Many people with Parkinson’s disease also experience depression.

Depression may be a result of the emotional challenges that can come from living with Parkinson’s. Someone may also develop depression as a result of chemical changes in the brain related to the disease itself.

Clinically significant depression occurs in 40 to 50 percent of patients living with Parkinson’s. But even though it’s common, there are ways to help manage depression if you’re living with Parkinson’s. Read on to learn more.

People living with any of the stages of Parkinson’s are more likely to experience depression, compared with other people. This includes those with both early onset and late stage Parkinson’s.

Depression can pre-date other signs and symptoms of Parkinson’s — even some of the motor symptoms. This may be because depression is commonly caused by the chemical changes that happen in the brain as a result of Parkinson’s.

Depression is sometimes missed in those with Parkinson’s because many symptoms overlap. Both conditions can cause:

Depression can be overlooked if symptoms develop after the Parkinson’s diagnosis is made.

Symptoms that may indicate depression include:

  • consistent low mood that lasts most days for at least 2 weeks
  • thoughts of self-harm or suicide
  • pessimistic thoughts of the future, the world, or one’s self
  • waking very early in the morning, if this is out of character
  • excessive sleeping
  • loss of appetite

Depression has been reported to cause a worsening of other seemingly unrelated Parkinson’s symptoms. Because of this, if you notice any sudden worsening of your Parkinson’s symptoms, it’s a good idea to tell your doctor that you’ve been feeling depressed.

Depression must be treated differently in people who have Parkinson’s disease. Many people can be treated with a type of antidepressant called serotonin reuptake inhibitors (SSRIs). However, some other Parkinson’s symptoms may worsen from SSRI use in a very small number of people.

SSRIs shouldn’t be taken if you’re currently taking selegiline (Zelapar). This is a commonly prescribed medication to control other symptoms of Parkinson’s.

If both are taken at once, it could cause serotonin syndrome. Serotonin syndrome occurs when there’s excessive nerve cell activity, and it can be fatal. Symptoms can include:

  • confusion, disorientation, or hallucinations
  • anxiety or irritability
  • muscle spasms or rigidity
  • shivering or tremors
  • digestive issues like diarrhea or nausea
  • rapid heartbeat, or tachycardia
  • high blood pressure
  • overactive reflexes, or hyperreflexia
  • dilated pupils

Some medications used to treat other symptoms of Parkinson’s, like dopamine agonists, may have an antidepressant effect. These appear to be particularly helpful in those who experience periods when their medication isn’t effective. This is also known as “on-off” motor fluctuation.

Alternatives to medication

Non-prescription treatment options are an excellent first line of defense for Parkinson’s-related depression. Even if your doctor prescribes antidepressants, they’ll be most effective when used with therapy and other positive lifestyle changes.

Psychological counseling — like cognitive behavioral therapy — with a licensed therapist can be beneficial. Exercise can boost feel-good endorphins. Sticking to a regular sleep schedule can also help you boost serotonin levels naturally.

These treatments are often very effective. They may resolve symptoms entirely in some people with Parkinson’s. Others may find it helpful but still need additional treatments.

Other alternative remedies for depression include:

  • relaxation techniques
  • massage
  • acupuncture
  • aromatherapy
  • music therapy
  • meditation
  • light therapy

There are also an increasing number of Parkinson’s support groups that you can attend. Your doctor or therapist may be able to recommend some. You can also search for them, or check this list to see if there are any you’re interested in.

If you’re unable to find a local support group, there are also excellent support groups online.

One very small study indicated that electroconvulsive therapy (ECT) has been a safe and effective short-term treatment for depression in people with Parkinson’s. ECT treatment may also temporarily alleviate some motor symptoms of Parkinson’s, though this is typically only for a short period of time.

ECT is generally used when other depression treatments aren’t effective. Common side effects of ECT can be significant and include:

  • nausea
  • fatigue
  • headache
  • confusion
  • memory loss

More-severe side effects are uncommon, but can include issues with the following systems:

  • cardiovascular
  • pulmonary
  • cerebrovascular

Depression in people living with Parkinson’s is common. Treating and prioritizing depression as a symptom of Parkinson’s can significantly improve a person’s quality of life and overall comfort and happiness.

If you live with Parkinson’s and you’re experiencing depression symptoms, talk with your doctor and about your treatment options.