Depression and PD: A Non-Drug Treatment Option

It is estimated that at least 50 percent of people living with Parkinson’s Disease (PD) experience depression at some time during the course of their disease. The Parkinson’s Foundation Parkinson’s Outcomes Project found that together, mood, depression and anxiety have the greatest impact on health status, even more than the motor impairments commonly associated with the disease. The persistent sadness and hopelessness that accompanies depression make the challenges of living with PD even greater. The good news is that depression is a Parkinson’s symptoms that can be controlled. No one chooses Parkinson’s, but you can choose how to cope with it.

Learn the skills that will empower you take control of your mood, worry less and find meaning in daily life. These skills are modeled on a non-drug therapy called cognitive behavioral therapy, which has been proven helpful for Parkinson’s-related depression. To cope with depression, you can put the skills you’ll learn in therapy into action.

The following article is based on the latest research and a Parkinson’s Foundation Expert Briefing about depression, hosted by Roseanne D. Dobkin, PhD, from Rutgers, The State University of New Jersey, Robert Wood Johnson Medical School.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a non-drug approach to developing the skills and actions that change patterns of thought and behavior related to depression.

Many factors can cause a person to become and stay depressed. How we think about things and interpret what goes on around us influences how we feel. So does our behavior—what we do, or don’t do, in response to the stresses of life. Depression can have a biological cause. Brain changes that underlie PD are also thought to contribute to depression. But biology is not the only cause. Learning how to consciously change your thoughts and behaviors can help treat your depression.

Focus on Goals to Change Behavior

The first step is to make plans and set goals for activities. Emotions can take control when we feel depressed or anxious. Instead, let your behavior — your activities — guide you. Think strategically about increasing your involvement in meaningful activities — avoiding being busy for the sake of it. Goals should be small and realistic.

Focus on these three areas when setting goals:

Exercise. Identify a reasonable daily exercise goal, whether it’s walking for 15 minutes, doing Tai Chi or seated exercises, or going to an exercise class. Ask for guidance from a physical or occupational therapist.
Socialize. Keep socializing goals small and do-able. Don’t jump in to hosting a dinner party—it could be as simple as answering the phone or saying hello to a cashier.
Self-soothe. Take time every day for an activity that will lead to a positive emotion—something that just feels good. For instance, relax with a cup of hot tea, soak in the bath or listen to music.

While planning activities that guide your day, consider these questions:

Are there things you used to love to do that fell off the radar with your PD diagnosis? Consider re-introducing those activities.
If the daily activities you used to enjoy are no longer feasible, are there new activities that can replace them?
Can you modify an activity that used to be enjoyable and work it back into your life?

Here’s how my friend Howard used CBT to gradually take control over and improve his mood. Howard was a career firefighter. Five years into his PD diagnosis, he was no longer physically able to fight fires. He became depressed and withdrawn, cutting off ties with his firefighter friends, who were like family to him.

During therapy, we tested different ways he could re-connect with his friends. First, he went to a chili dinner—and it wasn’t embarrassing like he thought it would be. Then, although he couldn’t participate, he began attending weekly training sessions to shoot pool afterward. Gradually, Howard began to reconnect. He even helped with the fire department’s fundraising campaign. He realized that even though he couldn’t ride a fire truck, he could stay connected and contribute.

Tips to help you set daily goals:

Make them small and meaningful.
Choose activities that make you feel productive and satisfied.
Plan around your physical limitations and “off” time.
Pace yourself.
Be flexible. If you can’t walk for 30 minutes, start with 15.
Ask your doctor for referrals to physical, occupational and speech therapy.

Examine Negative Thoughts to Achieve Balance

When depressed or anxious, thoughts tend to include a lot of negative predictions—we begin to think that things will not go right. Most of the time, these predictions are not as accurate as we believe. Yet negative thoughts influence what we do.

Cognitive behavioral therapy aims to recognize, analyze and test negative thoughts, evolving them into a more balanced, healthier mindset. Try these steps:

Catch the negative thoughts and write it down (for example, “my PD makes my friends uncomfortable”).
Share the thought with a loved one. Recognize that it is your opinion and ask, “do others share my perception? Is there evidence against it?”
Revise your thought or prediction in a way that helps you cope with the challenges of PD more objectively.
Fight back against worst-case thinking.

If possible, find a way to test your thinking. Perhaps you think you can’t eat at a restaurant because of your tremor. Find out. Make plans to test your thought. Increase your chances of success by taking your symptoms into account— for example, go when the restaurant is not crowded, order food you don’t need to cut or ask for a lid and straw for your drink.

Then see what happens. Identify what worked. Can you revise your original negative thought? Going forward, try using more balanced, accurate thoughts to guide how you feel during the day. Healthy thoughts will help you cope with PD, whereas destructive ones derail your efforts.

Care Partners

Caregivers play an essential role in supporting people with PD who cope with depression. Research has shown people with Parkinson’s using CBT have more improvement in their depression and see results last longer when their care partners receive educational sessions on CBT. Additional benefits for people with PD included less anxiety, fewer negative thoughts and better ability to reframe them, more social interaction and better motor function. The more a loved one was involved with therapy for a person with PD, the better the outcome.

Reinforcing Success

For a person who is depressed, taking action is hard. A surprising effect of cognitive behavioral therapy is that it is self-reinforcing. Set small, specific goals and let the goal guide your behavior, no matter how you feel. When you feel a glimmer of success, your enthusiasm to do more will kick in. A small change in activity can improve a person’s mood. A better outlook can inspire more activity, and a more objective assessment of the future.

Conclusion: Don’t Suffer in Silence

Your mood is a critical aspect of living with PD that you can control. Talk to your friends, family and doctor if you feel persistently sad or hopeless. If symptoms are severe, you and your medical team might consider one of the many antidepressant medications. But effective, non-drug treatments also are available, both in combination with drug therapies and on their own. If you are depressed, speak up and seek help. For more information on depression, anxiety and treatment, read the Parkinson’s Foundation book, Mood: A Mind Guide to Parkinson’s Disease or call the foundation’s free Helpline at 1-800-4PD-INFO (473-4636) to speak with a Parkinson’s specialist.

Tips for Taming Anxiety

Many people with PD experience both anxiety and depression. Visit Parkinson.org to learn more about anxiety and ways to treat it. Try some of these non-conventional techniques:

Breathing exercises
Massage therapy
Music therapy
Guided imagery
Meditation

CBT: How to Find a Therapist

Ask your doctor or neurologist for a referral
Ask support group members for recommendations
Call the Parkinson’s Foundation’s free Helpline at 1-800-4PD-INFO (473-4636)

Tips for Better Sleep to Help Ward Off Anxiety and Depression

Go to bed and get up at around the same time every day.
Use the bed for sleep only.
Limit daytime naps.
Don’t lie in bed unable to sleep for long periods — get up and do something else until you feel tired, then try to sleep again.
Limit caffeine and alcohol in the evening.
To learn more about Parkinson’s and Sleep read the Parkinson’s Foundation book, Sleep: A Mind Guide to Parkinson’s Disease or call the Foundation’s free Helpline at 1-800-4PD-INFO (473-4636) to speak with a Parkinson’s specialist.