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Parkinson’s Disease Foundation
PD ExpertBriefing: Anxiety in Parkinson’s Disease
Led By: Joseph H. Friedman, M.D., Director of the Movement
Disorders Program of Butler Hospital and Professor and Division of Movement Disorders, Warren Alpert Medical School, Brown University,
Providence, RI.
This session was held on: Tuesday, January 5, 2016 at 1:00 PM ET.
If you have any questions, please contact: Valerie Holt at vholt@pdf.org or call (212) 923-4700
Introduction
Robin A. Elliott, President Parkinson’s Disease Foundation
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Joseph H. Friedman, M.D. Stanley Aronson Chair in
Neurodegenerative Disorders Director, Movement Disorders Program
Butler Hospital Dept. of Neurology
Alpert Medical School of Brown University
Anxiety in Parkinson’s Disease
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Anxiety « Definition: excessive concern with the “anticipation of
future threat.” (DSM V, 1983)
« Synonyms: worries, nervousness
« Probable overlap with physical restlessness (akathisia)
« Anxiety is a normal part of human life and deciding when anxiety is excessive may be somewhat arbitrary
« Anxiety is a problem when it interferes with quality of life and normal function
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Types of Anxiety « There are 12 types of anxiety listed in the Diagnostic and
Statistical Manual, 5th edition, 2013
« Three types are common in PD: « Generalized anxiety disorder
« Nervous most of the time; chronic worries about most things
« Panic attacks « Episodes of feeling doomed, about to die, short of
breath, chest tightness, tingling in lips and fingers, throat tightness
« Social phobia « Fear of social interactions or even being in a group
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Behavioral Associations
« Depression
« Dementia
« Sleep disturbance
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Anxiety Causes Problems (1) « It makes motor function worse, particularly tremor « It increases freezing of gait « It makes it difficult to fall asleep and to stay asleep « It interferes with taking medications by increasing
fear of side effects and increasing the likelihood of side effects
« It annoys others and detracts from social interactions « It is annoying to patient to hear, “Don’t worry so
much.” (see above)
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Anxiety Causes Problems (2)
« Vicious cycle: it worsens motor function which causes worse anxiety
« It worsens psychosis
« It may cause dementia-like problems
« It worsens memory
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Anxiety In PD vs. the General Population
« Prevalence is much higher in PD than the general population
« Gender equality for anxiety in PD but women more affected outside of PD
« Few treatment trials
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Treatment
« Treating anxiety can be extremely rewarding although the effectiveness of treatment remains unknown
« When anxiety is controlled many other problems in PD may also be better controlled
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Treatment Can Be Very Effective! « Non-drug
« Cognitive behavioral therapy « Other talk therapies, like mindfulness (meditation, breathing)
« Drugs
« Antidepressants « SSRI’s like sertraline (Zoloft), citalopram (Celexa) and many more « Other antidepressants like mirtazepine (Remeron), venlafaxine
(Effexor), trazodone (Desyrel), « Antipsychotics: quetiapine (Seroquel) and clozapine
« Anti anxiety medications « Benzodiazepines: diazepam (Valium), lorazepam (Ativan), alprazolam
(Xanax), clonazepam (Klonopin)
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Treatment Concerns « Benzodiazepines are relatively contra-indicated due
to concerns about falls, cognition and sleep disturbances
« Occasionally an SSRI might increase tremor
« Antipsychotics are relatively contra-indicated due to concerns about sedation, lowered blood pressure (hypotension) leading to falls, and increased death rate
« Talk therapy requires a large time investment
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Tips for Patients and Families
« Anxiety is part of normal life, but excess anxiety is not
« Be aware that new and excess worrying may be part of PD and should be brought to the attention of the doctor
« Anxiety may be treatable, either with talk therapy or medications
« Medications “for PD” target motor problems and do not improve anxiety or other neurobehavioral problems
« Calm reassurance may be helpful but will not solve the problem
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What You Can Do « Learn about the non-motor problems in PD
« Discuss anxiety, depression and other non-motor problems at support group meetings, pointing out their importance in quality of life and noting that they are part of the disease
« Support your loved one by acknowledging the problem and noting that it is part of PD
« Do not be paternalistic and keep repeating, “Don’t worry.”
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Conclusions « Anxiety is common in PD
« Anxiety is probably part of the disease and not only a reaction to motor problems
« It is associated with other neurobehavioral problems
« Anxiety causes other PD problems (motor and non-motor) to worsen which then causes a vicious cycle
« It is frequently under recognized and therefore undertreated
« We believe it is treatable but data on treatment is scarce
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Thank You!
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“When I paint, I forget I have Parkinson’s. Every time I complete a new painting or take an art class, my mood lifts. I am excited to see what I can create.”
A Snowy Day, Elaine Wilcox PDF Creativity and Parkinson’s Project
Questions and Discussion
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Resources from PDF
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Parkinson’s HelpLine • Available at (800) 457-‐6676 or info@pdf.org • Monday through Friday • 9:00 AM – 5:00 PM ET
Fact Sheets • CombaIng Depression
Online Seminars • A Closer Look at Anxiety and Depression in PD
Upcoming PD ExpertBriefings Dealing with Dementia in PD Tuesday, March 1, 2016, 1:00 PM - 2:00 PM ET Jennifer G. Goldman, M.D., M.S., Associate Professor, Section of Parkinson Disease and Movement Disorders, Department of Neurological Sciences, PDF Research Center at Rush University Medical Center What’s in the PD Pipeline? Gene and Cell Therapies Tuesday, April 5, 2016, 1:00 PM - 2:00 PM ET Roger Barker, M.B.B.S, M.R.C.P, Ph.D., Professor of Clinical Neuroscience and Honorary Consultant, Neurology, University of Cambridge and Addenbrooke's Hospital Apathy or Depression: Which One Is It? Tuesday, June 14, 2016, 1:00 PM - 2:00 PM ET Dawn Bowers, Ph.D., Professor of Neuropsychology, University of Florida, Director, Cognitive Neuroscience Laboratory at McKnight Brain Institute
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