand.\r\n\r\n– [Patrice, voiceover]\r\nHe also had trouble turning his phone in his hand. – For me, my symptoms are extreme fatigue at times, stiffness of joints and\r\nmuscles, and slow movement. – [Patrice, voiceover]\r\nHe says depression is the worst symptom. – Depression is such a\r\nshaming symptom or condition. And of recent, I’ve been going through quite a bit of depression. You just kind of withdraw into yourself, and, you know, the worst thing I\r\ncan do is start to withdraw. – [Patrice, voiceover]\r\nRocco was afraid of his diagnosis at first but now has no fear. He focuses on slowing the\r\nprogression of the disease. Medication helps. So does mountain biking. Rocco has always been active; he loves getting on his bike and hitting the trails near his house.\r\n\r\nHe believes the high-intensity workout helps relieve symptoms of Parkinson’s and restores the chemical dopamine, which diminishes in Parkinson’s. That’s a chemical that gives\r\nus a sense of well-being and a good feeling. – I mean, it’s almost\r\nlike medicine itself. It really is. And it just helps out so much. I would say, the biggest effect, right after I’m done with exercising, is the depression is\r\nalmost immediately gone. And it doesn’t resurface until\r\nthree or four days later. It’s the exercise. Really, that blood flow to the brain is so crucial. – [Patrice, voiceover]\r\nBut sometimes he’s so drained, he can’t ride. And the cold weather makes\r\nhis muscles stiffen up. But he got back on that bike recently, and he realizes it’s\r\nsomething he has to do to feel better. – Yeah. Sometimes I don’t wanna do it. – [Patrice, voiceover]\r\nDoctors have also changed medicines to help lessen\r\nthe symptoms of depression, and improve his sleep at night. Rocco says the toughest part was explaining the diagnosis\r\nto his three young children.\r\n\r\nBut he laughs when\r\nrecalling their reaction. – Once I was diagnosed, we pretty much immediately told them. Their reaction was,\r\n“Are you going to die?” I said, no, I’m not going to die. And then they said, okay, and then they just went\r\nabout what they were doing. – [Patrice, voiceover] Rocco says one of the hardest\r\nparts about this disease is having to retire early from his job as a technology\r\nteacher, a job he loves. – It takes a lot of energy out of you, and at the end of the day, I am completely exhausted. I’ll have to come home and\r\nsleep for two to three hours. – [Patrice, voiceover]\r\nAfter he retires in June, he’ll still teach, but\r\nin a more personal way. – I wanna be there to help people, and show them a path of being positive, or maybe even exercise,\r\nor whatever it might be, that it isn’t the end.\r\n\r\n– So let’s talk about Rocco’s experience, in what ways his symptoms are typical of someone with Parkinson’s and\r\ndepression, as well as anxiety. I know, Bob, you have\r\nexperienced more anxiety, but also bouts of depression. Tell us what you went through\r\nand still are going through. – Well, before I was\r\ndiagnosed, I mentioned that I was already in\r\ntreatment for anxiety. That time, I thought I\r\nwas worried about stuff. You know, my family, my situation. I had no idea I had Parkinson’s. So, when I got Parkinson’s, the good news for me was, well, now I know what it is, but then I started learning a little bit, and that it could be bad. Like Rocco, I identified\r\nwith that feeling of, wow, now what have I got? And that’s where you have to get the intervention of treatment. – And I know we heard Rocco say how down he gets, and that\r\nsometimes he feels alone even surrounded by people. It’s not uncommon, is it? – It’s not uncommon at all.\r\n\r\nAnd a complicating factor is, for me, sleep problems. I was having fragmented sleep,\r\nwaking up every 90 minutes, having trouble getting back to sleep. When you don’t have sleep,\r\nyou can rapidly feel bad. And sleeping pills were not the answer, alcohol is not the answer. But there are good treatments\r\navailable for this, that we can get into, but you have to realize\r\nthat it’s the disease. It’s not caused by external\r\nfactors, like your environment. – Right. And I know that Rocco had expressed, too, his sleeping is horrible,\r\nwhich makes him more depressed, more fatigued. And I know, Roseanne,\r\nthis is not uncommon. – No, it’s not uncommon at all. And like we were saying\r\nearlier on in the episode, we always try to optimize\r\nthe Parkinson’s medication as a starting point to treating\r\ndepression and anxiety. Sleep is another area where\r\nwe really want to optimize when we’re embarking on\r\nother treatment approaches. If somebody isn’t getting\r\na good night’s sleep, it’s going to make effective\r\ndaytime coping that much harder.\r\n\r\nAnd we don’t want this to be\r\nany harder than it needs to be. – Bas, what about you? What did you learn from Rocco? – A lot of things. First of all, I have seen thousands and thousands of patients, and when I see Rocco, it touches me. The impact on his life, a young man, a young family, beautiful children, devastated by Parkinson’s. The same thing, and it\r\nalways gives me goosebumps when I see the film, is, he doesn’t sit down, he’s proactive, he starts to exercise. And you beautifully see\r\nhow it’s not just drugs, but how exercise is a treatment, helps him to regain confidence\r\nand to treat his symptoms. I think it’s a very compelling movie. – And I know, sometimes,\r\nthe medications can cause other symptoms, correct? And I know that happened in Rocco’s case.\r\n\r\nThey were adjusting medications because they were causing\r\nworse things for him. – Right. In some of the other\r\nepisodes of ParkinsonTV, we’ll talk about side effects, like impulse control disorders. Most patients tolerate\r\nParkinson’s pills relatively well, because it corrects something that is missing from their brain. But obviously, there can be side effects, which you have to be aware of. – Roseanne, any advice\r\nto people who are, maybe, seeing the symptoms,\r\nsuch as Bob and Rocco, and just the general need\r\nfor awareness, correct? – Absolutely. And one of the things that I\r\ntake away from hearing Rocco, and learning about his story, is that one of the very powerful\r\ntools that he used to cope with was taking on this proactive\r\napproach in his own self-care, and I want everyone who’s\r\nlistening and watching right now to recognize that we have power.\r\n\r\nWe have control. There are skills, there are\r\ntechniques, there are tools that you can start using today to manage depression and anxiety, and to live a better\r\nlife with Parkinson’s. And for Rocco, some of\r\nthose tools were exercises, really trying to prioritize his social connections with his family. And the other thing that\r\nI heard him allude to, which is so important, there were times when he just\r\ndidn’t feel like exercising. He didn’t have the motivation, he didn’t have the get-up and go, but he did it anyway\r\nbecause he set a goal. And he knew why it would be important to actually get on that\r\nmountain bike and go. – Bob, what do you do? What kind of physical exercise? – Well, I used to be a runner. And I felt really good, at\r\nthat time when I was running. I have problems, now, with my feet, so I get on my spin cycle at home, and I go to the gym. But I love being outside, so walking is very important for me. Set goals and don’t\r\nlisten to your feelings.\r\n\r\nThat’s a good part of therapy. Cognitive-behavioral therapy. I also have joined support groups. And that’s the socialization,\r\nmy care partner. We talk about everything. You need that social\r\ncapital, that safety net. Also, meditation is very important for me. One of my worst symptoms of all is fear. There’s a way out of that. Because fear is a thought. And the average thought\r\nlasts for maybe 20 seconds. So if I can identify what’s bothering me, a fearful thought, for example, I can accept that, that\r\nI’m having a thought, and I can put it in perspective.\r\n\r\n
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