woman with parkinson's disease being shown how to use cane for walking

Living with Parkinson’s Disease (PD) is physically and emotionally challenging. The degenerative nature of the disorder can have a profound impact on an individual’s quality of life, leading to depressive symptoms. Depression is, in fact, the most common neuropsychiatric disorder in Parkinson’s patients, affecting as much as 50% of those diagnosed. Current therapies for the treatment of depression in Parkinson’s Disease are similar to those without PD. But the nature of PD and the factors contributing to depressive symptoms means that these therapies are not always effective. Alternative therapies, such as ketamine-assisted psychotherapy, may offer long-term, rapid relief in PD patients experiencing refractory depression. 

Why is Depression So Common in Parkinson’s Disease?

The symptoms of Parkinson’s Disease are caused by the progressive death of dopaminergic neurons in the brain. In other words, patients with Parkinson’s have a dopamine deficiency. Dopamine is a neurotransmitter that is important in regulating mood, sleep, memory, and movement. It also plays a role in motivation, triggering feelings of satisfaction and pleasure when a goal is accomplished. 

It would seem, then, that the root cause of PD would entail certain depressive symptoms: lack of motivation, poor sleep, mood swings, and a loss of interest in previously enjoyed activities. Add in the progressive loss of motor skills, poor health-related quality of life, and social isolation associated with the disease, and it is not surprising that these patients often experience symptoms of depression. 

Diagnosing Depression in Parkinson’s Disease

Despite the prevalence of depressive symptoms, depression can be more difficult to diagnose in patients with PD. As we discussed above, the symptoms of PD and depression often overlap, such as sleeping problems or feeling “heavy” or slowed down. Other factors that might contribute to underdiagnosis of depression in PD patients include:

Facial masking: a phenomenon that occurs in many PD patients whereby they have difficulty conveying their emotions through facial expression. Signs of distress that might otherwise be visible through frowning, crying, brow furrowing, etc. are often not detected in PD patients whose facial muscles have been affected. 

Communication issues: as Parkinson’s Disease progresses, it affects the ability to speak. PD patients often talk in a monotone or quiet manner. Slurring and stuttering is common. PD is also known to affect perception and memory. About one third of PD patients will develop dementia in addition to motor problems. These issues can make it difficult for someone to effectively communicate how they are feeling. 

Subsyndromal depression: depression in Parkinson’s disease may not meet current criteria for major or nonmajor depressive disorders. Some patients, for example, may only experience symptoms during an “off” period (when motor symptoms return during breaks from medication). This is different from the periods of prolonged sadness or despair that is required in a typical diagnosis of major depression. 

How is Depression in Parkinson’s Disease Treated?

Depression in PD patients typically involves a combination of psychotherapy and medication. This is not dissimilar to the treatment for anyone else with depressive symptoms. As we have discussed, however, there are unique circumstances that contribute to depression in Parkinson’s Disease, and current research shows little efficacy in standard treatments.

Likewise, dopamine agonists (drugs which stimulate dopamine receptors in the brain) have shown conflicting results in PD patients with depression. It seems that an alternative treatment of depression in Parkinson’s Disease is badly needed.   

Could Ketamine Be Used for Treatment of Depression in Parkinson’s Disease?

Ketamine may be one alternative to traditional therapies for treating depression in Parkinson’s disease patients. It has been FDA-approved, specifically, for treatment-resistant depression, and has demonstrated efficacy in a wide array of other mental health disorders. 

Studies are currently underway regarding the use of ketamine-assisted psychotherapy in PD patients with depression. Trials hypothesize that ketamine will have marked results compared to placebo, paving the way for this therapy to be standardized in the treatment of depression in Parkinson’s disease. 

Ketamine Assisted Psychotherapy in Destin

At the Crane Center, we offer a holistic approach when it comes to treating mental health disorders. We utilize a variety of therapies and techniques, including ketamine-assisted psychotherapy, so you can achieve the best possible results. If you have been struggling with treatment-resistant depression or another persistent mental health issue, please call our office or go online today to schedule an appointment. 

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