Understanding Mood Changes and Demoralization in Parkinson’s
Changes in mood are very common in those with PD and can occur before motor symptoms begin, early in the disease, or later in the disease. Some people develop anxiety, depression, apathy (lack of motivation), and/or irritability (very common). This is thought to be due to the chemical changes caused by PD. Suicidal thinking is rare, but should be reported to your doctor as soon as possible.
Sometimes people’s moods can be directly related to when their PD medications are working, so if their medications are “wearing off,” they may develop worsening mood symptoms. Other times, people’s moods are not at all related to when they take their PD medications. It is important to work with your neurologist to make sure that your mood is the best that it can be, as mood symptoms can make PD symptoms appear worse than they are. If needed, it may be recommended to try antidepressant or antianxiety medications. These are commonly prescribed to people with PD.
Understanding Demoralization: A Different Kind of Struggle
In addition to depression and anxiety, many people with PD experience something called “demoralization.” About 1 in 5 people with Parkinson’s Disease experience this. Demoralization is different from depression, though the two can overlap. It involves feeling overwhelmed, hopeless, or like you have lost your sense of purpose or meaning in life. You might feel like you can’t cope with what’s happening or that your situation is unchangeable.
Key differences between demoralization and depression:
– With demoralization, you may still be able to enjoy activities and experience moments of happiness, but you feel unable to cope with your situation.
– Depression typically involves persistent sadness and loss of pleasure in most activities.
– Antidepressant medications alone often do not relieve demoralization. It usually requires different approaches focused on coping skills and finding meaning.
Demoralization often begins around the time of diagnosis, when your assumptions about your future are suddenly disrupted. It can also occur during major transitions, like giving up driving, changing jobs, or needing more help with daily activities.
What Can Help?
The good news is that both mood changes and demoralization can improve with the right support!
Mindfulness and Meditation
There is strong evidence that meditation and mindfulness techniques can be very beneficial to those with Parkinson’s Disease. A recent randomized trial of 159 people with PD found that both meditation and yoga significantly improved anxiety symptoms, motor symptoms, and quality of life compared to usual care. Meditation also significantly reduced depression symptoms. A meta-analysis of 12 trials confirmed that mindfulness-based interventions significantly reduce both depression and anxiety in PD.
Recommended programs to practice mindfulness and meditation:
– Calm: www.calm.com
– UCLA Mindfulness: www.uclahealth.org/marc/default.cfm
– “Mindfulness for Health: A Practice Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing” by Vidyamala Burch and Danny Penman provides step-by-step instructions on how to process your body’s signals with mindfulness techniques, with a focus on symptoms related to pain and discomfort.
Cognitive Behavioral Therapy (CBT)
CBT is a type of talk therapy that has been shown to be effective for both anxiety and depression in PD. A meta-analysis found that CBT led to substantial reductions in both anxiety and depression symptoms. CBT can be delivered in person or through telehealth (phone or video), and both approaches are effective.
Social Support
Social support is one of the strongest protectors against demoralization and mood problems. Numerous studies suggest that social interactions support brain health!
Consider:
– Joining a PD support group to connect with others who understand can reduce feelings of isolation.
– Finding a “PD buddy” or mentor who has lived experience with the condition.
– Staying engaged with family and friends, even when it feels difficult.
– Volunteering is an exceptionally good activity!
Take an Active Role in Your Care
– Learn about your condition. Knowledge can reduce fear of the unknown.
– Work with your healthcare team to optimize your symptoms.
– Focus on what you can control: your daily routine, exercise, nutrition, and sleep.
– Set small, achievable goals that bring you a sense of accomplishment.
Find Meaning and Purpose
– Identify activities that bring you joy or a sense of accomplishment.
– Consider how you might help others. Volunteering or mentoring can restore a sense of purpose!
– Explore what matters most to you and find ways to stay connected to those values.
A Message of Hope
Living with Parkinson’s disease is challenging, and it’s normal to feel demoralized or struggle with your mood at times. But with the right support, whether that is medication, therapy, mindfulness practices, or social connection, many people find ways to adapt, cope, and even thrive. You are not alone, and there is help available!
“Take control of those variables that are within your control. I may not have control over my diagnosis or my symptoms much of the time, but I do have control over certain aspects that if optimized, can improve my life experience.”
– A very wise person with Parkinson’s