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May Series: Mental Health Awareness Month- Psychiatric Issues


Written By:  Renee Rouleau, B.S., PhD student at the  Jacobs School of Biomedical Sciences, University of Buffalo

Mental health issues, an ongoing area of interest of mine, has led me to pursuing this traditionally taboo topic for my part of my doctoral research. With that said, let’s pull back the curtain on the topic of mental illness, bringing it to the forefront. 


Rarely do we hear people openly discuss their acute and/or chronic psychiatric issues. If we have cancer, diabetes, a broken leg, Parkinson’s, would we be so hush hush about it? I don’t think so. So, why if our soul is broken, do we keep that a secret?  Is this resistance to opening up about psychiatric issues due to lack of having a support system? Or, is not being able to articulate these issues?  Or, does one fear that others will judge them or shy away from them if they are mentally ill? Or, does one’s ego get in the way, not wanting others to think they are “less than” the strong persona they project. Or, is it lack of knowledge regarding what IS mental illness?  It’s most likely a combination of these. 


We need more advocacy in the area of mental health through education in our schools, in the home, in our society overall. Written in a digestible format, this article will educate the reader on the topic of mental health. Mental health awareness is an integral component of bringing together the body, spirit, and mind.


After the neurologist performs testing and talks in-depth with the patient and spouse/partner, they will make the diagnosis and say the following “dreaded” four words: “You have Parkinson’s Disease.” Then, most likely, the doctor prescribes medication to slow the progression of symptoms and improve movement, ”prescribe” a regular exercise regimen, and recommend the patient follow a healthy diet. 


Parkinson’s is a combination of motor and non-motor symptoms and while motor symptoms are openly addressed, the non-motor symptoms are rarely discussed in an open forum. Yes, we hear about what’s going on in the brain, physiologically, but I’m talking  about what happens with the human psyche. The most that a neurologist can do is listen, prescribe psycho therapy, which most tend not to follow, or prescribe more medication—usually in the form of SSRIs or anti-psychotics. But, it’s important to have the appropriate tools to help you understand the mind and mental health issues, how they can be treated, and how we can all support a healthy mind! 


Just to review, PD leads to motor symptoms which include slow movements, freezing of gait, tremors, rigidity and loss of voice, among others. We SEE these symptoms and are prescribed synthetic dopamine to address these motor symptoms. But, did you know that there are other symptoms of PD that are more mental and emotional? Some can include paranoia, hallucinations and psychosis on the extreme end, and anxiety and depression, or perhaps even apathy on the more common symptoms (Ausgten & March, 2022). These symptoms can be disconcerting particularly when there isn’t a lot of available information. Therefore, it is important to begin and maintain an open dialog with a neuropsychologist. Do your research and find a reputable clinician. 


Some of the non-motor symptoms can appear long before motor symptoms. For instance, many patients state that they feel depression and anxiety years before their official diagnosis, but they don’t realize it was due to PD until they experience motor symptoms. This is not to say that having depression and anxiety is the first symptom all the time, nor does it mean that it is a risk factor for symptom onset, but if you are feeling more anxious or depressed, along with other cognitive or nonmotor symptoms, it may be a good idea to start treatments or see a neurologist early. 


Depression and anxiety can have multiple causes. But what’s happening in our brains (that is to say, neuronally), is that there are a lot of changes going on in the structures of certain regions such as memory centers, movement centers, and higher order thinking centers (Austgen & Marsh, 2022). There are also more chemical changes taking place such as the loss of dopaminergic cells.  These changes can affect other chemicals in the brain related to dopamine such as serotonin, what we call the “monoaminergic system”. The monoaminergic system is a network of neurons that use monoamine neurotransmitters to regulate cognitive processes like emotion, arousal, and memory. Although this can sound scary, it’s important to realize that extensive research is taking place to help people experiencing these feelings and offering better treatments! Current medications do exist, one in particular is Selective Serotonin Reuptake Inhibitors (SSRIs). 


This particular class of medication helps to replenish some of those monoamines like serotonin that are being lost in the brain (Assogna et al., 2019). If you are not comfortable taking more medications (because sometimes SSRIs don’t work), there are other modes of treatment. Cognitive behavioral therapy (CBT) has shown to benefit those with depression and anxiety by retraining and exercising the brain to take on new pathways that can heighten one’s perspective on life, and help to establish healthy habits (Wu et al., 2017). In addition to medication and various therapeutic modalities two important tools for lessening symptoms of depression: exercise and social interactions!


 There has been extensive research showing  that exercise (like non-contact boxing) releases feel-good chemicals in your brain that help ease feelings of depression and anxiety, and social interaction helps  establish community and feelings of unity and wholeness in those experiencing depression (Wu et al., 2017). Good thing Rock Steady Boxing does both!


Some other mental health issues that are possible side effects of dopamine medications are things like impulse control disorder, or psychosis/hallucinations. Both of these can come from the fact that the body is no longer producing enough dopamine for itself, so we have to supplement the brain with external dopamine. However, knowing how much is too much or too little is extremely important. Having too little may exacerbate that apathy or depression we see, and having too much can cause hallucinations to occur (similar to how we see those with schizophrenia have hallucinations), or in some instances can cause patients to want to spend more money, eat more food, or engage in other compulsive, rewarding behavior. The reason this occurs is because dopamine can be considered a reinforcing neurotransmitter, meaning that when you engage in a certain behavior that we consider “rewarding”, dopamine will fire (Voon et al., 2018). Well, we’re supplementing the brain with lots of that reinforcing chemical, meaning that an excess of such may lead to doing more rewarding behaviors that can lead to bad habits over time (Weintraub and Claassen, 2017).


However, this is treatable by lowering the dose of what we call “dopamine agonists',” or something that makes the remaining dopamine neurons release more dopamine. The same goes for psychosis or hallucinations, which can be caused by an extra high release of dopamine in certain areas of the brain that lead people to hear or see things that are not real. Psychosis can also be caused by progression in neurodegeneration due to a dysfunction of several areas of the brain that react to outside stimuli and help to process that stimuli into information we use to process what’s going on around us (Factor et al., 2011). However, this is also treatable by using medications like serotonin (5-HT) medications that help to block receptor activity, especially things like pimavanserin, which blocks 5-HT2a receptors, a well known receptor in hallucinations and psychedelic effects (the main receptor I focus on in my research), that helps to tone down any of these hallucinations that people may experience (Espay et al., 2018).


Overall, many of these symptoms and mental health issues are treatable as long as you are open and willing to talk about and share feelings with your healthcare providers. With a combination of all or some - medication, therapy, social interaction, exercise - one can overcome mental health issues! In closing, I hope you feel more informed about what’s going on in your head, what you can do about it, and most importantly, that you’re not alone in these feelings. 


Just a little information goes a long way in assessing mental health, and we’re here for you when you need it most!



References:

Assogna, F., Pellicano, C., Savini, C., Macchiusi, L., Pellicano, G.R., Alborghetti, M., Caltagirone, C., Spalletta, G., Pontieri, F.E., 2019. Drug choices and advancements for managing depression in Parkinson’s disease. Curr. Neuropharmacol. 18. https://doi.org/ 10.2174/1570159x17666191016094857.


Austgen, G., Marsh, L., 2022. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. Progress in Brain Research. Elsevier. 269. https://doi.org/10.1016/bs.pbr.2022.01.009.


Espay, A.J., Guskey, M.T., Norton, J.C., Coate, B., Vizcarra, J.A., Ballard, C., Factor, S.A., Friedman, J.H., Lang, A.E., Larsen, N.J., Andersson, C., Fredericks, D., Weintraub, D., 2018. Pimavanserin for Parkinson’s disease psychosis: effects stratified by baseline cognition and use of cognitive-enhancing medications. Mov. Disord. 33. https://doi.org/ 10.1002/mds.27488.


Factor, S.A., Steenland, N.K., Higgins, D.S., Molho, E.S., Kay, D.M., Montimurro, J., Rosen, A.R., Zabetian, C.P., Payami, H., 2011. Disease-related and genetic correlates of psychotic symptoms in Parkinson’s disease. Mov. Disord. 26. https://doi.org/ 10.1002/mds.23806.


Weintraub, D., Claassen, D.O., 2017. Impulse control and related disorders in Parkinson’s disease. Int. Rev. Neurobiol. https://doi.org/10.1016/bs.irn.2017.04.006.


Wu, P.L., Lee, M., Huang, T.T., 2017. Effectiveness of physical activity on patients with depression and Parkinson’s disease: a systematic review. PLoS One. https://doi.org/10.1371/ journal.pone.0181515.

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