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May: Mental Health Awareness

Written By: Dr. Caitlin A. Bender, OTR/L

Dopamine’s Role 

Parkinson’s Disease is a movement disorder characterized by tremor, rigidity, bradykinesia, and postural instability, however non-motor symptoms such as changes in mood or behavior may also occur, but go underrecognized or even undertreated. In Parkinson’s Disease, mood changes may be linked to the degeneration of dopamine producing neurons within the basal ganglia, which is primarily responsible for motor control; however this degeneration process extends beyond the midbrain and involves the loss of noradrenergic and serotonergic neurons within the limbic system. Together, these neuronal systems are associated with regulation of mood and reward systems (Marsh, 2013). Mood changes in Parkinson’s may be the result of neurochemical imbalance, as well as being in part due to a reaction to the progressive condition itself, with 50% of people with Parkinson’s Disease experiencing some form of depression, and only 20% seeking treatment (Frisina, 2008). Individuals with Parkinson’s Disease may feel particularly vulnerable to depression due to new symptoms emerging, medication changes, and reduced social opportunities; however clinical studies have demonstrated the efficacy of both medication and therapy for Parkinson’s Disease depression (Frisina, 2008). It is important to note that depression in the context of PD is multifactorial, and the individual’s character and resilience, the presence of fears and anxiety, and contextual factors such as financial status or limited support systems have an important role in causing depression as well as the treatment. 

Daily Impact

The key neurotransmitters affected by Parkinson’s Disease are also involved in depression, and changes in these neurotransmitters may make people with Parkinson’s more likely to become depressed, yet no two people are alike, and the causes of depression will vary. It is important to note that depression in individuals with Parkinson’s Disease may be difficult to diagnose, as non-motor symptoms may overlap with the symptoms of depression, which can include, but are not limited to: 

  • Persistent sadness

  • Loss of interest in previously enjoyed activities

  • Decreased attention to hygiene or medical needs

  • Feelings of guilt, self-criticism, and worthlessness

  • Increased fatigue and lack of energy

  • Feelings of helplessness or hopelessness

  • Feeling restless or changes in sleep

  • Social disengagement 

  • Poor attention and difficulty concentrating

  • Frequent reflections on disability and death

Other factors of PD progression such as facial masking or communication difficulties may also play a role in the diagnosis of depression in people with Parkinson’s Disease. The impact of untreated depression can extend far beyond mood symptoms and result in earlier initiation of dopaminergic therapy, greater functional disability, faster physical and cognitive deterioration, poorer quality of life, and increased caregiver distress (Müller, 2013). As stated previously depression, while common in PD, is often overlooked and undertreated, so it is important to take action and share your concerns with a physician so you can begin to tailor a treatment that works for you. 


Depression can manifest and present differently for each person, and similarly each treatment will also vary. Studies have shown that depression in PD can be treated effectively with specific anti-depressant, such as tricyclic antidepressants, which also had a beneficial effect on rigidity, tremors, and akinesia (Frisna, 2008). SSRI’s have also shown to significantly lower depression in people with Parkinson’s Disease, however the motor improvements noted with tricyclic antidepressants did not present. 

The following medications work well and have limited interactions with other Parkinson’s specific medications. Please always consult with your Parkinson’s specialist before starting a new medication. 

  • Prozac (Fluoxetine) 

  • Zoloft (Sertraline)

  • Paxil (Paroxetine)

  • Celexa (Citalopram)

  • Lexapro (Escitalopram) 

  • Effexor (Venlafaxine)

  • Remeron (Mirtazapine)

  • Wellbutrin (Bupropion)

  • Amoxapine (Tricyclic antidepressants)

Another primary treatment is psychotherapy, which can include cognitive behavioral therapy (CBT). Studies have shown that CBT which incorporated behavioral activation, cognitive restructuring, anxiety management techniques, sleep hygiene approaches, and caregiver support, had notable improvements in PD depression (Marsh, 2013). Other complementary therapies that are recommended by The Parkinson’s Foundation could include:

  • Light therapy

  • Relaxation techniques

  • Massage therapy

  • Acupuncture

  • Aromatherapy

  • Meditation

  • Music therapy

  • Parkinson’s support group

Always discuss any supplementary wellness strategies with your care provider. This can uncover potentially serious side effects, prevent prescription medication interactions and ensure well-being.

OT Tips and Tricks

  • Scheduling: creating a regular routine can help people with low motivation accomplish their daily tasks, and establishes time for activities that are enjoyable to the individual each day. A large calendar can also be used to schedule weekly social outings like meeting for lunch with a friend or volunteering to stay connected. 

  • Journaling: try writing down your negative emotions which can be good for self-reflection and processing your emotions, or try writing down all the things you're grateful for, good moments from the day, etc., can help to refocus your mood and thought process.

  • Goal setting: plan short-term goals that you can achieve daily. Small accomplishments contribute to a feeling of self-worth.

  • Challenge your line of thought: when experiencing negative thoughts or emotions try to challenge them with statements such as “Is there evidence to support this thought?”, or “What are the advantages and disadvantages of thinking this way?” to recenter yourself. 

  • Boost your happy chemicals: take part in activities that naturally increase dopamine and serotonin such as eating your favorite foods, meditating, exercising, or being in the sun. 

  • Breathing techniques: mindful breathing can help to reduce feelings of anxiety, stress, and depression. 

  • Mood board: if having difficulty processing or communicating emotions try a mood board with different emotions listed such as “agitated, proud, supported, relaxed, hurt, pleasant” etc. to help work through your emotions. 

  • Staying active: exercise has been found to be a proven, simple, therapeutic approach for improving mood and depression. It can include walking, stretching, Yoga, Tai-Chi, dance, or any other form of exercise you find enjoyable. References Frisina, P. G., Borod, J. C., Foldi, N. S., & Tenenbaum, H. R. (2008). Depression in Parkinson's disease: health risks, etiology, and treatment options. Neuropsychiatric disease and treatment, 4(1), 81–91. Marsh L. (2013). Depression and Parkinson's disease: current knowledge. Current neurology and neuroscience reports, 13(12), 409.  Müller B, Assmus J, Herlofson K, Larsen JP, Tysnes OB. (2013). Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease. Parkinsonism Relat Disord. doi: 10.1016/j.parkreldis.2013.07.010.  

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