“Mental Health and Parkinson’s” – Webinar Notes

“Mental Health and Parkinson’s” – Webinar Notes

In late March, the Parkinson Society British Columbia hosted clinical counselor Courtney Doherty to speak on “Mental Health and Parkinson’s.”  She described depression, anxiety, and apathy — all common changes in mood in Parkinson’s disease (PD).  And she provided extensive information for how these changes can be treated, particularly in non-pharmacological ways. 

At least half of those with PD experience depression or anxiety, which are real medical conditions with many emotional, physical, behavioral and cognitive components.  With depression, there can be constant sadness, feeling worthless, low energy, insomnia, weight change, appetite change, and suicidal thoughts. Anxiety can include fear and nervousness, excessive worry, increase in heart rate, heavy breathing, urges to avoid situations, and difficulty with ruminating thoughts and realistic thinking. You don’t need to have all of these symptoms to be diagnosed with anxiety or depression. 

Apathy is not classified as its own mental health disorder but is very common (over 40%) for people with PD. Apathy is a lack of interest and motivation in certain things we may have had interest and felt motivated to do previously. It is often without sadness, hopelessness, or suicidal thoughts. 

Stigma associated with mental health problems is a barrier to diagnosis or treatment. Treatments can include medication, familial support, psychotherapy and cognitive behavioral therapy, mindfulness, and exercise. 

For more resources on the topics covered in the webinar please see the Stanford Parkinson’s Community Outreach webpages here:

The webinar recording can be found on the Parkinson Society British Columbia YouTube webpage here

Please see below for notes on the March 30th webinar.

Regards, 

– Joëlle Kuehn


“Mental Health and Parkinson’s”

Speakers: Courtney Doherty, registered clinical counselor  

Webinar Host:  Parkinson Society British Columbia

Webinar Date: March 30, 2021 

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

Parkinson’s disease (PD): 

  • Progressive and chronic neurological disorder
  • Neurodegenerative disorder
  • The loss of dopamine in a part of the brain called the substantia nigra; area important for controlling movement
  • Average age of diagnosis in Canada is usually around 60, but up to 20% develop some PD symptoms before the age of 50.  12% of Canada’s population over 80 has PD
  • If diagnosed under the age of 60, it is called young onset PD (YOPD)
  • Second most common neurodegenerative disorder after Alzheimer’s

Symptoms of PD:

  • Motor:
    • Resting tremor
    • Rigidity
    • Slowness of movement (bradykinesia)
    • Balance and postural impairment
    • Softened voice (hypophonia)
  • Non-motor:
    • Reduced facial expressions (hypomimia)
    • Sleep disturbances
    • Constipation
    • Fatigue
    • Low blood pressure (when changing postures: orthostatic hypotension)
    • Visual issues
    • Swallowing and communication issues
    • Changes in mood – biggest one

Cognitive vs. Mental health:  Mental health can include cognitive health

  • For the purpose of the discussion, we will not be discussing cognitive health/impairment
  • Cognitive health can impact executive function, or word finding difficulties, attention or memory problems, reasoning and problem solving

Interesting fact: At least 50% of people with PD experience depression or anxiety.

Depression:

  • Real medical condition with many emotional, physical, behavioral and cognitive symptoms
  • Emotional symptoms:
    • Constant sadness
    • Feeling worthless/hopeless
    • Loss of interest or pleasure in things we used to enjoy
  • Physical symptoms:
    • Low energy, aches & pains, insomnia (inability to sleep) /hypersomnia (always wanting to sleep)
    • Changes in weight
  • Behavioral symptoms:
    • Changes in appetite (over or under eating)
    • Impression of restlessness
  • Cognitive symptoms:
    • Difficulty making decisions or focusing or concentrating on certain things
    • Suicidal thoughts (suicidal ideation)
  • A lot of these symptoms overlap with PD symptoms

Anxiety:

  • Anxiety is a real medical condition, and affects people on an emotional, physical, behavioral and cognitive level
  • Emotional symptoms
    • Feeling fear and/or nervousness
    • Having excessive worry
  • Physical symptoms
    • Increase in heart rate and blood pressure
    • Breathing heavily, shallow breathing
    • Feeling dizzy or lightheaded
  • Behavioral symptoms:
    • Urges to escape or avoid situations/activities/people
  • Cognitive symptoms:
    • Difficulty with ruminating thoughts and realistic thinking
  • Don’t need to have all of these symptoms to be diagnosed with anxiety
  • If you experienced anxiety pre-PD diagnosis and maybe even years ago, you may be more susceptible to feeling the effects of anxiety post-PD diagnosis

Apathy:

  • Not classified as its own mental health disorder in the DSM, but it is very common for people with PD
  • 40% of people with PD experience some kind of apathy
  • Can be hard to distinguish apathy and depression; Is a part of depression but can have apathy without depression
  • Apathy: a lack of interest and motivation in certain things we may have had interest and felt motivated to do previously, but is often without sadness/hopelessness/suicidal thoughts
  • Important to distinguish the conditions for appropriate treatment

Causes:

  • Mental health issues in PD can be caused by:
    • Reaction by initial diagnosis
    • Changes experienced as the disease progresses
    • Changes in your brain chemistry.  They are true medical conditions and chemical reasons these things are happening
    • It is normal to be worried about your symptoms and to wonder what is coming in the future.  When it becomes persistent and you are feeling worried and anxious more often than not, and it is affecting other areas of your life is where we need to think about help and mental health diagnosis

Factors as barriers to diagnosis or treatment:

  • Stigma of mental health
  • Lack of awareness that mood disorders are part of PD
  • Similarities between the physical symptoms of PD and depression, anxiety and apathy.  Important to notice the differences between physical PD symptoms and mental health problems

Treatments:

  • Medication:
    • Different than PD medication you are on currently
    • Ask your physician and/or neurologist if you feel like this is something to look into.  It never hurts to ask
    • Medication for anxiety/depression can take some time to work (2-4 weeks), and you want to find the right one that doesn’t interact negatively with any of your other medications.  If you aren’t feeling the benefits, make sure you take them at the same time and have the appropriate dose and medication
  • Familial/Social support
    • Reach out to family and friends
    • Support groups
    • Peer support programs
    • With mental health issues we tend to want to isolate and is usually the worst thing to do, push yourself to reach out, especially in COVID times
  • Psychotherapy & Mindfulness:
    • Individual, couples, family counselling
    • CBT (cognitive behavior therapy) / Exposure therapies
    • Staying present
  • Complementary or Alternative therapies:
    • Exercise 
      • Walk, PWR! (Parkinson Wellness Recovery), yoga, tai chi, swim, pilates, dance
      • Regular exercise is more effective than medication
    • Diet (including supplements).  Mediterranean diet is best for those with PD
    • Art therapy
    • Meditation & visualization
    • Acupuncture
    • Massage
    • Music therapy
    • Reflexology
    • Chiropractic treatment

Psychotherapy:  Cognitive Behavior Therapy (CBT) is one of the most empirically valid therapies to treat mental health disorders

  • Situations lead to certain thoughts/emotions/behaviors which are all interconnected
  • Example of thoughts/emotions/behaviors:
    • Situation: you see a friend walking down the street, so you wave at them and they don’t wave back
    • Option #1:
      • Thoughts: “They don’t like me, I must’ve done something wrong”
      • If we have those thoughts, what kinds of emotions would we feel?
      • Emotions: sad, confused, depressed, anxious, vulnerable
      • How would we behave based on these thoughts and emotions?
      • Behaviors: go home and cry, ignore them next time you see them, replay the scenario in your head repeatedly
    • Option 2: Alternative thoughts to same situation:
      • Thought: “They must’ve not seen me, maybe they’re preoccupied”
      • Emotions: neutral
      • Behaviors: call friend later to see how they’re doing and check in
      • This pattern would resolve the issue within a matter of minutes and doesn’t change stress
  • Cognitive approach:
    • Identify distorted (negative) thinking styles and patterns and negative core beliefs
    • Ex. catastrophizing (worst case scenario), all-or-nothing thinking (black/white, perfect, or not at all), overgeneralization (they didn’t say hi so they hate me now)
    • Ex: “I’m not worthy”
    • Once patterns are identified we can actively work to reframe our thoughts
    • Leads to improved emotions and behaviors
  • Behavioral approach:
    • Identify negative/unhealthy behaviors that we are engaging in
    • Create new/healthy behaviors that we can go to 
    • Can be especially helpful for apathy/amotivation 
      • Be mindful of it
      • Committing for 5 minutes – just try it for 5 minutes
        • Action before motivation
        • Non-negotiable
        • When you commit to something to 5 minutes knowing you can go back to doing what you were before, you usually don’t.
        • Start small
    • Connecting to the WHY of your goal
      • Make the why a strong one (for self, grand kids, to feel stronger, improve balance)
      • Write it down and put it in a few places (fridge, etc.)

Mindfulness:

  • Opposite of mindlessness
  • Practice staying present and in the moment without judgement (judgement on self, things around you “I don’t like the light”
  • Learn about your mind and how your thoughts come and go without reaction
    • 5 senses exercises – grounded exercise
    • Using 5 senses to name things around you
    • Ex: 5 things you see, 4 things you hear, 3 things you taste, two things you touch, 1 thing you smell
    • Ex: name 5 things you see in front of you
    • Turns the rational part of the brain (prefrontal cortex) back on and lowers the anxiety
  • Thoughts tend toward past/future
    • Realize you can’t change past, and can’t predict the future
    • Notice and gently bring thoughts to the present
    • Replace what “if” with what “is”
    • Ex: “Today I am healthy enough to go for a walk”
  • Practice using guided recordings or apps (ex. Headspace, Calm)
    • Free versions should be enough 
  • Practice throughout the day (ex. eating (what does it smell like, is it warm/spicy/cold, what does it feel like, what is the color), walking, sitting, driving, etc.)
  • Takes practice!

More practical tips:

  • Journaling thoughts, emotions, positive affirmations
  • Practicing deep diaphragmatic breathing exercises.  Technique needs to be right (keep chest still, only breathe through diaphragm, etc)
  • staying/getting active
  • Limiting news and getting outside more
  • Seeking support from professionals and loved ones

Question & Answer:

Question: Thoughts on shame and PD?


Answer: Shame isn’t studied in particular with PD. It can be so individual. I would look into where it comes from and what led us to feel this way because we often feel a certain way based on the way we are thinking in our thinking patterns so if we can reframe that we can help ourselves to feel better.