Anxiety and Parkinson’s Disease

Our mood can change throughout the day and having feelings of worry is an understandable reaction for someone with Parkinson’s Disease. However, when feelings of worry, fear, or nervousness go beyond a reasonable point, you might be experiencing anxiety. Anxiety is one of the non-motor symptoms that can occur in individuals with Parkinson’s. Research estimates it affects between 25%-43% of those with PD. In this blog post we will discuss anxiety and possible treatment options to manage the symptoms.

Anxiety Defined

Anxiety Symptoms include excessive worry, apprehension, or nervousness.

• Anxiety can be experienced in numerous ways including feeling worried and concerned, overwhelmed, restless, irritable, or ruminating on matters that result in anxiety.

• Anxiety can be experienced through physical symptoms (called somatic symptoms), such as autonomic arousal (sweating, dizziness, shortness of breath, increased heart rate), fatigue, muscle tension/aches, shakiness (different than a typical PD tremor), distraction, and sleep disturbance.

• Anxiety can present as having a specific phobia or fear (i.e. afraid of social settings, large crowds, enclosed spaces), separation anxiety, obsessive thoughts and compulsive behaviors, stress related to trauma, and panic or anxiety attacks.

Anxiety Disorder- When anxiety, worry, or physical symptoms (due to anxiety) cause significant distress or impede social, occupational, or other important areas of functioning. There are specific criteria for anxiety disorders that specialists use for classification.  

 Forms of Anxiety

Anxiety can present itself in different forms and you may experience one of more of the ones listed below.

Generalized anxiety disorder - feelings of nervousness and recurring thoughts of worry and fear. Physical symptoms may include difficulty breathing, increased heart rates, nausea, and increased tremor.

Panic attacks - often panic or anxiety attacks begin with a sense of severe physical and emotional distress. You may feel as if you can no longer breathe or are having a heart attack. Panic attacks in those with Parkinson’s have been shown to increase and are often associated with “off” periods in your medication cycle. 

Phobia - this can be an avoidance and fear of being around others or certain places and situations that might increase panic or feelings of being trapped, helpless or embarrassed. 

Causes of Anxiety

Anxiety can be caused from both reactions to a situation or to biological factors.

Psychological- One common trigger of anxiety is being unable to function independently during an “off” period. Others can include worry about the progression of PD or fear of falling. 

Biological- There has been expanding research that anxiety is an early symptom of PD, even prior to the PD diagnosis. More evidence is looking at changes in dopamine and other neurochemicals that may be related to increased symptoms and anxiety in PD.  

How is Anxiety Treated?

Medical Management: If you are experiencing anxiety, speak with your Physician. Medications are often one of the first interventions.  Prescribed medication may include benzodiazepines, buspirone, selective serotonin re-uptake inhibitors (SSRIs), and related antidepressants. While these medications may be effective, they have side effects and risk factors - particularly for those with PD. If medication is prescribed, your physician will work with you to find the best option for you.

Psychotherapy/Cognitive Behavioral Therapy - Counseling is a way to combat anxiety disorders. Counseling alone does not involve medications, so this intervention does not have medication side effects. In addition, you can gain understanding about your symptoms and coping skills to manage them.  Cognitive Behavioral Therapy is a form of psychotherapy that emphasizes 1) the relationships between thoughts, feelings, and behaviors and 2) a collaborative approach between patient and psychotherapist to proactively implement healthy ways to cope with life’s difficulties.

Complementary Therapies

Mindfulness and Meditation - Meditation can be anything from breath work, sitting with your thoughts, or listening to a meditation that allows you to calm your nervous system down. Mindfulness is a mental state achieved by focusing your awareness on the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations. It is often used as a therapeutic technique. Check out or blog post on Mindfulness Meditation and Parkinson’s to learn more!

Diet: Try and maintain a well-balanced, healthy diet. Check out our post Nutrition and Parkinson’s to see what the research tells us about how food affects your brain, body, and the progression of Parkinson’s disease. 

Exercise: One of the best ways to combat stress and release tension and anxiety is through general exercise. We at NeuroLab 360 LOVE exercise and know the endless benefits it has on our body and mind. Our post Exercise Prescription for Individuals with Parkinson’s Disease is a great quick review to get started and implement exercise into your daily routine! Check out our blog post section to see more posts on exercise.

Yoga - Yoga is a gentle exercise that aims to improve flexibility, strength, balance, and breathing. Research has shown that yoga can reduce anxiety and stress.

Acupuncture - Acupuncture is part of traditional Chinese medicine. It involves a therapist inserting thin needles at specific points on your body. Evidence that acupuncture can reduce anxiety is mixed, however some people find it very helpful.

Tai Chi- Tai chi is a Chinese martial art that puts emphasis on balance and movement. It involves moving the body slowly and gently. This practice has been shown to improve strength, balance, physical function, and prevent falls in older adults. More research needs to be completed looking specifically at Tai Chi and the reduction in anxiety, but quality of life measures do show improvements with this practice. 

Family, Friends, and Support!

The stress that comes with a Parkinson’s Disease diagnosis is real for the individual and family. Care Partners may experience many of the symptoms discussed today due to the challenges they begin to face as their loved ones with PD change. Having a good support network, friends, and family that you can rely on is important. Finding support groups in your area is a great way to build your support network with individuals who are going through the same experiences. Check out Parkinson’s Association of San Diego for local support groups!

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:American Psychiatric Publishing.

Dissanayaka NN, Sellbach A, Matheson S, et al. (2010). Anxiety disorders in Parkinson’s disease: prevalence and risk factors. Mov Disord 15:7.

Pontone GM, Williams JR, Anderson KE, et al. (2009). Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson’s disease. Mov Disord, 24:1333-1338.

Sources: 13. Li F, Harmer P, Fisher KJ, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:187–94. 

Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of Tai Chi for the prevention of falls: the Central Sydney Tai Chi Trial. J Am Geriatr Soc. 2007;55:1185–91. 

Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Am Geriatr Soc. 1996;44:489–97.

Sirwan K L Darweesh, Vincentius J A Verlinden, Bruno H Stricker, Albert Hofman, Peter J Koudstaal, M Arfan Ikram; (2017). Trajectories of prediagnostic functioning in Parkinson’s disease, Brain, 140(2), 429–441

Koychev, I & Okai, D. 2017. Cognitive-behavioural therapy for non-motor symptoms of Parkinson’s disease: a clinical review. Evidenced Based Mental Health, 20(1):15-20.

Sharma, N. K., Robbins, K., Wagner, K., & Colgrove, Y. M. (2015). A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson’s disease. International Journal of Yoga, 8(1), 74–79.

Shulman, L., Wen, M., Weiner, W. Bateman, R., Minagar, A., Duncan, R., Konefal, J. (2002). Acupuncture therapy for the symptoms of Parkinson’s disease. Movement Disorders, 17 (4): 799-802