Anxiety in Parkinson’s Disease

Anxiety in Parkinson’s Disease

The definition of anxiety is excessive concern with the anticipation of future threat.  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.  The prevalence of anxiety in the PD population is much higher than the general population.

The three common types of anxiety in PD are:

  • Generalised Anxiety Disorder (GAD) – Chronic worries about most things; and nervous most of the time.
  • Social Phobia- fear of social interactions or being in a social group
  • Panic attacks – Episodes of feeling doomed, about to die, short of breath, chest tightness, tingling in fingers and toes, throat tightness.

Anxiety causes problems:

  • It makes motor functions worse particularly tremor
  • It increases freezing of gait
  • It makes falling asleep difficult and staying asleep
  • It interferes with taking medications by increasing fear of side effects and increasing the likelihood of side effects
  • It’s a vicious cycle it worsens the motor function which causes worse anxiety
  • It worsens memory and causes dementia like problems

Treatment

Non-drug

  • Cognitive behavioral therapy
  • Other talk therapies, like mindfulness (meditation, breathing)

Drugs

  • Antidepressants
  • Antipsychotics
  • Anti-anxiety medications

Tips for People with PD 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

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

 

Source: the following information was sourced from the Parkinson’s Disease Foundation http://www.pdf.org/pdf/slides_pdexpertbriefing_anxiety16_010415.pdf