Cognitive & Psychiatric Disorders in Parkinson's Disease - Andrew Ridder, MD
Are People With Parkinson's Disease Depressed or Demoralized?
Depression and demoralization may look similar, but they’re different emotional states with different treatments.
By Brian P. Dunleavy
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April 4, 2019
Parkinson’s disease, a progressive and incurable condition, carries with it significant physical symptoms.
Unfortunately, it can take a heavy emotional toll as well.
A new study published in the journal Neurology, the official peer-reviewed publication of the American Academy of Neurology, may help provide greater understanding of the mental and emotional ramifications of Parkinson’s. The study findings were published online on April 4.
Researchers enrolled 180 adults, 94 of whom had been diagnosed with Parkinson’s disease before the start of the study. Study participants submitted surveys with their responses to questions such as, “Do you experience feelings of helplessness, hopelessness or giving up?” and, “Do you feel that you have failed to meet your expectations or those of other people?” Mental health professionals also assessed them for depression, a common mental health condition in those with Parkinson’s.
RELATED: Do You Have Early Warning Signs of Parkinson’s Disease?
Demoralization: Feeling Helpless and Hopeless
The study authors found that those with Parkinson’s were far more likely to feel demoralized — which they defined as a state of helplessness and hopelessness coupled with feelings of incompetence — than those without the condition. Among the 94 study participants with Parkinson’s, 17 (or 18 percent) felt demoralized, compared with 7 (8 percent) of the 86 people enrolled who didn’t have the condition. In addition, 19 of the 94 study subjects with Parkinson’s were depressed, compared with just 3 of the 86 in the non-Parkinson’s group.
“Demoralized patients may feel bewildered or perplexed about what course of action they may need to take in order to improve their situation, and thus feel powerless to help themselves,” says one of the study's coauthors, Brian B. Koo, MD, an associate professor of neurology at the Yale School of Medicine and the director of the Yale Center for Restless Legs Syndrome, in New Haven, Connecticut. “This can happen in depression, but often in depression, the overwhelming feeling is sadness.”
Several earlier studies have linked depression and Parkinson’s disease, with one study published in the March 2013 issue of the journal Internal Medicine finding that more than half those with the movement disorder also have depression. The Neurology study may be the first to focus on feelings of demoralization.
You Don’t Have to Be Depressed to Feel Demoralized
Perhaps the most interesting finding of the new research is that not all those with Parkinson’s who were depressed were also demoralized, and vice versa — meaning, they didn’t have to be depressed to feel demoralized with the condition.
Among the 19 study subjects with Parkinson’s who were also depressed, 12 were demoralized and 7 were not. Conversely, 5 of the 17 study participants with Parkinson’s who felt demoralized were not depressed.
According to Dr. Koo, the distinction between the two conditions — demoralization and depression — is significant because the treatments for each are different. While many of those with depression benefit from drug therapy with prescription antidepressant medication, those who feel demoralized may not.
“The treatment for demoralization is cognitive behavioral therapy,” Koo explains. “These patients really need professional help from a psychologist.”
Koo and his colleagues were inspired to look into the emotional ramifications of Parkinson’s after noticing that many people with the condition “seemed overwhelmed by their diagnosis and did not seem to know what to do.”
This is not uncommon. But with increased understanding of how these feelings develop, those with Parkinson’s may be more likely to receive the treatment — and emotional support — they need.
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