Mood Disorders and Anxiety in Parkinson’s Disease: Current Concepts

Abstract

Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson’s disease. Non-motor symptoms of Parkinson’s disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson’s disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson’s disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson’s disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson’s disease with a brief discussion of the future outlook of the field given the current state of the literature.

Efficacy of acupuncture (Jin’s three-needle) on motor symptoms and anxiety in patients with Parkinson’s disease: protocol for a multicentre, randomised, assessor-blinded clinical trial

“…Motor symptoms often interact with non-motor symptoms, like anxiety, in a bidirectional manner 45. The emergence of anxiety can intensify motor symptoms, potentially leading to the onset of motor complications in patients with PD 46. Given this complex relationship, a more holistic approach that considers both motor symptoms and associated mental health aspects is necessary.…”

Anxiety in Parkinson’s Patients: What’s Timing Got to Do with It?

“…9,30 Our study found approximately 74% of patients with diagnosed anxiety had at least one form of documented treatment, most commonly pharmacotherapy. Of note, treatment guidelines for anxiety in PD continue to rely on observational study and expert opinion, 11 which informed the choice of pharmacotherapies included to describe current practice patterns. To our knowledge, CBT is the only therapy demonstrated to be effective in patients with PD and comorbid anxiety by randomized controlled trial.…”

“…9 While cognitive generally follows that of the general population, with SSRIs and psychotherapy considered to be first-behavioral therapy (CBT) has been demonstrated to be effective for anxiety in PD, 10 no other controlled trials for anxiety treatment have been conducted thus far in people with PD. 11,12 Psychotherapy, pharmacotherapy, and a combination have all been shown to be more effective than placebo in the treatment of anxiety disorders. 13,14 Pharmacotherapy - in particular selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and benzodiazepines- is useful in the management of anxiety.…”

Non-Motor symptoms in prodromal Parkinson’s disease are linked to reduced Quality of Life

“…Similarly, fatigue is reported by approximately half of the patients with PD 36,35,37 and is associated with an increased α-synuclein oligomer level in the cerebrospinal fluid 38 . Lintel et al 39 argue that symptoms of fatigue overlap with the diagnostic criteria for depression and hence challenging to separate. This thinking aligns with our results that identify these two symptoms as the most significant factors associated with poorer hrQoL in patients with iRBD.…”